Appendix 1 FIGURE 3. SAMPLE FAA FORM 8130-6, APPLICATION FOR A STANDARD AIRWORTHINESS CERTIFICATE – IMPORT GLIDER (FACE SIDE ONLY)
APPLICATION FOR
AIRWORTHINESS
CERTIFICATE II . CERTIFICATION REQUESTED EXPERIMEN TAL ONLY (Enter hours flown s ince la st cert ificate CERTIFICATED R EPAIR STATION (Give CertificateCERTIFICATED MECHANIC (Give AIRCRAFT SPECIFICATION O R TYPE CER TIFICATE D ATA SHEET (Give No. and AIRWORTHINES S DIRECTIVES (Check if all ap plica ble A D's c ompli ed wi th an d giv e the numb er of the l ast A D SUP PLEME NT av ailab le in the biwee kly s eries as o f the date of a pplic ation ) 96- 23 issued or re newed) N/A No.)
Revision No.)
G15EU 14 CF R part 121 C ERTIFI CATE H OLDER (Give Certificate No.)
A. REGISTE RED OW NER (A s show n on c ertifi cate o f airc raft r egistr ation) V. FAA
REPRESENTATIVE
CERTIFICATION I. AIRCRA FT DESC RIPTIONIII. OWNER'S CERTIFICATI ON IV. INSPECTIO N AGENCY
VERIFICATION A B X STANDARD AIRWORTHINESS CERTIFICATE (Indicate category) SPECIAL AIR WORTHINESS CERTIFICATE (Check approp riate items)
1. REGISTR ATION MARK N53B APPLICAT ION IS H EREBY MA DE FOR: (Check a pplicabl e items)
2. AIRCRAFT BU ILDER'S NAME (Make) Sc hlei cher FAA CODING3. AIRCRAFT MODEL DESIGNATION A S-K13
4. YR. MFR.
19 84
7. ENGINE MODEL DESIGNATION N/A
10. PRO PELLER MODEL DESIG NATION
N/A X IMPORT
11. AIRC RAFT IS (Check if appl icable) DATE DISTRICT OFFICE DESIGNEE'S SIG NATURE AND NO. FAA INSPECTOR 'S SIGNATURE (Check ALL appli cable bloc ks in item s A a nd B) A. I find that t he aircr aft desc ribed in Sec tion I or VI I meets requirements for X X NAME Elmer E. J ones
ADDRESS 160 1 E . 6 th Str eet San Die go, cali forn ia 9 5472 B. AIRCRAFT CERTIFICATION BASIS (C heck appli cable bloc ks an d complete items as indic ated) X C. AIRCRAFT OPERATION AND MAINTENANCE RECORDS
CHECK IF RECORDS IN
COMPLIANCE WITH 14 CF R se ctio n 91 .417
TOTAL AIRFRAME HOURS 320 3
DATE OF APPLICATION 11/2 5/ 96 D. CERTIFICATION - I hereby certify that I am the regi ster ed o wner (or his age nt) of t he a ircr aft desc ribe d ab ove, tha t th e ai rcraft i s regist ered wit h the Federal Av iati on A dministr ation in acc ordance with Title 49 of th e U nit ed Sta tes Co de 441 01 et seq. and appli cabl e Fe dera l Av iati on R egul atio ns, and that the air craf t ha s be en i nspe cted and is airw orth y an d el igib le f or t he airwo rthi ness cer tifi cate requ est ed.
A. THE AIRCRAFT DESCRIBED ABOVE HAS BEEN IN SPECTE D AND FO UND AIRWOR THY BY: (Complete this section only if 14 CFR part 21 . 183( d) app lies).
NAME AND TITLE (Print or type) Elmer E. Jo nes, Owner
SIGNATURE
DATE TITLE SIGNATURE INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for FAA use only. Submit origi nal only to an authorized FAA Representative. If additional space is required, use attachment. For special flight permits complete Sections II, VI, and VII as applicable.
B. Insp ecti on f or a spe cial fli ght permit u nder Sec tion VII wa s c ond uct ed by:
6. ENGINE BUILDER 'S NAME (Make) N/A
9. PROPELLER BUILDER'S NAME (Make) N/A
5. AIRCR AFT SER IAL NO.
8. NUMBER OF ENGINES N/A
IF DEALER, CHECK HERE AIRCRAFT LISTING (Give page number(s)) N/A SUPPLEMENTAL TYPE CERTIFICAT E (Li st number of each ST C inc orpor ated) N/A AIR CRAFT MANU FACTURER (Give name or firm) U.S. D epa rtment of Tr ansp orta tion Federal Aviation Administration Certificate No.)
O.M.B. No. 2120-0018
NORMAL UTILITY ACROBATIC TRANSPORT COMMUTE R BALLOON FAA Form 8130-6 (5-01) Supersedes Previous Edition NSN: 0052-00-024-7006 C MULTIPLE AIR WORTHINESS CERTIFICATE (Check ABOVE " Restr icted Oper ation " and "Sta ndard " or "Limi ted" as ap plica ble.)
SPECIAL FLIGHT PERMIT (Indi cate oper ati on to be con duc ted , t hen comple te S ecti on V I or VII as applica ble o n rev erse side)
LIMITED PROVIS IONAL (Indicate class) RESTRICTED (Indi cate opera tion( s) to be c ond uct ed)
AGRICULTURE AN D PEST CONTROL FOREST (W ildlife c onservation)
CLAS S I
CLAS S II AERIAL
PATROLLING
AERIAL ADVER TISING
WEATHER CONTROL
AMATEUR BUILT
CREW TRAINING
EXHIBITION
MARKET SURVEY
DELIVERIN G OR EX PORTING
TO SHOW COMPLIAN CE WITH THE CFR
CUSTOMER DEMONSTRATION FLIGHTS
PRODUCTION FLIGHT TESTING
FERRY FLIGHT FOR R EPAIRS, A LTERATION S, MAINT ENANCE, O R STORAGE
EVACUATE FROM AREA OF IMPENDING DANGER
OPERATION IN EX CESS OF MAX IMUM CERTIF ICATED TAKE -OFF WEIGHT
RESEARCH AND D EVELOPMENT AIR RACINGEXPERIM ENTAL (Indica te op erati on(s) to b e c ond uct ed) OTHER (Specify) OPERATING (Primary Category) KIT BUILT AIRCRAFT
PRIMARY
FAA INSPECTOR 14 CFR par t 65
FAA DE SIGNEE 14 CFR part 121 O R 135 14 CFR pa rt 145
THE CERTIFICA TE REQUESTED
AMENDMENT OR MODIFICATION OF CURRENT AIRWORTHIN ESS CERTIFICATE
CERTIFICATE HOLDER UNDER Import Gl ider X OTHER1 14 3 6 4 2 5 3 4 8 3 6 3 2 5 1 2 4 1 0 1 4 0 7 6 4 3 2 1 5 7 2 5 6 6 5 2
Appendix 1 FIGURE 4. SAMPLE FAA FORM 8130-6, APPLICATION FOR A STANDARD AIRWORTHINESS CERTIFICATE – SURPLUS MILITARY AIRCRAFT (FACE SIDE ONLY)
APPLICATION FOR
AIRWORTHINESS
CERTIFICATE II . CERTIFICATION REQUESTED EXPERIMEN TAL ONLY (Enter hours flown s ince la st cert ificate CERTIFICATED R EPAIR STATION (Give CertificateCERTIFICATED M ECHANIC (Give AIRCRAFT SPECIFICATION O R TYPE CER TIFICATE D ATA SHEET (Give No. and AIRW ORTHINES S DIRECTIVES (Check if all ap plica ble A D's c om pli ed wi th an d giv e the num b er of the l ast A D SUP PLEM E NT av ailab le in the biwee kly s eries as o f the date of a pplic ation ) 96- 23 issued or re newed) N/A No.)
Revision No.)
H3WE Rev 2 14 CF R part 121 C ERTIFI CATE H OLDER (Give Certificate No.)
A. REGISTE RED OW NER (A s show n on c ertifi cate o f airc raft r egistr ation) V. FAA
REPRESENTATIV E
CERTIFICATION I. AIRCRAFT DESCRIPTIONIII. OWNER'S CERTIFICATION IV. INSPECTIO N AGENCY
VERIFI CATIO N A B X STANDARD AIRW ORTHINESS CERTIFICATE (Indicate category) SPECIAL AIR W ORTHINESS CERTIFICATE (Check approp riate item s)
1. REGISTR ATION MARK N34 562 APPLICAT ION IS H EREBY MA DE FOR: (Check a pplicabl e item s)
2. AIRCRAFT BU ILDER'S NAME (M ake) Hug hes FAA CODING3. AIRCRAFT MODEL DESIGNATION 36 9A
4. YR. M FR.
19 66
7. ENGINE MODEL DESIGNATION 250- C10B
10. PRO PELLER MODEL DESIG NATION
N/A IM PORT
11. AIRC RAFT IS (Check if appl icable) DATE DISTRICT OFFICE DESIGNEE'S SIG NATURE AND NO. FAA INSPECTOR 'S SIGNATURE (Check ALL appli cable bloc ks in item s A a nd B) A. I fin d th at t he a ircr aft desc ribe d in Sec tion I o r VI I me ets requ irem ents for X X NAME Helico pter Opera tions , Inc
ADDRESS 2345 Perim eter Drive Stockton , C ali for nia 94 044 B. AIRCRAFT CERTIFICATION BASIS (C heck appli cable bloc ks an d com plete item s as indic ated) X C. AIRCRAFT OPERATION AND MAINTENANCE RECORDS
CHECK IF RECORDS IN
COMPLIANCE WITH 14 CF R se ctio n 91 .417
TOTAL AIRFRAME HOURS 285 2: 00 3
DATE OF APPLICATION 11/2 5/ 96 D. CERTIFICATION - I hereby certify that I am the regi ster ed o wner (or his age nt) of t he a ircr aft desc ribe d ab ove, tha t th e ai r cra ft i s re gist ered wit h th e Fe dera l Av iati on A dmin istr atio n in acc orda nce with Title 49 of th e U nit ed Sta tes Co de 441 01 et seq. and appli cabl e Fe dera l Av iati on R egul atio ns, and that the air craf t ha s be en i nspe cted and is airw orth y an d el igib le f or t he airwo rthi ness cer tifi cate requ est ed.
