Applicant | Address | Phone | Applicant Type | |
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Michael Mattson |
1335 Picture St Independence, OR 97351 United States |
+1 (503) 409-2181 | mike@kwvtsalem.com | Individual |
Applicant | Address | Phone | |
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[Confidential] |
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Applicant | Address | Phone | |
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The Preparer is same as the reimbursement contact. |
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Question | Response |
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Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. | No |
Briefly describe transition plan | KWVT displaced to VHF Ch 11 |
Section | Question | Response |
---|---|---|
Transmitter Related Expenses | Do you have transmitter related expenses? | Yes |
Section | Question | Response |
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Existing Transmitter Description | Type of change | Purchase New |
Use | Primary (Main) | |
Ownership | Owned | |
Is this transmitter currently shared with another station? | No | |
Is this transmitter currently in operating condition? | No | |
Existing Transmitter Manufacturer and Type | Manufacturer | |
Model | TAUD-200 | |
Year | 2011 | |
Type | Solid State | |
Solid State Cooling | Air Cooled | |
Solid State Power Capacity | .5 kW |
Section | Question | Response |
---|---|---|
New Transmitter | Use | Primary (Main) |
Change Type | Purchase New | |
Is this a request for upgraded equipment? | No | |
Manufacturer | ||
Model | TAVD-1000 | |
Transmitter Type | Solid State | |
Solid State Cooling | Air Cooled | |
Solid State Power capacity | 3 kW | |
Justification for New Transmitter | displaced from UHF to VHF |
Section | Question | Response |
---|---|---|
Other Transmitter Costs | ||
Does the transmitter installation require a Transmitter Building Site Survey/Installation? | Yes | |
Electrical Service | Service Entrance (3 phases 800A 208V) | No |
Switchgear (industrial 800 amp) | No | |
Transformer (480V) | No | |
Rigid Conduit and Wiring | No | |
Other Electrical Service | No | |
HVAC Service | Does the replacement transmitter require HVAC Service? | No |
Transmitter Building Addition/Modification or Leasehold Improvement | Does the Transmitter Building require an addition, modification, other leashold improvement? | No |
Section | Question | Response |
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Antenna Related Expenses | Do you have antenna related expenses? | Yes |
Section | Question | Response |
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Existing Antenna Description | Type of change | Purchase New |
Antenna Use | Primary (Main) | |
Ownership | Owned | |
Is the existing antenna shared with another station or stations? | No | |
Is the existing antenna directional? | No | |
Is antenna in operating condition? | No | |
Is antenna located on or in close proximity to an antenna farm? | No | |
Existing Antenna Manufacturer and Type | ||
Mounting | Side Mount | |
Antenna position in stack | Not in Stack | |
Polarization | Horizontal | |
Type | Slotted Coaxial | |
ERP: | 14.2 kW | |
Manufacturer | ||
Model | TFU-32GTH/VP-R | |
Year | 2011 |
Section | Question | Response |
---|---|---|
New Antenna Description | Use | Primary (Main) |
Change Type | Purchase New | |
Ownership | Owned | |
Is antenna shared? | No | |
Is antenna directional? | No | |
Will antenna be located on or in close proximity to an antenna farm? | No | |
New Antenna Manufacturer and Types | ||
Mounting | Side Mount | |
Antenna position in stack | Not in Stack | |
Polarization | Horizontal | |
Type | Other | |
Other Antenna Type | Super Turnstile | |
ERP: | 3.0 kW | |
Manufacturer | ||
Model | TECH-6B-11 | |
Year | 2019 | |
Justification for New Antenna | Displaced from UHF to VHF |
Section | Question | Response |
---|---|---|
Elbow Complex | Do you require the separate purchase of the Elbow Complex? | No |
Side Mount Brackets | Do you require the separate purchase of side mount brackets for a high power antenna? | No |
Pattern Scatter Analysis | Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? | No |
Sweep Test | Do you require the sweep testing of transmission line and antenna? | Yes |
Section | Question | Response |
---|---|---|
Transmission Line Related Expenses | Do you have transmission line related expenses? | Yes |
Section | Question | Response |
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Existing Transmission Line Description | Type of change | Purchase New |
Use | Primary (Main) | |
Ownership | Owned | |
Is the existing transmission line shared with another station or stations? | No | |
Is Transmission Line in operating condition? | No | |
