Appendix 8
A B C D FABRICATION AND ASSEMBLY TASKS Mfr Kit/Part/ Commercial Am-Builder Am-Builder Component Assistance Assembly Fabrication Task Propulsion — 27 Listed Tasks # P1 Fabricate Engine Mounts(s) P2 Assemble Engine Mount(s) to Next Level Structure P3 Fabricate Engine Cooling System/Baffles P4 Assemble Engine Cooling System Baffles to Engine P5 Fabricate Engine Compartment Overheat/Fire Detection System P6 Assemble Engine Compartment Overheat/Fire Detection System to Engine Compartment P7 Fabricate Induction System P8 Assemble Induction System to Engine P9 Fabricate Exhaust System P10 Assemble Exhaust System to Engine P11 Fabricate Engine Control Installation Brackets P12 Assemble Engine Controls to Next Level Structure P13 Rig and Adjust Engine Controls P14 Fabricate Brackets and Fittings P15 Assemble Brackets and Fittings to Next Level Structure P16 Fabricate Cables, Wires and Lines P17 Assemble Cables, Wires and Lines to next Level Structure P18 Assemble Engine (Likely N/A) P19 Assemble Engine to Engine Mount P20 Fabricate Engine Propeller (Likely N/A) P21 Fabricate Propeller Spinner Components P22 Assemble Propeller to Engine P23 Rig and Track Propeller P24 Fabricate Engine Cowling P25 Assemble Engine Cowling to Airframe P26 Fabricate Engine Fuel System Components P27 Assemble Engine Fuel System Components to Next Level Structure A dd item:
A dd item:
A dd item:
A dd item:
Total # of Mfr Kit/Part/ Commercial Am-Builder Am-Builder Propulsion Propulsion Subtotal Component Assistance Assembly Fabrication Tasks Propulsion Total Points ►
Amateur-Built Aircraft Fabrication and Assembly Checklist (2009) (Fixed-wing) page 7 of 11 8-7
Appendix 8
A B C D FABRICATION AND ASSEMBLY TASKS Mfr Kit/Part/ Commercial Am-Builder Am-Builder Component Assistance Assembly Fabrication Task Cockpit Interior — 11 Listed Tasks # C1 Fabricate Instrument Panel C2 Fabricate Instrument Panel Bracket and Fittings C3 Assemble Instrument Panel with Fittings and Brackets C4 Assemble Avionics to Instrument Panel C5 Fabricate Seats C6 Fabricate Seat Brackets and Fittings C7 Assemble Seats to Cockpit C8 Fabricate Seat Belts Fittings and Shoulder Harness Fittings C9 Assemble Seat Belts and Shoulder Harness to Structure C10 Fabricate Electrical Wiring, Controls and Switches C11 Assemble Electrical Systems Controls and Switches to Next Level Structure Add item:
Add item:
Add item:
Add item:
Total # of Cockpit Mfr Kit/Part/ Commercial Am-Builder Am-Builder Cockpit Interior Subtotal Interior Component Assistance Assembly Fabrication Tasks Cockpit Interior Total Points ► Total # of Aircraft Tasks ◄ SUM #1
Amateur-Built Aircraft Fabrication and Assembly Checklist (2009) (Fixed-wing) page 8 of 11
8-8
Appendix 8
► TOTAL TASKS AND LINE ITEMS ↓ ↓ ↓ ↓
FABRICATION AND ASSEMBLY SUMMARY A B C D Mfr Kit/Part/ Commercial Am-Builder Am-Builder Component Assistance Assembly Fabrication
1. Total Points for Each Category
2. Total Points for Complete Aircraft Construction (SUM #2) ► (SUM # 2 should equal SUM # 1 above.)
3. Percentage of Each Category as Part of Total Aircraft Construction
4. Total Percentages for Complete Aircraft Construction – Add all percentages in row 3. (Total should equal 100% (+ .5%).)