A. THE AIRCRAFT DESCRIBED ABOVE HAS BEEN IN SPECTE D AND FO UND AIRWOR THY BY: (Complete this section only if 14 CFR part 21 . 183( d) app lies).
NAME AND TITLE (Print or type) James J. J one s, Gen era l M ana ger
SIGNATURE
DATE TITLE SIGNATURE INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for FAA use only. Submit origi nal only to an authorized FAA Representative. If additional space is required, use attachment. For special flight permits complete Sections II, VI, and VII as applicable.
B. Insp ecti on f or a spe cial fli ght perm it u nder Sec tion VII wa s c ond uct ed by:
6. ENGINE BUILDER 'S NAME (M ake) Al lison
9. PROPELLER BUILDER'S NAME (M ake) N/A
5. AIRCR AFT SER IAL NO.
13 32
8. NUMBER OF ENGINES 1
IF DEALER, CHECK HERE AIRCRAFT LISTING (Give page number(s)) N/A SUPPLEMENTAL TYPE CERTIFICAT E (Li st number of each ST C inc orpor ated) N/A AIRCRAFT MANUFACTURER (Give name or firm) U.S. D epa rtm ent of Tr ansp orta tion Federal Aviation Administration Certificate No.)
O.M.B. No. 2120-0018
X NORMAL UTILITY ACROBATIC TRANSPORT COMMUTE R BALLOON FAA Form 8130-6 (5-01) Supersedes Previous Edition NSN: 0052-00-024-7006 C MULTIPLE AIR W ORTHINESS CERTIFICATE (Check ABOVE " Restr icted Oper ation " and "Sta ndard " or "Lim i ted" as ap plica ble.)
SPECIAL FLIGHT PERMIT (Indi cate oper ati on to be con duc ted , t hen com ple te S ecti on V I or VII as applica ble o n rev erse side)
LIM ITED PROVIS IONAL (Indicate class) RESTRICTED (Indi cate opera tion( s) to be c ond uct ed)
AGRICULTURE AN D PEST CONTROL FOREST (W ildlife c onservation)
CLAS S I
CLAS S II AERIAL
PATROLLING
AERIAL ADVER TISING
WEATHER CONTROL
AMATEUR BUILT
CREW TRAINING
EXHIBITION
MARKET SURVEY
DELIVERIN G OR EX PORTING
TO SHOW COMPLIAN CE WITH THE CFR
CUSTOMER DEMONSTRATION FLIGHTS
PRODUCTION FLIGHT TESTING
FERRY FLIGHT FOR R EPAIRS, A LTERATION S, MAINT ENANCE, O R STORAGE
EVACUATE FROM AREA OF IMPE NDING DANGER
OPERATION IN EX CESS OF MAX IMUM CERTIF ICATED TAKE -OFF W EIGHT
RESEA RCH AND D EVELOPMENT AIR RACINGEXPERIM ENTAL (Indica te op erati on(s) to b e c ond uct ed) OTHER (Specify) OPERATING (Primary Category) KIT BUILT AIRCRAFT
PRIMARY
FAA INSPECTOR 14 CFR par t 65
FAA DE SIGNEE 14 CFR part 121 O R 135 14 CFR pa rt 145
THE CERTIFICA TE REQUESTED
AMENDMENT OR MODIFICATION OF CURRENT AIRW ORTHINESS CERTIFICATE
CERTIFICATE HOLDER UNDER OTHER1 14 3 6 4 2 5 3 4 8 3 6 3 2 5 1 2 4 1 0 1 4 0 7 6 4 3 2 1 5 7 2 5 6 5 2
Appendix 1 FIGURE 5. SAMPLE FAA FORM 8130-6, APPLICATION FOR A STANDARD AIRWORTHINESS CERTIFICATE – AIRCRAFT BUILT FROM SPARE AND SURPLUS PARTS (NO PREVIOUS U.S. AIRWORTHINESS CERTIFICATE ISSUED) (FACE SIDE ONLY)
APPLICATION FOR
AIRWORTHINESS
CERTIFICATE II. CERTIFICATION REQUESTED EXPERIMEN TAL ONLY (Enter hours flown s ince la st cert ificate CERTIFICATED R EPAIR STATION (Give CertificateCERTIFICATED MECHANIC (Give AIRCRAFT SPECIFICATION O R TYPE CER TIFICATE D ATA SHEET (Give No. and AIRW ORTHINES S DIRECTIVES (Check if all ap plica ble A D's c om pli ed wi th an d giv e the num b er of the l ast A D SUP PLEM E NT av ailab le in the biwee kly s eries as o f the date of a pplic ation ) 96- 23 issued or re newed) N/A No.)
Revision No.)
H-1, R ev. 36 14 CF R part 121 C ERTIFI CATE H OLDER (Give Certificate No.)
A. REGISTE RED OW NER (A s show n on c ertifi cate o f airc raft r egistr ation) V. FAA
REPRESENTATIV E
CERTIFICATION I. AIRCRA FT DE SC RIPTIONIII. OWNER'S CERTIFICATION IV. INSPECTIO N AGENCY
VERIFI CATIO N A B X STANDARD AIRW ORTHINESS CERTIFICATE (Indicate category) SPECIAL AIR W ORTHINESS CERTIFICATE (Check approp riate item s)
1. REGISTR ATION MARK N 6934M APPLICAT ION IS H EREBY MA DE FOR: (Check a pplicabl e item s)
2. AIRCRAFT BU ILDER'S NAME (M ake) S mith FAA CODING3. AIRCRAFT MODEL DESIGNATION C-172M
4. YR. M FR.
19 80
7. ENGINE MODEL DESIGNATION 0 -32 0-B
10. PRO PELLER MODEL DESIG NATION 1C16 0/CTM IM PORT
11. AIRC RAFT IS (Check if appl icable) DATE DISTRICT OFFICE DESIGNEE'S SIG NATURE AND NO. FAA INSPECTOR 'S SIGNATURE (Check ALL appli cable bloc ks in item s A a nd B) A. I fin d th at t he a ircr aft desc ribe d in Sec tion I o r VI I me ets requ irem ents for X X NAME John R. S mith
ADDRESS 6224 Arb or W ay Spring fie ld, Ten nes see 70 653 B. AIRCRAFT CERTIFICATION BASIS (C heck appli cable bloc ks an d com plete item s as indic ated) X C. AIRCRAFT OPERATION AND MAINTENANCE RECORDS
CHECK IF RECORDS IN
COMPLIANCE WITH 14 CF R se ctio n 91 .417
TOTAL AIRFRAME HOURS
6.5 3
DATE OF APPLICATION 11/2 5/ 96 D. CERTIFICATION - I hereby certify that I am the regi ster ed o wner (or his age nt) of t he a ircr aft desc ribe d ab ove, tha t th e ai r cra ft i s re gist ered wit h th e Fe dera l Av iati on A dmin istr atio n in acc orda nce with Title 49 of th e U nit ed Sta tes Co de 441 01 et se q . and appli cabl e Fe dera l Av iati on R egul atio ns, and that the air craf t ha s be en i nspe cted and is airw orth y an d el igib le f or t he airwo rthi ness cer tifi cate requ est ed.
A. THE AIRCRAFT DESCRIBED ABOVE HAS BEEN IN SPECTE D AND FO UND AIRWOR THY BY: (Complete this section only if 14 CFR part 21 . 183( d) app lies).
NAME AND TITLE (Print or type) John R. Sm ith, Owner
SIGNATURE
DATE TITLE SIGNATURE INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for FAA use only. Submit origi nal only to an authorized FAA Representative. If additional space is required, use attachment. For special flight permits complete Sections II, VI, and VII as applicable.
B. Insp ecti on f or a spe cial fli ght perm it u nder Sec tion VII wa s c ond uct ed by:
6. ENGINE BUILDER 'S NAME (M ake) Lyco ming
9. PROPELLER BUILDER'S NAME (M ake) M c Cauley
5. AIRCR AFT SER IAL NO.
Smi th 001
8. NUMBER OF ENGINES One
IF DEALER, CHECK HERE AIRCRAFT LISTING (Give page number(s)) N/A SUPPLEMENTAL TYPE CERTIFICAT E (Li st number of each ST C inc orpor ated) N/A AIRCRAFT MANUFACTURER (Give name or firm) U.S. D epa rtm ent of Tr ansp orta tion Federal Aviation Administration Certificate No.)
O.M.B. No. 2120-0018
X NORMAL UTILITY ACROBATIC TRANSPORT COMMUTE R BALLOON FAA Form 8130-6 (5-01) Supersedes Previous Edition NSN : 0052-00-024-7006 C MULTIPLE AIR W ORTHINESS CERTIFICATE (Check ABOVE " Restr icted Oper ation " and "Sta ndard " or "Lim i ted" as ap plica ble.)
