Design Request Form:

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In order to ensure that our lightning protection system design meets your requirements please fill out as completely as possible this design and quote questionnaire. The proposed lightning protection system design will be based on the information presented and best engineering practices.

Project Information
Project: Location: Country: Client: Contact Na e: Pre#. Re$. No. Date: Agent/Distributor: Contact Na e: E! ail A""ress: Fa% Nu ber:

Design Parameters an! Structure Detai"s

&. Altitu"e o$ site abo#e sea le#el: ' (Assu e" ' i$ not su))lie"* (Re+uire" i$ , -'' * .. Lig/tning Protection le#el "esire" by custo er. 001 021 0&1 341 5. 6)eci$y Do7n con"uctor )re$erence ERICORE TAPE CABLE 4. Nu ber o$ t/un"erstor "ays )er year: N/A (8uil"ing 9 -' /eig/t* !a#s (Re+uire" i$ buil"ing , -' * :. 8uil"ing Details Pro#i"e" Di ensione" roo$ )lan an" ele#ation "ra7ings. ;nclu"e location an" /eig/t abo#e roo$ o$ ec/anical e+ui) ent< $ans< #ent stac=s H>AC< etc. Please su))ly AutoCAD "ra7ing i$ a#ailable. -. ?ar= location an" /eig/t o$ t/e $ollo7ing on t/e roo$: Antennas 8ill 8oar"s 6igns Co )any signs an" logos Lig/ts Flag )oles @t/er 2. 6tate a#iation /eig/t restriction< i$ a))licable. 3. ?a%i u total /eig/t o$ ?ast: . 6tructural $ra e buil"ing Ball bearing ty)e construction @t/er buil"ing Facility ot/er t/an buil"ing Ra"io Ao7er Lig/ting )ole/to7er ;!8ea su)erstructure (&* 8on"e" (.* 6cre7e" (5* Bel"e" @t/er: &'. Describe stage o$ construction: Co )lete" construction C occu)ie" Co )lete" but unoccu)ie" ;nitial stages o$ construction Partially constructe" (E%)lain construction )rogress D can "o7n con"uctors still be conceale" in air s)ace be/in" e%terior or locate" in con"uits t/at can still be installe"E @t/er: &&. ?ar= 7/ere t/ere is sensiti#e electronic e+ui) ent so t/at "o7n con"uctors can be route" se)arately: Pro#i"e layout< Dra7ing B/at $loor @t/er: &.. B/at is t/e nature o$ nearby to)ogra)/y: Frban area 7it/ ot/er buil"ings o$ si ilar or greater /eig/t 6uburban or rural area 7it/ no ot/er structures o$ t/is /eig/t Near a large to7er< s)ire (stee)le* or ot/er /ig/ structure ("escribe*: @t/er:

0. Ay)e o$ buil"ing structure:

Please tic= your )re$erence o$ returning "esign in$or ation: E! ail (sent as .PDF $ile $or at* Fa% Courier (a""ress re+uire"* ?ail ()lease su))ly ailing a""ress*

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