5. Total Builder Points – Add together points in row 1, columns C and D only.
6. Total Builder Percentage – Add together percentages in row 3, columns C and D only.
Amateur-Built Aircraft Fabrication and Assembly Checklist (2009) (Fixed-wing) page 9 of 11
8-9
Appendix 8 8-10 Instructions for Completing the Amateur-Built Aircraft Fabrication and Assembly Checklist (2009)
1. Total Points for Each Category (columns A, B, C and D). Each column’s total points are tallied by adding the sum of the points awarded to the tasks in each section (for example, Fuselage, Wings, Empennage). Include points assigned to additional items in each section. Boxes with a N/A (not applicable) have zero points.
2. Total Points for Complete Aircraft Construction.
SUM #1. To find total points, add up the six “Total # of Tasks” blocks at the bottom left of each fabrication and assembly tasks section.
SUM #2. In the FABRICATION AND ASSEMBLY SUMMARY section, add the four blocks from each column’s category total (columns A+B+C+D).
Compare SUM #1 to SUM #2. SUM #1 should be equal to SUM #2. (Verify the two sums are equal within a deviation of ±0.5). Total points will vary from aircraft to aircraft depending on number of N/As (not applicable), and additional items applied (123 listed task points + additional items - N/As).
3. Percentage of Each Category. To compute percentages, divide each of the point totals in each column (row 1) individually by the number derived in row 2. For example, if the total points of Mfr Kit/Part/Component category (column A) equals 60 and the number in row 2 equals 170, then divide 60 by 170 to equal 35.3 percent. Do this for each category column. Percentages may be rounded to the nearest tenth (for example,
22.86 percent is rounded up to 22.9 percent).
4. Total Percentages for Complete Aircraft Construction as Part of Total Aircraft Construction. Add the percentages of each of the four categories together (columns A+B+C+D). Total must be equal to 100 percent with a deviation limited to ± 0.5 percent. For example, a derived percentage between 99.5 percent and 100.5 percent is acceptable. If this computation falls outside the accepted deviation, then an error has occurred in row 1, 2, or 3.
5. Total Builder Points. Add the two point tallies from column C and column D derived in row 1. Total will vary from aircraft to aircraft depending on number of N/As applied.
6. Total Builder Percentage. Add the two percentage tallies from column C and column D derived in row 3. Total must exceed 50 percent to be eligible for amateur-built status and to meet the major portion requirement under 14 CFR § 21.191(g).
Amateur-Built Aircraft Fabrication and Assembly Checklist (2009) (Fixed-wing) page 10 of 11
Appendix 8 8-11 Explanations and Examples ►A point (each task equals 1 point) can be divided over multiple categories (Manufacturer, Commercial Assistance, Amateur-Builder Assembly, and Amateur- Builder Fabrication) into 1/10 fractions. A manufacturer may be a kit manufacturer, a component manufacturer, or a part(s) manufacturer. Commercial assistance (for hire or compensation) may include assistance provided by kit manufacturers, commercial assistance centers, individuals (for example, A&P mechanics or avionics technicians).
►For example, 0.5 point can be assigned to the manufacturer, 0.3 point as commercial assistance, and 0.2 point to the amateur builder as fabrication, for a total of 1 point.
►All points are added at the end of the form in the FABRICATION AND ASSEMBLY SUMMARY section under their respective categories. The point total is comprised of all the credits awarded for primary delineated tasks plus any credits given for additional items.
►Additional items may be assigned points the same as primary listed tasks if work or parts not reflected in the main entries need to be credited.
►The applicants’ completion of tasks can be documented in a number of ways and may include the following:
Comprehensive builder’s logs, to include photographs of all the steps included in each of the listed tasks in the Amateur-Builder Aircraft Fabrication and Assembly Checklist (2009), materials and techniques used in construction, as well as dates, locations, and detailed descriptions, Photographs/video/DVD, Drawings and engineering specifications, Kit manufacturer data when necessary, Relevant documentation (for example, plans) and references (for example, handbooks) used, Documentation concerning any commercial assistance used, Documentation concerning any non-commercial assistance used, Part inventories and histories, Receipts and Catalogs, and Logbook entries.
In addition to using this checklist, the builder should document the entire fabrication and assembly process. To issue an airworthiness certificate, the FAA must make a major portion determination (the major portion of an aircraft was fabricated and assembled by an amateur builder(s)). Making this finding requires sufficient, credible, and adequate documentation.