SPECIAL FLIGHT PERMIT (Indi cate oper ati on to be con duc ted , t hen com ple te S ecti on V I or VII as applica ble o n rev erse side)
LIM ITED PROVIS IONAL (Indicate class) RESTRICTED (Indi cate opera tion( s) to be c ond uct ed)
AGRICULTURE AN D PEST CONTROL FOREST (W ildlife c onservation)
CLAS S I
CLAS S II AERIAL
PATROLLING
AERIAL ADVER TISING
WEATHER CONTROL
AMATEUR BUILT
CREW TRAINING
EXHIBITION
MARKET SURVEY
DELIVERIN G OR EX PORTING
TO SHOW COMPLIAN CE WITH THE CFR
CUSTOMER DEMONSTRATION FLIGHTS
PRODUCTION FLIGHT TESTING
FERRY FLIGHT FOR R EPAIRS, A LTERATION S, MAINT ENANCE, O R STORAGE
EVACUATE FROM AREA OF IMPENDING DANGER
OPERATION IN EX CESS OF MAX IMUM CERTIF ICATED TAKE -OFF W EIGHT
RESEA RCH AND D EVELOPMENT AIR RACINGEXPERIM ENTAL (Indica te op erati on(s) to b e c ond uct ed) OTHER (Specify) OPERATING (Prim ary Category) KIT BUILT AIRCRAFT
PRIMARY
FAA INSPECTOR 14 CFR par t 65
FAA DE SIGNEE 14 CFR part 121 O R 135 14 CFR pa rt 145
THE CERTIFICA TE REQUESTED
AMENDMENT OR MODIFICATION OF CURRENT AIRWORTHIN ESS CERTIFICATE
CERTIFICATE HOLDER UNDER OTHER1 14 3 6 4 2 5 3 4 8 3 6 3 2 5 1 2 4 1 0 1 4 0 7 6 4 3 2 1 5 7 2 5 6 5 2
Appendix 1 FIGURE 6. SAMPLE FAA FORM 8130-6, APPLICATION FOR A SPECIAL AIRWORTHINESS CERTIFICATE – PRIMARY CATEGORY AIRCRAFT CERTIFICATED UNDER SECTION 21.184(a) (FACE SIDE ONLY)
APPLICATION FOR
AIRWORTHINESS
CERTIFICATE II. CERTIFICATION REQUESTED EXPERIMEN TAL ONLY (Enter hours flown s ince la st cert ificate CERTIFICATED R EPAIR STATION (Give CertificateCERTIFICATED MECHANIC (Give AIRCRAFT SPECIFICATION O R TYPE CER TIFICATE D ATA SHEET (Give No. and AIRW ORTHINES S DIRECTIVES (Check if all ap plica ble A D's c om pli ed wi th an d giv e the num b er of the l ast A D SUP PLEM E NT av ailab le in the biwee kly s eries as o f the date of a pplic ation ) 96- 23 issued or re newed) No.)
Revision No.)
CE785 14 CF R part 121 C ERTIFI CATE H OLDER (Give Certificate No.)
A. REGISTE RED OW NER (A s show n on c ertifi cate o f airc raft r egistr ation) V. FAA
REPRESENTATIV E
CERTIFICATION I. AIRCRA FT DE SC RIPTIONIII. OWNER'S CERTIFICATION IV. INSPECTIO N AGENCY
VERIFI CATIO N A B X STANDARD AIRW ORTHINESS CERTIFICATE (Indicate category) SPECIAL AIR W ORTHINESS CERTIFICATE (Check approp riate item s)
1. REGISTR ATION MARK N2EZ APPLICAT ION IS H EREBY MA DE FOR: (Check a pplicabl e item s)
2. AIRCRAFT BU ILDER'S NAME (M ake) Fl ight Corp.
FAA CODING3. AIRCRAFT MODEL DESIGNATION F-C-1A
4. YR. M FR.
7. ENGINE MODEL DESIGNATION 1 0-36 0-ES
10. PRO PELLER MODEL DESIG NATION 2A 34C 209 IM PORT
11. AIRC RAFT IS (Check if appl icable) DATE DISTRICT OFFICE DESIGNEE'S SIG NATURE AND NO. FAA INSPECTOR 'S SIGNATURE (Check ALL appli cable bloc ks in item s A a nd B) A. I fin d th at t he a ircr aft desc ribe d in Sec tion I o r VI I me ets requ irem ents for X X NAME Flight Corp.
ADDRESS 10 La ne A ve Doby, TX 78 907 B. AIRCRAFT CERTIFICATION BASIS (C heck appli cable bloc ks an d com plete item s as indic ated) X C. AIRCRAFT OPERATION AND MAINTENANCE RECORDS
CHECK IF RECORDS IN
COMPLIANCE WITH 14 CF R se ctio n 91 .417
TOTAL AIRFRAME HOURS
2.1 3
DATE OF APPLICATION 11/2 5/ 96 D. CERTIFICATION - I hereby certify that I am the regi ster ed o wner (or his age nt) of t he a ircr aft desc ribe d ab ove, tha t th e ai r cra ft i s re gist ered wit h th e Fe dera l Av iati on A dmin istr atio n in acc orda nce with Title 49 of th e U nit ed Sta tes Co de 441 01 et se q . and appli cabl e Fe dera l Av iati on R egul atio ns, and that the air craf t ha s be en i nspe cted and is airw orth y an d el igib le f or t he airwo rthi ness cer tifi cate requ est ed.
A. THE AIRCRAFT DESCRIBED ABOVE HAS BEEN IN SPECTE D AND FO UND AIRWOR THY BY: (Complete this section only if 14 CFR part 21 . 183( d) app lies).
NAME AND TITLE (Print or type) Joe Qu ality, Direc tor QA
SIGNATURE
DATE TITLE SIGNATURE INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for FAA use only. Submit origi nal only to an authorized FAA Representative. If additional space is required, use attachment. For special flight permits complete Sections II, VI, and VII as applicable.
B. Insp ecti on f or a spe cial fli ght perm it u nder Sec tion VII wa s c ond uct ed by:
6. ENGINE BUILDER 'S NAME (M ake) TCM
9. PROPELLER BUILDER'S NAME (M ake) M c Cauley
5. AIRCR AFT SER IAL NO.
F0 002
8. NUMBER OF ENGINES One
IF DEALER, CHECK HERE AIRCRAFT LISTING (Give page number(s)) N/A SUPPLEMENTAL TYPE CERTIFICAT E (Li st number of each ST C inc orpor ated) N/A AIRCRAFT MANUFACTURER (Give name or firm) U.S. D epa rtm ent of Tr ansp orta tion Federal Aviation Administration Certificate No.)
OMB No. 2120-0018
NORMAL UTILITY ACROBATIC TRANSPORT COMMUTE R BALLOON FAA Form 8130-6 (5-01) Supersedes Previous Edition NSN: 0052-00-024-7006 C MULTIPLE AIR W ORTHINESS CERTIFICATE (Check ABOVE " Restr icted Oper ation " and "Sta ndard " or "Lim i ted" as ap plica ble.)
SPECIAL FLIGHT PERMIT (Indi cate oper ati on to be con duc ted , t hen com ple te S ecti on V I or VII as applica ble o n rev erse side)
LIM ITED PROVIS IONAL (Indicate class) RESTRICTED (Indi cate opera tion( s) to be c ond uct ed)
AGRICULTURE AN D PEST CONTROL FOREST (W ildlife c onservation)
CLAS S I
CLAS S II AERIAL
PATROLLING
AERIAL ADVER TISING
WEATHER CONTROL
AMATEUR BUILT
CREW TRAINING
EXHIBITION
MARKET SURVEY
DELIVERIN G OR EX PORTING
TO SHOW COMPLIAN CE WITH THE CFR
CUSTOMER DEMONSTRATION FLIGHTS
PRODUCTION FLIGHT TESTING
FERRY FLIGHT FOR R EPAIRS, A LTERATION S, MAINT ENANCE, O R STORAGE
EVACUATE FROM AREA OF IMPENDING DANGER
OPERATION IN EX CESS OF MAX IMUM CERTIF ICATED TAKE -OFF W EIGHT
RESEA RCH AND D EVELOPMENT AIR RACINGEXPERIM ENTAL (Indica te op erati on(s) to b e c ond uct ed) OTHER (Specify) OPERATING (Prim ary Category) KIT BUILT AIRCRAFT
X PRIMARY
FAA INSPECTOR 14 CFR par t 65
FAA DE SIGNEE 14 CFR part 121 O R 135 14 CFR pa rt 145
THE CERTIFICA TE REQUESTED
AMENDMENT OR MODIFICATION OF CURRENT AIRWORTHIN ESS CERTIFICATE
CERTIFICATE HOLDER UNDER OTHER1 14 3 6 4 2 5 3 4 8 3 6 3 2 5 1 2 4 1 0 1 4 0 7 6 4 3 2 1 5 7 2 5 6 5 2
Appendix 1 FIGURE 7. SAMPLE FAA FORM 8130-6, APPLICATION FOR A SPECIAL AIRWORTHINESS CERTIFICATE – LIMITED CATEGORY (FACE SIDE ONLY)
APPLICATION FOR
AIRWORTHINESS
CERTIFICATE II . CERTIFICATION REQUESTED EXPERIMEN TAL ONLY (Enter hours flow n s ince la st cert ificate CERTIFIC ATED R EPAIR STATION (Give CertificateCERTIFIC ATED M EC HANIC (Give AIRCRAFT SPECI FICATION O R TYPE CER TIFICATE D ATA SHEET (Give No. and AI RWORTHI NESS DI RECTI VES (Check if all ap plica ble A D's c om pli ed wi th an d giv e the num b er of the l ast A D SU P PLEM E NT av ailab le in the biw ee kly s eries as o f the date of a pplic ation ) 96 -23 issued or re newed) N/A No.)
Revision N o.)
AL-33 Rev.1 14 CF R part 121 C ER TIFI CATE H OLDER (Give Certificate No.)