Existing Transmission Line Manufacturer and Type | Manufacturer | |
Type | Flexible Foam | |
Diameter | 7/8 inches | |
Number of parallel runs | 1 | |
Length | 950 feet per run |
Section | Question | Response |
---|---|---|
New Transmission Line Costs | Use | Primary (Main) |
Change Type | Purchase New | |
Is this a request for upgraded equipment? | No | |
Type | Flexible Foam | |
Diameter | 7/8 inches | |
Number of parallel runs | 1 | |
Length | 310 feet per run | |
Justification for New Transmission Line | Displaced from UHF to VHF | |
Interior RF Systems | Does the Installation of the Transmission Line require an additional or replacement Inside RF system including switching, patch panels, and dehydrators? | No |
Section | Question | Response |
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Tower Equipment or Rigging Costs Changes | Do you have tower equipment or rigging costs changes? | Yes |
Section | Question | Response |
---|---|---|
Existing Tower Description | Type of change | Move Equipment |
Tower Use | Primary (Main) | |
Ownership | Leased | |
Is this tower consider Complex? | No | |
Is this tower currently shared with any other stations? | No | |
Is tower documented for structural analysis? | Unknown | |
Is tower compliant with Rev G? | Unknown | |
Existing Tower Structure Registration | Do you have a tower registration number? | Yes |
ASR Number | 1032285 | |
Coordinates (NAD83) | Latitude (NAD83) | 45° 31' 22.0" N- |
Longitude (NAD83) | 122° 45' 11.0" W- | |
Overall Structure Height | 1081.02 feet | |
Support Structure Height | 975.05 feet | |
Ground Elevation Above Mean Sea Level (AMSL) | 966.85 feet | |
Structure Type | TOWER - Free Standing or Guyed Structure | |
Tower Owner | KPTV-KPDX Broadcasting Corporation | |
Date Constructed | 10/24/1994 |
Section | Question | Response |
---|---|---|
Tower Rigging Costs | Complex Tower | N/A |
Helicopter Services Required | Are helicopter services required? | No |
Section | Question | Response |
---|---|---|
Outside Project Management Services | Do you require outside project management services? | No |
Outside RF consulting Engineering Services | Perform engineering study for displacement application | No |
Prepare engineering section of Form FCC Construction Permit Application | Yes | |
For Auxiliary Facility | No | |
For Main Facility | Yes | |
Prepare engineering section of Form FCC License to Cover Application | No | |
Prepare request for Special Temporary Authority | No | |
Prepare Form 601 | No | |
Attorney and Other Outside Consulting Services | Prepare and file Form FCC Construction Permit Application | No |
Prepare and file Form FCC License to Cover Application | No | |
Prepare request for Special Temporary Authority | No | |
Negotiation of Lease and other Matter for Shared Locations | No | |
Prepare or Review FCC Form 399 for Reimbursement | Yes | |
Form 399 assistance or other program management costs | Yes | |
RF Field Engineering Services | Comprehensive coverage verification via field study | No |
RF exposure measurements | No | |
Additional Field Engineering Service | Yes | |
Number of Days | 3 | |
Justification | Change out of equipment from UHF to VHF |
Section | Question | Response |
---|---|---|
AM Pattern Disturbance | Is an Impact Study needed? | No |
Is Remediation needed? | No | |
Permit and Filing Costs | FCC Construction Permit Major Change | No |
FCC Construction Permit Minor Change | No | |
FCC License to Cover Application | Yes | |
FCC Special Temporary Authority Application | No | |
Other Miscellaneous Expenses | Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? | No |
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? | No | |
Does this relocation require Equipment Storage? | No | |
Point to Point Microwave (STL/ICR) | Frequency Coordination for Unidirection System | No |
Frequency Coordination for Bi-Direction System | No | |
New Point to Point Microwave System | No |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $111,000.00 | $31,852.51 | N/A | $31,852.51 | N/A |
Total for all systems | $294,037.50 | $60,836.51 | N/A | $60,836.51 | N/A |
Primary Transmitter TAVD-1000 | $111,000.00 | $31,852.51 | $31,852.51 | ||
High VHF - Air Cooled Solid State Transmitter 1.1 - 4.4 kW | $101,000.00 | $31,852.51 | N/A | $31,852.51 | actual cost |
Transmitter Building Site Survey/Installation | $10,000.00 | $0.00 | N/A | N/A | N/A |
Actual Information Description | File Name |
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High VHF - Air Cooled Solid State Transmitter 1.1 - 4.4 kW | |
Transmitter Building Site Survey/Installation | Information not provided. |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $15,730.00 | $10,000.00 | N/A | $10,000.00 | N/A |
Total for all systems | $294,037.50 | $60,836.51 | N/A | $60,836.51 | N/A |