Amateur-Built Aircraft Fabrication and Assembly Checklist (2009) (Fixed-wing) page 11 of 11
Appendix 9 APPENDIX 9. SAMPLE AERONAUTICAL CENTER FORM 8050-88,
AFFIDAVIT OF OWNERSHIP FOR AMATEUR-BUILT AIRCRAFT Paperwork Reduction Act Statement: The information collected on this form is necessary to ensure applicant eligibility. The information is used to determine that the applicant meets the necessary qualifications as owner of an amateur built aircraft. We estimate that it will take approximately 30 minutes to complete the form. The information collection is required to obtain a benefit. The information collected becomes part of the aircraft registration system.
Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. OMB 2120-0042.
Comments covering the accuracy of this burden and suggestions for reducing the burden should be directed to the FAA at 800 Independence Avenue SW, Washington, DC 20591. ATTN: Information Collection Clearance Officer, ABA-20
AFFIDAVIT OF OWNERSHIP FOR EXPERIMENTAL AIRCRAFT INCLUDING
AMATEUR-BUILT AIRCRAFT AND OTHER NON-TYPE CERTIFICATED AIRCRAFT (does not include light-sport) U.S. Identification N130EA Name of Amateur built builder OR Name of Non TC'd manufacturer Early A. Builder Model VAN'S RV-6 Serial Number 1001 Class (airplane, rotorcraft, glider, weight shift control, powered-parachute, etc.) Airplane Type of Engine Installed (reciprocating, turbopropeller,2 or 4 cycle, etc.) reciprocating Number of Engines Installed Manufacturer, Model and Serial Number of each Engine Installed LY-CON, 0-320 EXP., L023-48X Built for Land or Sea Operation Land Number of Seats 2
MUST CHECK ONE
- More than 50% of the above-described aircraft was built from miscellaneous parts and I am the owner. (This option is for amateur-built aircraft.)
More than 50% of the above-described aircraft was built from a kit (prefabricated parts) and I am the owner. The bill of sale from the kit manufacturer is attached. (This option is for amateur-built aircraft.)
I certify that the above-described aircraft is a newly manufactured non-type certificated aircraft and is not currently registered in another country. (This option is for manufacturers only.)
I certify that the above-described aircraft is a previously manufactured (used) non-type certificated aircraft and is not currently registered in another country.
(This option is for owners of previously manufactured aircraft only.)
Evidence of ownership from the aircraft manufacturer through any intervening owners is attached (chain of ownership).
Unable to obtain complete chain of ownership. Statement as to ownership history and whereabouts of aircraft is attached.
Name of Owner: signature of Owner Early Q. Builder Tile of Signe if Appropriate): Early A. Builder 1240 Boi d'Arc Road City: Savoy State: TX Zip: 75479 Telephone: 903-555-1212 Notary Public:
State of: County of:
Subscribed and sworn to before me this day of My Commission Expires:
(Signature of Notary Public) AC FORM 8050-88 (01/07) 9-1
Appendix 10 APPENDIX 10. SAMPLE AERONAUTICAL CENTER FORM 8050-2,
AIRCRAFT BILL OF SALE UNITED STATES OF AMERICA MD NO. 2R0002 U.S. DEPARTMENT OF TRANSPORTATION FEDERAL AVIATION ADMINISTRATION
KIT ABCRAEL BILL OF SALE THE
UNDERSIGNED OWNER(S) FULL LEGAL
AND BENEFICIAL TITLE OF THE AIRCRAFT DES- CRIBED AS FOLLOWS:
REGISTRATION NUMBER / 130EA UNITED STATES AIRCRAFT MANUFACTURER & MODEL VAN'S RV-6 AIRCRAFT SERIAL No.
1001 DOES THIS DAY OF 20
HEREBY SELL, GRANT, TRANSFER AND
DELIVER ALL RIGHTS, TITLE, AND INTERESTS IN AND TO SUCH AIRCRAFT UNTO: Do Not Write In This Block
FOR FAA USE ONLY
NAME AND ADDRESS (IF INDIVIDUAL(S), GIVE LAST NAME, FIRST NAME, AND MIDDLE INITIAL.)