A. REGISTE R ED OW NER (A s show n on c ertifi cate o f airc raft r egistr ation) V. FAA
REPRESENTATIV E
CERTIFICATION I. AIRCRAFT DESCRIPTIONIII. OWNER'S CERTIFICATION IV. INSPECTIO N AGENCY
VERIFI CATIO N A B X STANDARD AIRW ORTHINESS CERTIFICATE (Indicate cate gory) SPECIAL AIR W OR TH INESS C ER TIFICATE (Check approp riate item s)
1. REGISTR ATION M ARK N1 256 APPLICAT ION IS H EREBY M A D E FOR : (C heck a pplicabl e item s)
2. AI RCRAFT BU I L DER'S NAME (Make) M artin FAA CODI NG3. AIRCRAFT MODEL DESI GNATION B -26C
4. YR . M FR.
19 43
7. ENGINE M ODEL DE SIGNATION R- 2800- 83AM B
10. PRO PELLER MODEL DESIG NATION 42 E60 -7/ 689 5-8 IM POR T
11. AIRC RAFT IS (C heck if appl icable) DATE DI STRI CT OFFICE DESIGNEE'S SIG NATURE AND NO. FAA INSPECTOR 'S SIGNATURE (C heck ALL appli cable bloc ks in item s A a nd B) A. I fin d th at t he a ircr aft desc ribe d in Sec tion I o r VI I me ets requ irem ents for X X NAME Gas Transmis sion Company
ADDRESS 1216 W est 48 th Str eet Dallas, Texas 64072 B. AIR CR A FT CE RTIFI C ATIO N BAS IS (C heck appli cable bloc ks an d com plete item s as indic ated) X C. AI RCRAFT OPERATION AND MAI NTENANCE RECORDS
CHECK IF RECORDS IN
COMPLIANCE WITH 14 C F R se ctio n 91 .417
TOTAL AIRFRAME HOURS 12,632 3
DATE OF APPLI CATION 11/20/96 D . CERTIFIC ATION - I hereby certify that I am the regi ster ed o w ner (or his age nt) of t he a ircr aft desc ribe d ab ove, tha t th e ai r cra ft i s re gist ered w it h th e Fe dera l Av iati on A dmin istr atio n in acc orda nce with Title 49 of th e U nit ed Sta tes Co de 441 01 et seq . and appli cabl e Fe dera l Av iati on R egul atio ns, and that the air craf t ha s be en i nspe cted and is airw orth y an d el igib le f or t he airw o rthi ness cer tifi cate requested.
A. TH E AIRCR AFT D ES C RIBED ABOVE HAS B EEN IN SPECTE D AND FOUN D AIRW OR TH Y BY : (Com plete this sectio n only if 14 CFR p art 21 .183( d) app lies).
NAM E AND T ITLE (Prin t or type) George Brow n, P resi dent
SIGNATURE
DATE TITLE SIGNATURE INSTRU CTIONS - Print or type. Do not write in shaded areas; these are for FAA use only. Submit origi nal only to an authorized FAA Representative. If additional space is required , use attachment. For special flight p ermits complete Sections II, VI, and VII as applicable.
B. Insp ecti on f or a spe cial fli ght perm it u nder Sec tion VII wa s c ond uct ed by:
6. ENGI NE BUI L DER 'S NAME (M ake) P&W
9. PROPELLER BUILDER'S NAME (Make) Ha mil ton St and ard
5. AIRCR AFT SER IAL NO.
22 56
8. NUMBER OF ENGINES Tw o
I F DEALER, CHECK HERE AIR CR AFT LISTI N G (Gi ve pag e numb er(s)) N/A SU PPLEM ENTAL TYPE C ERTI FICAT E (Li st nu mber of ea ch ST C inc orpor ated) N/A AIRCRAFT MANUFACTURER (Give name or firm) U.S. D epa rtm ent of Tr ansp orta tion Federal Aviation Administration Certificate No.)
O.M.B. No. 2120-0018
NORMA L UTILITY ACR OBATIC TRANSPORT COMMUTER BALL OON FAA Form 8130-6 (5-01) Supersedes Previous Edition NSN: 0052-00-024-7006 C M U LTIPLE AIR W ORTHIN ESS CERTIFIC ATE (C heck ABOVE " R estr icted Oper ation " and "Sta ndard " or "Lim i ted" as ap plica ble.)
X
SPEC IAL FLIGH T PERM IT (Indi cate oper ati on to be con duc ted , t hen com ple te S ecti on V I or VII as ap p licab le on re ve rse side )
LIMITED PROVISIONAL (Indicate class) RESTRICTED (Indi cate opera tion( s) to be c ond uct ed)
AGRI CUL TURE AN D PEST CONTROL FOREST (W ildlife c onservation)
CLAS S I
CLAS S II AERIAL
PATRO LLING
AERIAL ADVER TISING
WEATHER CONTROL
AM ATEUR BUILT
CREW TRAINING
EXHIBITION
MARKET SURVEY
DELIVERIN G OR EX PORTING
TO SHOW COMPL I ANCE WI TH THE CFR
CUSTOMER DEMONSTRATION FLIGHTS
PRODUCTION FLIGHT TESTING
FERRY FLIGHT FOR R EPAIRS, A LTERATION S, MAINT ENANCE, O R STORAGE
EVACUATE FROM AREA OF IM PE NDING DANGER
OPERATION IN EX C ESS OF M AX IM UM C ERTIF ICATED TAKE -OFF W EIGH T
RESEARCH AND DEVELOPMENT AI R RACI NGEXPERIM ENTAL (Indica te operati on(s) to be c onducted) OTHER (Specify) OPERATING (Primary Category) KIT BUILT AIRCRAFT
PRIMARY
FAA INSPECTOR 14 CFR par t 65
FAA DE SIGNEE 14 CFR part 121 O R 135 14 CFR pa rt 145
THE CERTIFICA TE REQUESTED
AM ENDM ENT OR MODIFICATION OF CURRENT AIRW ORTHINESS CERTIFICATE
CERTI FI CATE HOLDER UNDER OTHER1 14 3 6 4 2 5 3 4 8 3 6 3 2 5 1 2 4 1 0 1 4 0 7 6 4 3 2 1 5 7 2 5 6 5 2
Appendix 1 FIGURE 8. SAMPLE FAA FORM 8130-6, APPLICATION FOR A SPECIAL AIRWORTHINESS CERTIFICATE – PROVISIONAL CATEGORY (FACE SIDE ONLY)
APPLICATION FOR
AIRWORTHINESS
CERTIFICATE II. CERTIFICATION REQUESTED EXPERIMEN TAL ONLY (Enter hours flown s ince la st cert ificate CERTIFICATED R EPAIR STATION (Give CertificateCERTIFICATED MECHANIC (Give AIRCRAFT SPECIFICATION O R TYPE CER TIFICATE D ATA SHEET (Give No. and AIRW ORTHINES S DIRECTIVES (Check if all ap plica ble A D's c om pli ed wi th an d giv e the num b er of the l ast A D SUP PLEM E NT av ailab le in the biwee kly s eries as o f the date of a pplic ation ) 96- 23 issued or re newed) N/A No.)
Revision No.)
A1SO 14 CF R part 121 C ERTIFI CATE H OLDER (Give Certificate No.)
A. REGISTE RED OW NER (A s show n on c ertifi cate o f airc raft r egistr ation) V. F AA
REPRESENTA TIVE
CERTIFICATION I. AIRCRA FT DESCRIPTIONIII. OWNER'S CERTIFICATI ON IV. INSPECTION AGENCY
VERIFICATION A B X STANDARD AIRW ORTHINESS CERTIFICATE (Indicate category) SPECIAL AIR W ORTHINESS CERTIFICATE (Check approp riate item s)
1. REGISTR ATION MARK N 502A APPLICAT ION IS H EREBY MA DE FOR: (Check a pplicabl e item s)
2. AIRCRAFT BU ILDER'S NAME (M ake) Lock heed -Geo rgia Co.
FAA CODING3. AIRCRAFT MODEL DESIGNATION 3 82G
4. YR. M FR.
19 96
7. ENGINE MODEL DESIGNATION 501- D22A
10. PRO PELLER MODEL DESIG NATION 54H60- 91/ 54H 60- 117 IM PORT
11. AIRC RAFT IS (Check if appl icable) DATE DISTRICT OFFICE DESIGNEE'S SIG NATURE AND NO. FAA INSPECTOR 'S SIGNATURE (Check ALL appli cable bloc ks in item s A a nd B) A. I fin d th at t he a ircr aft desc ribe d in Sec tion I o r VI I me ets requ irem ents for X X NAME Lockh eed Ge org ia Co.
ADDRESS M arietta , G eor gia 30 060 B. AIRCRAFT CERTIFICATION BASIS (C heck appli cable bloc ks an d com plete item s as indic ated) X C. AIRCRAFT OPERATION AND MAINTENANCE RECORDS
CHECK IF RECORDS IN
COMPLIANCE WITH 14 CF R se ctio n 91 .417
TOTAL AIRFRAME HOURS 10 .2 3
DATE OF APPLICATION 11/2 5/ 96 D. CERTIFICATION - I hereby certify that I am the regi ster ed o wner (or his age nt) of t he a ircr aft desc ribe d ab ove, tha t th e ai r cra ft i s re gist ered wit h th e Fe dera l Av iati on A dmin istr atio n in acc orda nce with Title 49 of th e U nit ed Sta tes Co de 441 01 et seq . and appli cabl e Fe dera l Av iati on R egul atio ns, and that the air craf t ha s be en i nspe cted and is airw orth y an d el igib le f or t he airwo rthi ness cer tifi cate requ est ed.
A. THE AIRCRAFT DESCRIBED ABOVE HAS BEEN IN SPECTE D AND FO UND AIRWOR THY BY: (Complete this section only if 14 CFR part 21 . 183( d) app lies).
NAME AND TITLE (Print or type) James A. Jone s Vi ce P resi dent Eng inee ring
SIGNATURE
DATE TITLE SIGNATURE INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for FAA use only. Submit origi nal only to an authorized FAA Representative. If additional space is required, use attachment. For special flight permits complete Sections II, VI, and VII as applicable.
B. Insp ecti on f or a spe cial fli ght perm it u nder Sec tion VII wa s c ond uct ed by:
6. ENGINE BUILDER 'S NAME (M ake)
Al lison
9. PROPELLER BUILDER'S NAME (M ake) H amil ton- Stan dard
5. AIRCR AFT SER IAL NO.
43 87
8. NUMBER OF ENGINES Four
IF DEALER, CHECK HERE AIRCRAFT LISTING (Give page number(s)) N/A SUPPLEMENTAL TYPE CERTIFICAT E (Li st number of each ST C inc orpor ated) N/A AIR CRAFT MANU FACTURER (Give name or firm) U.S. D epa rtm ent of Tr ansp orta tion Federal Aviation Administration Certificate No.)
