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Opportunity ID:

Street address:
City, State, Zip
LCON name:
Site survey completed by:
Date site survey completed:
Network SPOC name:

Product:

Building Demarcation:
Local Switch: EXISTING NEW Location: MPOP/Telco Room
CPE: EXISTING NEW Location: MPOP/Telco Room

Electrical Requirements: Receptacles (select all that apply)


Local Switch: 120
LOCKING EXISTING NEW MPOP/Telco Room
VAC
Comments - Local Switch:
CPE: 120 VAC LOCKING EXISTING NEW MPOP/Telco Room
Comments - CPE:

Electrical Requirements: Grounding for Local Switch


Grounding: EXISTING NEW

Grounding Bar within 6 ft of the local switch location that is bonded to a building ground source by a stran
source in order of preference: driven ground system, metallic water pipe, continuous and bonded building
This type of grounding is not required for CPE equipment; a grounded power outlet (receptacle) is sufficie
Backboard or Relay Rack Requirements: (select all that apply)
Local Switch: BB EXISTING NEW NOT REQUIRED 4'x4'x3/4"
RR
EXISTING NEW NOT REQUIRED 19" RR

CPE: BB EXISTING NEW NOT REQUIRED 4'x4'x3/4"


RR
EXISTING NEW NOT REQUIRED 19" RR

Comments:

Entrance Facility (Property Line to MPOP/Telco Room) Requirements: (select all that apply)
New Entrance Type: New conduit and cable New direct-buried cable Cable in existing and/or in new ID
Approximate distance from last utility vault to MPOP/Telco Room:

New Innerduct (ID): New ID in occupied conduit New ID in new conduit

Comments Entrance and ID:


Yes No
BEA required for Entrance Facility:

Clear Path (MPOP/Telco Room to Customer Suite/APOP) Requirements: (select all that apply)
Fiber Requirement: N/A New Conduit New Fiber Cable/Jumper Riser
Comments:
Electrical Requirement: N/A New Cat5e New Cat6
Comments:

Environmental Requirements
Yes
Room meets environmental requirements: No
1. Temperature: HVAC systemsTemperature:
sufficient to maintain a 55°F to
HVAC systems 85°F. to maintain a 55°F to 85°F.
sufficient
2. Ventilation sufficient to exchange air at least once every two hours.
3. Fire Detector and Extinguisher Recommended - CenturyLink prefers not to place equipment if equipme
4. Sufficient Lighting: Intensity of 50 ft-candles at 3 ft is recommended.
5. Room should be clear of obstructions, water, chemical and dust free, and able to support 650 lbf.
Commercial Customer Premises & Carrier Hotels Electronic Equipment Environmental Specificat
Embedded Documents and Additional Notes (position cursor over comment for instruction to embed do
Business name:
Building #:
Suite #:
LCON PH #:
PH #:
SST ID:
Network SPOC PH #:

MTU/GPON:

MPOP/Telco Room Customer Suite # of available ports:


MPOP/Telco Room Customer Suite

y)
MPOP/Telco Room Customer Suite #of receptacles:

MPOP/Telco Room Customer Suite #of receptacles:

onded to a building ground source by a stranded/solid #6 AWG minimum. Ground


water pipe, continuous and bonded building steel, ACEG, or power company's MGN.
grounded power outlet (receptacle) is sufficient for CPE.
pply)
4'x4'x3/4" 4'x8'x3/4" Other:
19" RR 32" RR Other:
4'x4'x3/4" 4'x8'x3/4" Other:
19" RR 32" RR Other:

equirements: (select all that apply)


Cable in existing and/or in new ID Technicians do not complete this section
if new conduit is require, size: It is assumed we have fiber facilities into
if new ID is require, size:

Requirements: (select all that apply)


Riser Plenum # Floors/Appx footage from switch to CPE: #/#
# Floors/Appx footage from switch to CPE: #/#

If no, state why in the additional notes section.


sufficient to maintain a 55°F to 85°F.

nk prefers not to place equipment if equipment will be placed under sprinklers.

dust free, and able to support 650 lbf.


onic Equipment Environmental Specifications & Installation Guide
sor over comment for instruction to embed documents/pictures)
do not complete this section
d we have fiber facilities into the building.

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