PURCHASER BUILDER, Early A. 1240 Bois d' Arc Road Savoy, IX 75479
DEALER CERTIFICATE NUMBER
AND TO EXECUTORS, ADMINISTRATORS, AND ASSIGNS TO HAVE AND TO HOLD
SINGULARLY THE SAID AIRCRAFT FOREVER, AND WARRANTS THE TITLE THEREOF IN TESTIMONY WHEREOF HAVE SET HAND AND SEAL THIS DAY OF 20
NAME (S) OF SELLER SIGNATURE (S) TITLE (TYPED OR PRINTED) (TYPED OR PRINTED)
FOR CO-OWNERSHIP, ALL MUST SIGN.)
SELLER VAN'S CKNOWLEDGMENT (NOT REQUIRED FOR PURPOSES OF FAA RECORDING: HOWEVER, MAY BE REQUIRE / LOCAL LAW FOR VALIDITY OF THE INSTRUMENT ORIGINAL: TO FAA AC Form 8050-2 (9/92) (NSN 0052-00-629-0003) Supersedes Previous Edition 10-1
Appendix 11
APPENDI X 11. SAMPLE LETTER FOR REQUESTING AN AIRCRAFT REGISTRATION NUMBER UNDER 14 CFR § 47.15 [Insert Date] Federal Aviation Administration Aircraft Registration Branch, AFS-750 P.O. Box 25504 Oklahoma City, OK 73125-0504 Sir/Madam:
This is a request for a U.S. identification number assignment for my amateur-built aircraft.
Aircraft Description:
Make/Builder: Early A. Builder Type (airplane, rotorcraft, glider, or balloon): Airplane Model: VAN’S RV-6 Serial Number: 1001 This aircraft has not previously been registered anywhere (reference 14 CFR § 47.15(a)(1)).
X Normal Request ($5); fee attached (check or money order) X Special Registration Number Request ($10); fee attached (check or money order) Choices 1st 130EA 2nd 130JR 3rd 130FE 4th 130JJ 5th 130TX Sincerely, Early A. Builder Early A. Builder Owner 11-1
Appendix 12 APPENDIX 12. SAMPLE FAA FORM 8130-12,
ELIGIBILITY STATEMENT, AMATEUR-BUILT AIRCRAFT OME NO. 2120-01 Instructions: Print or type all information except signature ELIGIBILITY STATEMENT Submit original to an authorized FAA representative US Department of Transportation AMATEUR-BUILT AIRCRAFT Applicant completes Section I thru III. Notary Public cera vation Completes Section IV.
Administration I. REGISTERED OWNER INFORMATION Name(s) Early A. Builder Address(es) - 1240 Bois d'Arc Road Savoy TX 75479 No. & Street City State Zip Telephone No (s) (999)555-1212 (214) 555-1212 Residence Business II. AIRCRAFT INFORMATION Model VAN'S RV 6 Engine(s) Make _ LY-CON 0-360 EXP Assigned Serial No. 1001 Engine(s) Serial No. _ L 023-48X Registration No. N130EA Prop./Rotor(s) Make _ Sensenich Aircraft Fabricated: Plan • Kit X Prop./Rotor(s) Serial No.(s) C2YK-1BF/F7661B4 III. MAJOR PORTION ELIGIBILITY STATEMENT OF APPLICANT I certify that the major portion of this aircraft (identified in Section Il above) was fabricated and assembled by Early A. Builder, Son O. Builder Names of all builders (Please Print) solely for my (our) education or recreation, in accordance with 14 CFR part 21, Certification Procedures for Products and Parts, §
21.191(g), Operating amateur-built aircraft. I have records to support this statement and will make them available to the FAA upon request.
During the fabrication and assembly of this project, I/ we used the following commercial assistance (mark N/A if no commercial assistance was used):
N/A Name of company or individual(s) City & State Phone N/A Name of company or individual(s) City & State Phone -NOTICE- Whoever in any matter within the jurisdiction of the executive, legislative, or judicial branch of the Government of the United States, knowingly and willfully falsifies, conceals or covers up by any trick, scheme, or device a material fact, or who makes any materially false, fictitious or fraudulent statement or representation, or makes or uses any false writing or document knowing the same to contain any materially false, fictitious or fraudulent statement or entry, shall be fined under this title, imprisoned not more than 5 years or, if the offense involves international or domestic terrorism, imprisoned not more than 8 years, or both.