O.M.B. No. 2120-0018
NORMAL UTILITY ACROBATIC TRANSPORT COMMUTE R BALLOON FAA Form 8130-6 (5-01) Supersedes Previous Edition NSN:0052-00-024-7006 C MULTIPLE AIR W ORTHINESS CERTIFICATE (Check ABOVE " Restr icted Oper ation " and "Sta ndard " or "Lim i ted" as ap plica ble.)
X SPECIAL FLIGHT PERMIT (Indi cate oper ati on to be con duc ted , t hen com ple te S ecti on V I or VII as applica ble o n rev erse side)
LIM ITED PROVIS IONAL (Indicate class) RESTRICTED (Indi cate opera tion( s) to be c ond uct ed) X
AGRICULTURE AN D PEST CONTROL FOREST (W ildlife c onservation)
CLAS S I
CLAS S II AERIAL
PATROLLING
AERIAL ADVER TISING
WEATHER CONTROL
AMATEUR BUILT
CREW TRAINING
EXHIBITION
MARKET SURVEY
DELIVERIN G OR EX PORTING
TO SHOW COMPLIAN CE WITH THE CFR
CUSTOMER DEMONSTRATION FLIGHTS
PRODUCTION FLIGHT TESTING
FERRY FLIGHT FOR R EPAIRS, A LTERATION S, MAINT ENANCE, O R STORAGE
EVACUATE FROM AREA OF IMPENDING DANGER
OPERATION IN EX CESS OF MAX IMUM CERTIF ICATED TAKE -OFF W EIGHT
RESEA RCH AND D EVELOPMENT AIR RACINGEXPERIM ENTAL (Indica te op erati on(s) to b e c ond uct ed) OTHER (Specify) OPERATING (Primary Category) KIT BUILT AIRCRAFT
PRIMARY
FAA INSPECTOR 14 CFR par t 65
FAA DE SIGNEE 14 CFR part 121 O R 135 14 CFR pa rt 145
THE CERTIFICA TE REQUESTED
AMENDMENT OR MODIFICATION OF CURRENT AIRWORTHIN ESS CERTIFICATE
CERTIFICATE HOLDER UNDER OTHER1 14 3 6 4 2 5 3 4 8 3 6 3 2 5 1 2 4 1 0 1 4 0 7 6 4 3 2 1 5 7 2 5 6 5 2
Appendix 1 FIGURE 9. SAMPLE FAA FORM 8130-6, APPLICATION FOR A SPECIAL AIRWORTHINESS CERTIFICATE – RESTRICTED CATEGORY (FACE SIDE ONLY)
APPLICATION FOR
AIRWORTHINESS
CERTIFICATE II. CERTIFICATION REQUESTED EXPERIMEN TAL ONLY (Enter hours flown s ince la st cert ificate CERTIFICATED R EPAIR STATION (Give CertificateCERTIFICATED MECHANIC (Give AIRCRAFT SPECIFICATION O R TYPE CER TIFICATE D ATA SHEET (Give No. and AIRW ORTHINES S DIRECTIVES (Check if all ap plica ble A D's c om pli ed wi th an d giv e the num b er of the l ast A D SUP PLEM E NT av ailab le in the biwee kly s eries as o f the date of a pplic ation ) 96- 23 issued or re newed) N/A No.)
Revision No.)
A4SW R ev. 5 14 CF R part 121 C ERTIFI CATE H OLDER (Give Certificate No.)
A. REGISTE RED OW NER (A s show n on c ertifi cate o f airc raft r egistr ation) V. F AA
REPRESENTA TIVE
CERTIFICATION I. AIRCRA FT DESCRIPTIONIII. OWNER'S CERTIFICATION IV. INSPECTION AGENCY
VERIFICATION A B X STANDARD AIRW ORTHINESS CERTIFICATE (Indicate category) SPECIAL AIR W ORTHINESS CERTIFICATE (Check approp riate item s)
1. REGISTR ATION MARK N7 777 APPLICAT ION IS H EREBY MA DE FOR: (Check a pplicabl e item s)
2. AIRCRAFT BU ILDER'S NAME (M ake) North Ameri can Ro ckwell FAA CODING3. AIRCRAFT MODEL DESIGNATION S2R
4. YR. M FR.
19 50
7. ENGINE MODEL DESIGNATION R1 340A N1(S 3H1)
10. PRO PELLER MODEL DESIG NATION 12 D40- 305/ EAC/ AG 1 00-2 IM PORT
11. AIRC RAFT IS (Check if appl icable) DATE DISTRICT OFFICE DESIGNEE'S SIG NATURE AND NO. FAA INSPECTOR 'S SIGNATURE (Check ALL appli cable bloc ks in item s A a nd B) A. I fin d th at t he a ircr aft desc ribe d in Sec tion I o r VI I me ets requ irem ents for X X NAME John J J ones , R. B. J ones DBA Crop Duster s, Inc.
ADDRESS Rt. 5 Greenvill e, M i ssiss ippi 38701 B. AIRCRAFT CERTIFICATION BASIS (C heck appli cable bloc ks an d com plete item s as indic ated) X C. AIRCRAFT OPERATION AND MAINTENANCE RECORDS
CHECK IF RECORDS IN
COMPLIANCE WITH 14 CF R se ctio n 91 .417
TOTAL AIRFRAME HOURS 21 05 3
DATE OF APPLICATION 11/2 5/ 96 D. CERTIFICATION - I hereby certify that I am the regi ster ed o wner (or his age nt) of t he a ircr aft desc ribe d ab ove, tha t th e ai r cra ft i s re gist ered wit h th e Fe dera l Av iati on A dmin istr atio n in acc orda nce with Title 49 of th e U nit ed Sta tes Co de 441 01 et seq . and appli cabl e Fe dera l Av iati on R egul atio ns, and that the air craf t ha s be en i nspe cted and is airw orth y an d el igib le f or t he airwo rthi ness cer tifi cate requ est ed.
A. THE AIRCRAFT DESCRIBED ABOVE HAS BEEN IN SPECTE D AND FO UND AIRWOR THY BY: (Complete this section only if 14 CFR part 21 . 183( d) app lies).
NAME AND TITLE (Print or type) John J. Jon es, Co-O wner
SIGNATURE
DATE TITLE SIGNATURE INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for FAA use only. Submit origi nal only to an authorized FAA Representative. If additional space is required, use attachment. For special flight permits complete Sections II, VI, and VII as applicable.
B. Insp ecti on f or a spe cial fli ght perm it u nder Sec tion VII wa s c ond uct ed by:
6. ENGINE BUILDER 'S NAME (M ake) P&W
9. PROPELLER BUILDER'S NAME (M ake) Ha mil ton St and ard
5. AIRCR AFT SER IAL NO.
19 16R
8. NUMBER OF ENGINES One
IF DEALER, CHECK HERE AIRCRAFT LISTING (Give page number(s)) N/A SUPPLEMENTAL TYPE CERTIFICAT E (Li st number of each ST C inc orpor ated) N/A AIRCRAFT MANUFACTURER (Give name or firm) U.S. D epa rtm ent of Tr ansp orta tion Federal Aviation Administration Certificate No.)
O.M.B. No. 2120-0018
NORMAL UTILITY ACROBATIC TRANSPORT COMMUTE R BALLOON FAA Form 8130-6 (5-01) Supersedes Previous Edition NSN: 0052-00-024-7006 C MULTIPLE AIR W ORTHINESS CERTIFICATE (Check ABOVE " Restr icted Oper ation " and "Sta ndard " or "Lim i ted" as ap plica ble.)
X SPECIAL FLIGHT PERMIT (Indi cate oper ati on to be con duc ted , t hen com ple te S ecti on V I or VII as applica ble o n rev erse side)
LIM ITED PROVIS IONAL (Indicate class) RESTRICTED (Indi cate opera tion( s) to be c ond uct ed)
AGRICULTURE AN D PEST CONTROL FOREST (W ildlife c onservation)
CLAS S I
CLAS S II AERIAL
PATROLLING
AERIAL ADVER TISING
WEATHER CONTROL
AMATEUR BUILT
CREW TRAINING
EXHIBITION
MARKET SURVEY
DELIVERIN G OR EX PORTING
TO SHOW COMPLIAN CE WITH THE CFR
CUSTOMER DEMONSTRATION FLIGHTS
PRODUCTION FLIGHT TESTING X
FERRY FLIGHT FOR R EPAIRS, A LTERATION S, MAINT ENANCE, O R STORAGE
EVACUATE FROM AREA OF IMPENDING DANGER
OPERATION IN EX CESS OF MAX IMUM CERTIF ICATED TAKE -OFF W EIGHT
RESEA RCH AND D EVELOPMENT AIR RACINGEXPERIM ENTAL (Indica te op erati on(s) to b e c ond uct ed) OTHER (Specify) OPERATING (Prim ary Category) KIT BUILT AIRCRAFT
PRIMARY
FAA INSPECTOR 14 CFR par t 65
FAA DE SIGNEE 14 CFR part 121 O R 135 14 CFR pa rt 145
THE CERTIFICA TE REQUESTED
AMENDMENT OR MODIFICATION OF CURRENT AIRWORTHIN ESS CERTIFICATE
CERTIFICATE HOLDER UNDER OTHER1 14 3 6 4 2 5 3 4 8 3 6 3 2 5 1 2 4 1 0 1 4 0 7 6 4 3 2 1 5 7 2 5 6 5 2
Appendix 1 FIGURE 10. SAMPLE FAA FORM 8130-6, APPLICATION FOR A SPECIAL AIRWORTHINESS CERTIFICATE – EXPERIMENTAL CATEGORY AMATEUR-BUILT (FACE SIDE ONLY)
APPLICATION FOR
AIRWORTHINESS
CERTIFICATE II. CERTIFICATION REQUESTED EXPERIMEN TAL ONLY (Enter hours flown s ince la st cert ificate CERTIFICATED R EPAIR STATION (Give CertificateCERTIFICATED MECHANIC (Give AIRCRAFT SPECIFICATION O R TYPE CER TIFICATE D ATA SHEET (Give No. and AIRW ORTHINES S DIRECTIVES (Check if all ap plica ble A D's c om pli ed wi th an d giv e the num b er of the l ast A D SUP PLEM E NT av ailab le in the biwee kly s eries as o f the date of a pplic ation ) 96- 23 issued or re newed)
0.0 No.)
Revision No.)