Primary Antenna TECH-6B-11 | $15,730.00 | $10,000.00 | $10,000.00 | ||
Sweep test of transmission line and antenna | $5,730.00 | $0.00 | Actual Cost | $0.00 | N/A |
High VHF-Low Power, Side Mount, Other, 3.0kW input, Horizontal | $10,000.00 | $10,000.00 | N/A | $10,000.00 | N/A |
Actual Information Description | File Name |
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Sweep test of transmission line and antenna | Information not provided. |
High VHF-Low Power, Side Mount, Other, 3.0kW input, Horizontal |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $3,410.00 | $5,150.00 | N/A | $5,150.00 | N/A |
Total for all systems | $294,037.50 | $60,836.51 | N/A | $60,836.51 | N/A |
Primary Transmission Line | $3,410.00 | $5,150.00 | $5,150.00 | ||
Flexible Foam Transmission Line - dielectric, 7/8" | $3,410.00 | $5,150.00 | Actual Cost | $5,150.00 | N/A |
Actual Information Description | File Name |
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Flexible Foam Transmission Line - dielectric, 7/8" |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $157,750.00 | $10,024.00 | N/A | $10,024.00 | N/A |
Total for all systems | $294,037.50 | $60,836.51 | N/A | $60,836.51 | N/A |
Primary Tower TOWER | $157,750.00 | $10,024.00 | $10,024.00 | ||
Tower Rigging Tall Tower (greater than 500') | $157,750.00 | $10,024.00 | N/A | $10,024.00 | N/A |
Actual Information Description | File Name |
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Tower Rigging Tall Tower (greater than 500') |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $5,812.50 | $3,810.00 | N/A | $3,810.00 | N/A |
Total for all systems | $294,037.50 | $60,836.51 | N/A | $60,836.51 | N/A |
Outside Professional Services | $5,812.50 | $3,810.00 | $3,810.00 | ||
Prepare/ Review 399 reimbursement form | $1,710.00 | $1,710.00 | N/A | $1,710.00 | N/A |
Form 399 assistance or other Program Management costs | $2,000.00 | $2,000.00 | Eligibility and 1876 preparation and submission | $2,000.00 | N/A |
Additional Field Engineering Service, 3 Days | $0.00 | $0.00 | 3 days @ $1000 / day per cost catalog | $0.00 | N/A |
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application | $2,102.50 | $100.00 | N/A | $100.00 | N/A |
Actual Information Description | File Name |
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Prepare/ Review 399 reimbursement form | |
Form 399 assistance or other Program Management costs | |
Additional Field Engineering Service, 3 Days | Information not provided. |
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application |
Description | Predetermined Cost Estimate |
Estimated Cost | Estimated Cost Justification | Actual Cost | Actual Cost Justification |
---|---|---|---|---|---|
Sub-total | $335.00 | $0.00 | N/A | $0.00 | N/A |
Total for all systems | $294,037.50 | $60,836.51 | N/A | $60,836.51 | N/A |
Other Expenses | $335.00 | $0.00 | $0.00 | ||
FCC Filing Fees - Form 2100 license to cover application | $335.00 | $0.00 | N/A | N/A | N/A |
Predetermined Cost Estimate |
Estimated Cost | Actual Cost | |
---|---|---|---|
Total for all systems | $294,037.50 | $60,836.51 | $60,836.51 |
Question | Response |
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The facility has ceased operating on its pre-auction channel. | Yes |
Construction of final facilities or all necessary modifications are complete. | Yes |
All receipts for reimbursement have been submitted no further costs are expected to be incurred. Note this will lock the Form 399 from further editing and begin close-out procedures with the Fund Administrator. | Yes |
Section | Question | Response |
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Submission of Estimated Expenses Statements | WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT. |
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I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above. | Susan Hansen Consultant 09/03/2022 |
Section | Question | Response |
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Submission of Actual Cost Documentation Statements | WILLFUL FALSE, FRAUDULENT, OR FICTITIOUS STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISIONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE AND/OR FRAUDULENT STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT (U.S. CODE, TITLE 31, SECTIONS 3729-3733). |
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I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above. | Susan Hansen Consultant 09/03/2022 |
Section | Question | Response |
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Submission of Final Allocation or Accounting Information Statements | WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT. |
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I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above. | Michael Mattson Applicant 09/03/2022 |