(U.S. Code, Title 18, Sec. 1001) understand the Privacy Act statement that accompanies this form.
Signature of Applicant (In Ink) Date 8/1/2009 Early A. Builder IV. NOTARIZATION STATEMENT FAA Form 8130-12 (08-2009) Su NSN: 0052-00-889-9002 12-1
Appendix 13 APPENDIX 13. SAMPLE PROGRAM LETTER TO ACCOMPANY
APPLICATION FOR AIRWORTHINESS CERTIFICATE [Insert local FAA office or DAR] Date: [Insert date]
TO:
In accordance with 14 CFR § 21.193, I request a Special Airworthiness Certificate for my aircraft for the purpose of operating amateur-built aircraft. The aircraft description is as follows:
Builder: Early A. Builder Registration No.: N130EA Model: VAN’S RV-6 Serial No.: 1001 No. of Engines: 1 No. of Seats: 2 Design Criteria: my own design built from plans built from a kit X The aircraft is complete and the following items have been accomplished:
Yes No I enclose FAA Form 8130-6 with Sections I, II, and III complete.
Yes No I enclose FAA Form 8130-12 with Sections I, II, and III complete and notarized in Section IV.
Yes No I possess Aeronautical Center Form 8050-3.
Yes No I enclose a three-view drawing or photographs of the aircraft.
Yes No I have weighed the aircraft to determine that the most forward and aft center of gravity positions are within established limits. The weight and balance report is available at the aircraft, and a copy is submitted with this application.
Yes No I have maintained a construction log for the project, including photographs showing methods of construction and workmanship during the construction. Log entries describe all inspections conducted during construction.
Yes No The marking requirements of part 45 have been complied with, including permanent attachment of a fireproof identification (data) plate, permanent application of appropriate registration marks, and the word “experimental” displayed near each entrance to the cabin or cockpit.
Yes No The following placard is displayed in the cockpit in full view of all occupants (not required for single-place aircraft).
“PASSENGER WARNING—THIS AIRCRAFT IS
AMATEUR-BUILT AND DOES NOT COMPLY WITH
FEDERAL SAFETY REGULATIONS FOR STANDARD AIRCRAFT.”
13-1
Appendix 13 APPENDIX 13. SAMPLE PROGRAM LETTER TO ACCOMPANY
APPLICATION FOR AIRWORTHINESS CERTIFICATE (CONTINUED) The aircraft will be available for inspection at this location, and directions are as follows:
Grayson County Airport Hangar No. 3 4701 Airport Dr.
Sherman, TX 75020 I request airworthiness certification and operation limitations be issued permitting me to operate the aircraft within the following geographical area for flight testing. Initial flights will determine engine reliability and flight control characteristics. A flight test plan has been developed using the guidance in AC 90-89 and is available for review. After Phase I flight test completion, I plan to operate the aircraft under VFR conditions only.
25-statute mile radius of Grayson County Airport Latitude, 33-43 N; Longitude, 096-40W Dallas-Ft. Worth Sectional (L13) My residential telephone number is (903) 555-1212.
My daytime business number is (214) 555-1212.
Early A. Builder Early A. Builder Owner/Builder 13-2
Appendix 14 APPENDIX 14. SAMPLE FAA FORM 8610-2, AIRMAN CERTIFICATE
AND/OR RATING APPLICATION TYPE OR PRINT ALL ENTRIES IN INK Form Approved OMB No. 2120-0022 US Department of Transportator Federal Aviation Adininistration
AIRMAN CERTIFICATE AND/OR RATING APPLICATION
•MECHANIC 2 REPAIRMAN • PARACHUTE RIGGER
•AIRFRAME • POWERPLANT EXPERIMENTAL AIRCRAFT BUILDER • SENIOR O SEAT •MASTER • CHEST (Specify Rating) •BACK O LAP PLICATION FOR: 4 ORIGINAL ISSUANCE • ADDED RATING A. NAME (First. Middle, Last) K. PERMANENT MAILING ADDRESS Early A. INITIAL ONLY Builder 1240 Bois d' Arc Road I. APPLICANT INFORMATION B. SOCIAL SECURITY NO. 123-45-6789 C. DOB (Mo.Day Yr.) 12-12-1943 D. HEIGHT 76 JE. WEIGHT 235 NUMBER AND STREET. P.O. BOX, ETC IN.