N/A 14 CF R part 121 C ERTIFI CATE H OLDER (Give Certificate No.)
A. REGISTE RED OW NER (A s show n on c ertifi cate o f airc raft r egistr ation) V. F AA
REPRES ENTATIV E
CERTIFICATION I. AIRCRAFT DESC RIPTIONIII. OWNER'S CERTIFICATION IV. INSPECTIO N AGENCY
VERIFI CATIO N A B X STANDARD AIRW ORTHINESS CERTIFICATE (Indicate category) SPECIAL AIR W ORTHINESS CERTIFICATE (Check approp riate item s)
1. REGISTR ATION MARK N1 234 APPLICAT ION IS H EREBY MA DE FOR: (Check a pplicabl e item s)
2. AIRCRAFT BU ILDER'S NAME (M ake) P ratt FAA CODING3. AIRCRAFT MODEL DE SIGNATION B -3
4. YR. M FR.
19 96
7. ENGINE MODEL DE SIGNATION A-65
10. PRO PELLER MODEL DESIG NATION N76AM -2-50 IM PORT
11. AIRC RAFT IS (Check if appl icable) DATE DISTRICT OFFICE DESIGNEE'S SIG NATURE AND NO. FAA INSPECTOR 'S SIGNATURE (Check ALL appli cable bloc ks in item s A a nd B) A. I fin d th at t he a ircr aft desc ribe d in Sec tion I o r VI I me ets requ irem ents for X NAME Howard D . Pratt John J Smit h Co- Owner
ADDRESS 1120 W e st Str eet ST Louis , M i ssou ri 4 1346 B. AIRCRA FT CE RTIFI CATIO N BAS IS (C heck appli cable bloc ks an d com plete item s as indic ated) X C. AIRCRAFT OPERATION AND MAINTENANCE RECORDS
CHECK IF RECORDS IN
COMPLIANCE WITH 14 CF R se ctio n 91 .417
TOTAL AIRFRAME HOURS
0.0 3
DATE OF APPLICATION 11/2 5/ 96 D. CERTIFICATION - I hereby certify that I am the regi ster ed o wner (or his age nt) of t he a ircr aft desc ribe d ab ove, tha t th e ai r cra ft i s re gist ered wit h th e Fe dera l Av iati on A dmin istr atio n in acc orda nce with Title 49 of th e U nit ed Sta tes Co de 441 01 et seq. and appli cabl e Fe dera l Av iati on R egul atio ns, and that the air craf t ha s be en i nspe cted and is airw orth y an d el igib le f or t he airwo rthi ness cer tifi cate requ est ed.
A. THE AIRCRAFT DES CRIBED ABOVE HAS B EEN IN SPECTE D AND FO UND AIRWOR THY BY: (Complete this section only if 14 CFR part 21 . 183( d) app lies).
NAME AND TITLE (Print or type) Howard D. Pratt, Co Owner
SIGNATURE
DATE TITLE SIGNATURE INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for FAA use only. Submit origi nal only to an authorized FAA Representative. If additional space is required, use attachment. For special flight permits complete Sections II, VI, and VII as applicable.
B. Insp ecti on f or a spe cial fli ght perm it u nder Sec tion VII wa s c ond uct ed by:
6. ENGINE BUILDER 'S NAME (M ake) CM C
9. PROP ELLER B UILDER' S NAM E (M ake) Sen sen ich
5. AIRCR AFT SER IAL NO.
8. NUMBER OF ENGINES One
IF DEALER, CHECK HERE AIRCRAFT LISTI NG (Gi ve pag e numb er(s)) SUPPLEMENTAL TYPE CERTIFICAT E (Li st number of each ST C inc orpor ated) AIRCRAFT MANUFACTURER (Give name or firm) U.S. D epa rtm ent of Tr ansp orta tion Federal Aviation Administration Certificate No.)
O.M.B. No. 2120-0018
NORMAL UTILITY ACROBATIC TRANSPORT COMMUTE R BALLOON FAA Form 8130-6 (5-01) Supersedes Previous Edition N SN: 0052-00-024-7006 C MULTIPLE AIR W ORTHINESS CERTIFICATE (Check ABOVE " Restr icted Oper ation " and "Sta ndard " or "Lim i ted" as ap plica ble.)
SPECIAL FLIGHT PERMIT (Indi cate oper ati on to be con duc ted , t hen com ple te S ecti on V I or VII as applica ble o n rev erse side)
LIM ITED PROVIS IONAL (Indicate class) RESTRICTED (Indi cate opera tion( s) to be c ond uct ed)
AGRICULTURE AN D PEST CONTROL FOREST (W ildlife c onservation)
CLAS S I
CLAS S II AERIAL
PATRO LLING
AERIAL ADVER TISING
WEATHER CONTROL
AMATEUR BUILT
CREW TRAINING
EXHIBITION
MARKET SURVEY
DELIVERIN G OR EX PORTING
TO SHOW COMPLIAN CE WITH THE CFR
CUSTOMER DEMONSTRATION FLIGHTS
PRODUCTION FL IGHT TESTING
FERRY FLIGHT FOR R EPAIRS, A LTERATION S, MAINT ENANCE, O R STORAGE
EVACUATE FROM AREA OF IMPE NDING DANGER
OPERATION IN EX CESS OF MAX IMUM CERTIF ICATED TAKE -OFF W EIGHT
XRESEARCH AND DEVELOPMENT AIR RACINGEXPERIM ENTAL (Indica te op erati on(s) to b e c ond uct ed)X OTHER (Specify) OPERATING (Prim ary Category) KIT BUILT AIRCRAFT
PRIMARY
FAA INSPECTOR 14 CFR par t 65
FAA DE SIGNEE 14 CFR part 121 O R 135 14 CFR pa rt 145
THE CERTIFICA TE REQUESTED
AMENDMENT OR MODIFICATION OF CURRENT AIRWORTHIN ESS CERTIFICATE
CERTIFICATE HOLDER UNDER OTHER1 14 3 6 4 2 5 3 4 8 3 3 2 5 1 2 4 1 0 1 4 0 7 6 4 3 2 1 5 2 5 6 5 2
Appendix 1 FIGURE 11. SAMPLE FAA FORM 8130-6, APPLICATION FOR A SPECIAL AIRWORTHINESS CERTIFICATE – EXPERIMENTAL CATEGORY, NO PREVIOUS
EXPERIMENTAL CERTIFICATE ISSUED (FACE SIDE ONLY)
APPLICATION FOR
AIRWORTHINESS
CERTIFICATE II. CERTIFICATION REQUESTED EXPERIMEN TAL ONLY (Enter hours flown s ince la st cert ificate CERTIFICATED R EPAIR STATION (Give CertificateCERTIFICATED MECHANIC (Give AIRCRAFT SPECIFICATION O R TYPE CER TIFICATE D ATA SHEET (Give No. and AIRW ORTHINES S DIRECTIVES (Check if all ap plica ble A D's c om pli ed wi th an d giv e the num b er of the l ast A D SUP PLEM E NT av ailab le in the biwee kly s eries as o f the date of a pplic ation ) 96- 23 issued or re newed)
0.0 No.)
Revision No.)
N/A 14 CF R part 121 C ERTIFI CATE H OLDER (Give Certificate No.)
A. REGISTE RED OW NER (A s show n on c ertifi cate o f airc raft r egistr ation) V. FAA
REPRESENTATIV E
CERTIFICATION I. AIRCRA FT DE SC RIPTIONIII. OWNER'S CERTIFICATION IV. INSPECTIO N AGENCY
VERIFI CATIO N A B X STANDARD AIRW ORTHINESS CERTIFICATE (Indicate category) SPECIAL AIR W ORTHINESS CERTIFICATE (Check approp riate item s)
1. REGISTR ATION MARK N5 216 APPLICAT ION IS H EREBY MA DE FOR: (Check a pplicabl e item s)
2. AIRCRAFT BU ILDER'S NAME (M ake) Boe ing FAA CODING3. AIRCRAFT MODEL DESIGNATION 72 7-22 8
4. YR. M FR.
19 68
7. ENGINE MODEL DESIGNATION JT8D-7
10. PRO PELLER MODEL DESIG NATION
N/A IM PORT
11. AIRC RAFT IS (Check if appl icable) DATE DISTRICT OFFICE DESIGNEE'S SIG NATURE AND NO. FAA INSPECTOR 'S SIGNATURE (Check ALL appli cable bloc ks in item s A a nd B) A. I fin d th at t he a ircr aft desc ribe d in Sec tion I o r VI I me ets requ irem ents for X NAME The Bo ein g C omp any
ADDRESS PO Box 3707 Seat tle , W ash ing ton 98 124 B. AIRCRAFT CERTIFICATION BASIS (C heck appli cable bloc ks an d com plete item s as indic ated) X C. AIRCRAFT OPERATION AND MAINTENANCE RECORDS
CHECK IF RECORDS IN
COMPLIANCE WITH 14 CF R se ctio n 91 .417
TOTAL AIRFRAME HOURS
5. 51 3
DATE OF APPLICATION 11/2 5/ 96 D. CERTIFICATION - I hereby certify that I am the regi ster ed o wner (or his age nt) of t he a ircr aft desc ribe d ab ove, tha t th e ai r cra ft i s re gist ered wit h th e Fe dera l Av iati on A dmin istr atio n in acc orda nce with Title 49 of th e U nit ed Sta tes Co de 441 01 et seq . and appli cabl e Fe dera l Av iati on R egul atio ns, and that the air craf t ha s be en i nspe cted and is airw orth y an d el igib le f or t he airwo rthi ness cer tifi cate requ est ed.
A. THE AIRCRAFT DESCRIBED ABOVE HAS BEEN IN SPECTE D AND FO UND AIRWOR THY BY: (Complete this section only if 14 CFR part 21 . 183( d) app lies).
NAME AND TITLE (Print or type) R.B. Smith, Airwo rthin ess C ertif icati on M a nager
SIGNATURE
DATE TITLE SIGNATURE INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for FAA use only. Submit origi nal only to an authorized FAA Representative. If additional space is required, use attachment. For special flight permits complete Sections II, VI, and VII as applicable.
B. Insp ecti on f or a spe cial fli ght perm it u nder Sec tion VII wa s c ond uct ed by:
6. ENGINE BUILDER 'S NAME (M ake) P&W
9. PROPELLER BUILDER'S NAME (M ake) N/A
5. AIRCR AFT SER IAL NO.
20 540
8. NUMBER OF ENGINES T hree
IF DEALER, CHECK HERE AIRCRAFT LISTING (Give page number(s)) N/A SUPPLEMENTAL TYPE CERTIFICAT E (Li st number of each ST C inc orpor ated) AIRCRAFT MANUFACTURER (Give name or firm) U.S. D epa rtm ent of Tr ansp orta tion Federal Aviation Administration Certificate No.)
O.M.B. No. 2120-0018
NORMAL UTILITY ACROBATIC TRANSPORT COMMUTE R BALLOON FAA Form 8130-6 (5-01) Supersedes Previous Edition NSN: 0052-00-024-7006 C MULTIPLE AIR W ORTHINESS CERTIFICATE (Check ABOVE " Restr icted Oper ation " and "Sta ndard " or "Lim i ted" as ap plica ble.)
SPECIAL FLIGHT PERMIT (Indi cate oper ati on to be con duc ted , t hen com ple te S ecti on V I or VII as applica ble o n rev erse side)
LIM ITED PROVIS IONAL (Indicate class) RESTRICTED (Indi cate opera tion( s) to be c ond uct ed)
AGRICULTURE AN D PEST CONTROL FOREST (W ildlife c onservation)
CLAS S I
CLAS S II AERIAL
PATROLLING
AERIAL ADVER TISING
WEATHER CONTROL
AMATEUR BUILT
CREW TRAINING
EXHIBITION
MARKET SURVEY
DELIVERIN G OR EX PORTING
TO SHOW COMPLIAN CE WITH THE CFR
CUSTOMER DEMONSTRATION FLIGHTS
PRODUCTION FLIGHT TESTING X
FERRY FLIGHT FOR R EPAIRS, A LTERATION S, MAINT ENANCE, O R STORAGE
EVACUATE FROM AREA OF IMPENDING DANGER
OPERATION IN EX CESS OF MAX IMUM CERTIF ICATED TAKE -OFF W EIGHT
RESEA RCH AND D EVELOPMENT AIR RACINGEXPERIM ENTAL (Indica te op erati on(s) to b e c ond uct ed)X OTHER (Specify) OPERATING (Prim ary Category) KIT BUILT AIRCRAFT
PRIMARY
FAA INSPECTOR 14 CFR par t 65
FAA DE SIGNEE 14 CFR part 121 O R 135 14 CFR pa rt 145
THE CERTIFICA TE REQUESTED
AMENDMENT OR MODIFICATION OF CURRENT AIRWORTHIN ESS CERTIFICATE
CERTIFICATE HOLDER UNDER OTHER1 14 3 6 4 2 5 3 4 8 3 6 3 2 5 1 2 4 1 0 1 4 0 7 6 4 3 2 1 5 7 2 5 6 5 2
Appendix 1 FIGURE 12. SAMPLE FAA FORM 8130-6, APPLICATION FOR A SPECIAL AIRWORTHINESS CERTIFICATE – EXPERIMENTAL CATEGORY (FACE SIDE ONLY)
APPLICATION FOR
AIRWORTHINESS
CERTIFICATE II. CERTIFICATION REQUESTED EXPERIMEN TAL ONLY (Enter hours flow n s ince la st cert ificate CERTIFIC ATED R EPAIR STATION (Give CertificateCERTIFIC ATED M EC HANIC (Give AIRCRAFT SPECI FICATION O R TYPE CER TIFICATE D ATA SHEET (Give No. and AI RWORTHI NESS DI RECTI VES (Check if all ap plica ble A D's c om pli ed wi th an d giv e the num b er of the l ast A D SU P PLEM E NT av ailab le in the biw ee kly s eries as o f the date of a pplic ation ) 96- 23 issued or re newed) 22 .0 No.)
Revision N o.)
N/A 14 CF R part 121 C ER TIFI CATE H OLDER (Give Certificate No.)
A. REGISTE R ED OW NER (A s show n on c ertifi cate o f airc raft r egistr ation) V. FAA
REPRESENTATIV E
CERTIFICATION I. AIRCRAFT DESCRIPTIONIII. OWNER'S CERTIFICATION IV. INSPECTIO N AGENCY
VERIFI CATIO N A B X STANDARD AIRW ORTHINESS CERTIFICATE (Indicate cate gory) SPECIAL AIR W OR TH INESS C ER TIFICATE (Check approp riate item s)
1. REGISTR ATION M ARK N 51CA APPLICAT ION IS H EREBY M A D E FOR : (C heck a pplicabl e item s)
2. AI RCRAFT BU I L DER'S NAME (Make) C essna FAA CODI NG3. AIRCRAFT MODEL DESI GNATION 551
4. YR . M FR.
19 92
7. ENGINE M ODEL DE SIGNATION JT 15D -4
10. PRO PELLER MODEL DESIG NATION
N /A IM POR T
11. AIRC RAFT IS (C heck if appl icable) DATE DI STRI CT OFFICE DESIGNEE'S SIG NATURE AND NO. FAA INSPECTOR 'S SIGNATURE (C heck ALL appli cable bloc ks in item s A a nd B) A. I fin d th at t he a ircr aft desc ribe d in Sec tion I o r VI I me ets requ irem ents for X NAME C essna A ircra ft C o mpany
ADDRESS W ichi ta, Ka nsa s 6 727 7-7 704 B. AIR CR A FT CE RTIFI C ATIO N BAS IS (C heck appli cable bloc ks an d com plete item s as indic ated) X C. AI RCRAFT OPERATION AND MAI NTENANCE RECORDS
CHECK I F RECORDS I N
COMPLIANCE WITH 14 C F R se ctio n 91 .417
TOTAL AI RFRAME HOURS 2509 3
DATE OF APPLI CATION 11/25/96 D . CERTIFIC ATION - I hereby certify that I am the regi ster ed o w ner (or his age nt) of t he a ircr aft desc ribe d ab ove, tha t th e ai r cra ft i s re gist ered w it h th e Fe dera l Av iati on A dmin istr atio n in acc orda nce with Title 49 of th e U nit ed Sta tes Co de 441 01 et seq . and appli cabl e Fe dera l Av iati on R egul atio ns, and that the air craf t ha s be en i nspe cted and is airw orth y an d el igib le f or t he airw o rthi ness cer tifi cate requested.
A. TH E AIRCR AFT D ES C RIBED ABOVE HAS B EEN IN SPECTE D AND FOUN D AIRW OR TH Y BY : (Com plete this sectio n only if 14 CFR p art 21 .183( d) app lies).
NAM E AND T ITLE (Prin t or type) A.D. Smith , Qua lity C ontr ol M a nager
SIGNATURE
DATE TITLE SIGNATURE INSTRU CTIONS - Print or type. Do not write in shaded areas; these are for FAA use only. Submit origi nal only to an authorized FAA Representative. If additional space is required , use attachment. For special flight p ermits complete Sections II, VI, and VII as applicable.
B. Insp ecti on f or a spe cial fli ght perm it u nder Sec tion VII wa s c ond uct ed by:
6. ENGI NE BUI L DER 'S NAME (M ake) UACL
9. PROPELLER BUILDER'S NAME (Make) N/A
5. AIRCR AFT SER IAL NO.
55 1-0 004
8. NUMBER OF ENGINES Tw o
I F DEALER, CHECK HERE AIR CR AFT LISTI N G (Gi ve pag e numb er(s)) N/A SU PPLEM ENTAL TYPE C ERTI FICAT E (Li st nu mber of ea ch ST C inc orpor ated) N/A AIRC RAFT M AN UFA CTUR ER (Give n ame or firm) U.S. D epa rtm ent of Tr ansp orta tion Federal Aviation Administration Certificate No.)
O.M.B. No. 2120-0018
NORMA L UTILITY ACR OBATIC TRANSPORT COMMUTER BALL OON FAA Form 8130-6 (5-01) Supersedes Previous Edition NSN: 0052-00-024-7006 C M U LTIPLE AIR W ORTHIN ESS CERTIFIC ATE (C heck ABOVE " R estr icted Oper ation " and "Sta ndard " or "Lim i ted" as ap plica ble.)