F. HAIR G. EYES H. SEX T. NATIONALITY (Citizenship) Savoy_ brown brown M USA cty-- J. PLACE OF BIRTH TX 75479 Bug Tussle, TX STÄTE™ ZIP CODE L. HAVE YOU EVER HAD AN AIRMAN CERTIFICATE SUSPENDED OR REVOKED? M. DO YOU NOW OR HAVE YOU EVER HELD AN FAA AIRMAN "EMO BrES
CERTIFICATE
•YES (If "Yes." explain anacneo sneet ке lo approprate nem numperj SPECIFY TYE Private Pilot N. HAVE YOU EVER BEEN CONVICTED FOR ' TOLATION OF ANY FEDERAL OR STATE STATUTES DATE OF FINAL CONVICTION
PERTA NING TO NARCOC DRUGS MARIJUANA DRUGS OR SUBSTANCES? . . KI NO OYES -
•A. CIVIL • B. MILITARY •C. LETTER OF RECOMMENDATION FOR II. CERTIFICATE OR RATING APPLIED FOR EXPERIENCE (1) NAME AND LOCATION OF SCHOOL EXPERIENCE REPAIRMAN ((Attach copy) ON BASIS OF - L ° OF APPAOE OF APPROVED COURSE (2) SCHOOL NO. (3) CURRICULUM FROM WHICH GRADUATED (4) DATE
(1) SCHOOL NAME NO. (2) SCHOOL OFFICIAL'S SIGNATURE
AND IS RECOMMENDED TO TAKE THE ORAL/
• F MPECIAL AUTHORIZATION TO TAKE PRACTICAL TEST (FAR 65.80) (1) DATE AUTH. (2) DATE AUTH. EXPIRES (3) FAA INSPECTOR SIGNATURE (4) FAR DIST OFC
MECHANIC'S ORAL/PRACTICAL TEST (FAR 65.80) A. MILITARY (1) SERVICE (2) RANK OR PAY LEVEL (3) MILITARY SPECIALTY CODE
COMPETENCE
OBTAINED IN B. APPLICANTS OTHER THAN FAA CERTIFICATED SCHOOL GRADUATES, LIST EXPERIENCE RELATING TO CERTIFICATE AND RATING APPLIED FOR.
(Continue on separate sheet. if more space is needed) III. RECORD OF EXPERIENCE DATES-MONTH AND YEAR
TYPE WORK PERFORMED
FROM TO MAKE - Builder MODEL - Van's RV-6 SERIAL No. - 1001
CERTIFICATION DATE
OF AIRCRAFT
SEAT CHEST BACK LAP FOR PACKED AS A - C. PARACHUTE RIGGER APPLICANTS: INDICATE BY TYPE HOW MANY MASTER RA LING • SENIOR O MILITARY
PARACHUTES PACKED ONLY RIGGER
I CERTIFY THAT THE STATEMENTS BY ME ON THIS APPLICATION ARE TRUE IV. APPLICANT'S CERTIFICATION A. SIGNATURE Eady A. Builler B. DATE XXXX-XXXX
I FIND THIS APPLICANT MEETS THE EXPER- INSPECTOR'S SIGNATUF FAA DISTRICT OFFICE
v. IENCE REQUIREMENTS OF FAR 65 AND IS
ELIGIBLE TO TAKE THE REQUIRED TESTS
FOR FAA USE ONLY Emp. reg. D.O seal con iss Act Tlev [TR s.h. Sich Arie RATING (1) RATING (2) RATING (3) RATING (4) FAA Form 8610-2 (2-85) SUPERSEDES PREVIOUS EDITION TU.S.G.P.O.: 1993-769-012/80055 14-1