SPEC IAL FLIGH T PERM IT (Indi cate oper ati on to be con duc ted , t hen com ple te S ecti on V I or VII as ap p licab le on re ve rse side )
LIMITED PROVISIONAL (Indicate class) RESTRICTED (Indi cate opera tion( s) to be c ond uct ed)
AGRICULTURE AN D PEST CONTROL FOREST (W ildlife c onservation)
CLAS S I
CLAS S II AERIAL
PATRO LLING
AERIAL ADVER TISING
WEATHER CONTROL
AM ATEUR BUILT
CREW TRAINING
EXHIBITION
MARKET SURVEY
DELIVERIN G OR EX PORTING
TO SHOW COMPL I ANCE WI TH THE CFR
C USTOM ER DEM ONSTRATION FLIGH TS
PRODUCTION FLIGHT TESTING
FERRY FLIGHT FOR R EPAIRS, A LTERATION S, MAINT ENANCE, O R STORAGE
EVACUATE FROM AREA OF IM PE NDING DANGER
OPERATION IN EX C ESS OF M AX IM UM C ERTIF ICATED TAKE -OFF W EIGH T
RESEARCH AND DEVELOPMENT
AI R RACI NG X EXPERIM ENTAL (Indica te operati on(s) to b e c ond uct ed)X OTHER (Specify) OPERATING (Primary Category) KIT BUILT AIRCRAFT
PRIMARY
FAA INSPECTOR 14 CFR par t 65
FAA DE SIGNEE 14 CFR part 121 O R 135 14 CFR pa rt 145
THE CERTIFICA TE REQUESTED
AM ENDM ENT OR MODIFICATION OF CURRENT AIRW ORTHINESS CERTIFICATE
CERTI FI CATE HOLDER UNDER OTHER1 14 3 6 4 2 5 3 4 8 3 6 3 2 5 1 2 4 1 0 1 4 0 7 6 4 3 2 1 5 7 2 5 6 5 2
Appendix 1 FIGURE 13. SAMPLE FAA FORM 8130-6, APPLICATION FOR A PRIMARY CATEGORY CERTIFICATE – AIRCRAFT CERTIFICATED UNDER SECTION 21.191(h) (FACE SIDE ONLY)
APPLICATION FOR
AIRWORTHINESS
CERTIFICATE II. CERTIFICATION REQUESTED EXPERIMEN TAL ONLY (Enter hours flown s ince la st cert ificate CERTIFICATED R EPAIR STATION (Give CertificateCERTIFICATED M ECHANIC (Give AIRCRAFT SPECIFICATION O R TYPE CER TIFICATE D ATA SHEET (Give No. and AIRW ORTHINES S DIRECTIVES (Check if all ap plica ble A D's c om pli ed wi th an d giv e the num b er of the l ast A D SUP PLEM E NT av ailab le in the biwee kly s eries as o f the date of a pplic ation ) 96- 23 issued or re newed)
0.0 No.)
Revision No.)
A1W 1 14 CF R part 121 C ERTIFI CATE H OLDER (Give Certificate No.)
A. REGISTE RED OW NER (A s show n on c ertifi cate o f airc raft r egistr ation) V. FAA
REPRESENTATIV E
CERTIFICATION I. AIRCRAFT DESCRIPTIONIII. OWNER'S CERTIFICATION IV. INSPECTIO N AGENCY
VERIFI CATIO N A B X STANDARD AIRW ORTHINESS CERTIFICATE (Indicate category) SPECIAL AIR W ORTHINESS CERTIFICATE (Check approp riate item s)
1. REGISTR ATION MARK N65 4GL APPLICAT ION IS H EREBY MA DE FOR: (Check a pplicabl e item s)
2. AIRCRAFT BU ILDER'S NAME (M ake) N ight FAA CODING3. AIRCRAFT MODEL DESIGNATION N7-xray
4. YR. M FR.
19 96
7. ENGINE MODEL DE SIGNATION 1 0-36 0-ES
10. PRO PELLER MODEL DESIG NATION 2A 34C 209 IM PORT
11. AIRC RAFT IS (Check if appl icable) DATE DISTRICT OFFICE DESIGNEE'S SIG NATURE AND NO. FAA INSPECTOR 'S SIGNATURE (Check ALL appli cable bloc ks in item s A a nd B) A. I fin d th at t he a ircr aft desc ribe d in Sec tion I o r VI I me ets requ irem ents for X X NAME Ma ry Te st
ADDRESS 78 Chin a Drive Jumpi ng, Te xas 89 765 B. AIRCRA FT CE RTIFI CATIO N BAS IS (C heck appli cable bloc ks an d com plete item s as indic ated) X C. AIRCRAFT OPERATION AND MAINTENANCE RECORDS
CHECK IF RECORDS IN
COMPLIANCE WITH 14 CF R se ctio n 91 .417
TOTAL AIRFRAME HOURS
2.2 3
DATE OF APPLICATION 11/2 5/ 96 D. CERTIFICATION - I hereby certify that I am the regi ster ed o wner (or his age nt) of t he a ircr aft desc ribe d ab ove, tha t th e ai r cra ft i s re gist ered wit h th e Fe dera l Av iati on A dmin istr atio n in acc orda nce with Title 49 of th e U nit ed Sta tes Co de 441 01 et seq. and appli cabl e Fe dera l Av iati on R egul atio ns, and that the air craf t ha s be en i nspe cted and is airw orth y an d el igib le f or t he airwo rthi ness cer tifi cate requ est ed.
A. THE AIRCRAFT DES CRIBED ABOVE HAS B EEN IN SPECTE D AND FOUND AIRW OR THY BY : (Complete this section only if 14 CFR part 21 . 183( d) app lies).
NAM E AND T ITLE (Prin t or type) M ary Tes t, Owner
SIGNATURE
DATE TITLE SIGNATURE INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for FAA use only. Submit origi nal only to an authorized FAA Representative. If additional space is required, use attachment. For special flight permits complete Sections II, VI, and VII as applicable.
B. Insp ecti on f or a spe cial fli ght perm it u nder Sec tion VII wa s c ond uct ed by:
6. ENGINE BUILDER 'S NAME (M ake) TCM
9. PROPELLER BUILDER'S NAME (M ake) M c Cauley
5. AIRCR AFT SER IAL NO.
NX09
8. NUMBER OF ENGINES One
IF DEALER, CHECK HERE AIRCRAFT LISTI NG (Gi ve pag e numb er(s)) N/A SUPPLEMENTAL TYPE CERTIFICAT E (Li st number of each ST C inc orpor ated) N/A AIRCRAFT MANUFACTURER (Give name or firm) U.S. D epa rtm ent of Tr ansp orta tion Federal Aviation Administration Certificate No.)
O.M.B. No. 2120-0018
NORMAL UTILITY ACROBATIC TRANSPORT COMMUTE R BALLOON FAA Form 8130-6 (5-01) Supersedes Previous Edition NSN: 0052-00-024-7006 C MULTIPLE AIR W ORTHINESS CERTIFICATE (Check ABOVE " Restr icted Oper ation " and "Sta ndard " or "Lim i ted" as ap plica ble.)
SPECIAL FLIGHT PERMIT (Indi cate oper ati on to be con duc ted , t hen com ple te S ecti on V I or VII as applica ble o n rev erse side)
LIM ITED PROVIS IONAL (Indicate class) RESTRICTED (Indi cate opera tion( s) to be c ond uct ed)
AGRICULTURE AN D PEST CONTROL FOREST (W ildlife c onservation)
CLAS S I
CLAS S II AERIAL
PATRO LLING
AERIAL ADVER TISING
WEATHER CONTROL
AMATEUR BUILT
CREW TRAINING
EXHIBITION
MARKET SURVEY
DELIVERIN G OR EX PORTING
TO SHOW COMPLIAN CE WITH THE CFR
CUSTOMER DEMONSTRATION FLIGHTS
PRODUCTION FL IGHT TESTING
FERRY FLIGHT FOR R EPAIRS, A LTERATION S, MAINT ENANCE, O R STORAGE
EVACUATE FROM AREA OF IMPE NDING DANGER
OPERATION IN EX CESS OF MAX IMUM CERTIF ICATED TAKE -OFF W EIGHT
RESEA RCH AND D EVELOPMENT AIR RACINGEXPERIM ENTAL (Indica te op erati on(s) to b e c ond uct ed)X OTHER (Specify) OPERATING (Prim ary Category) KIT BUILT AIRCRAFT X
PRIMARY
FAA INSPECTOR 14 CFR par t 65
FAA DE SIGNEE 14 CFR part 121 O R 135 14 CFR pa rt 145
THE CERTIFICA TE REQUESTED
AMENDMENT OR MODIFICATION OF CURRENT AIRW ORTHINESS CERTIFICATE
CERTIFICATE HOLDER UNDER OTHER1 14 3 6 4 2 5 3 4 8 3 6 3 2 5 1 2 4 1 0 1 4 0 7 6 4 3 2 1 5 7 2 5 6 5 2
Appendix 1 FIGURE 14. SAMPLE FAA FORM 8130-6, APPLICATION FOR A SPECIAL AIRWORTHINESS CERTIFICATE – SPECIAL FLIGHT PERMIT FOR FERRY FLIGHT IN
EXCESS OF MAXIMUM TAKE-OFF WEIGHT (FACE SIDE)
APPLICATION FOR
AIRWORTHINESS
CERTIFICATE II. CERTIFICATION REQUESTED EXPERIMEN TAL ONLY (Enter hours flown s ince la st cert ificate CERTIFICATED R EPAIR STATION (Give CertificateCERTIFICATED MECHANIC (Give AIRCRAFT SPECIFICATION O R TYPE CER TIFICATE D ATA SHEET (Give No. and AIRW ORTHINES S DIRECTIVES (Check if all ap plica ble A D's c om pli ed wi th an d giv e the num b er of the last AD SUPP LEM EN T ava ilabl e in the b iweek ly se ries as of the date of ap plica tion) issued or re newed) No.)
Revision No.)
14 CF R part 121 C ERTIFI CATE H OLDER (Give Certificate No.)
A. REGISTE RED OW NER (A s show n on c ertifi cate o f airc raft r egistr ation) V. FAA
REPRESENTATIV E
CERTIFICATION I. AIRCRA FT DE SC RIPTIONIII. OWNER'S CERTIFICATION IV. INSPECTIO N AGENCY
VERIFI CATIO N A B X STANDARD AIRW ORTHINESS CERTIFICATE (Indicate category) SPECIAL AIR W ORTHINESS CERTIFICATE (Check approp riate item s)
1. REGISTR ATION MARK
APPLICAT ION IS H EREBY MA DE FOR: (Check a pplicabl e item s)
2. AIRCRAFT BU ILDER'S NAME (M ake) FAA CODING3. AIRCRAFT MODEL DESIGNATION 4. YR. MFR.
7. ENGINE MODEL DESIGNATION
10. PRO PELLER MODEL DESIG NATION
IM PORT
11. AIRC RAFT IS (Check if appl icable) DATE DISTRICT OFFICE DESIGNEE'S SIG NATURE AND NO. FAA INSPECTOR 'S SIGNATURE (Check ALL appli cable bloc ks in item s A a nd B) A. I fin d th at t he a ircr aft desc ribe d in Sec tion I o r VI I me ets requ irem ents for
NAME ADDRESS B. AIRCRAFT CERTIFICATION BASIS (C heck appli cable bloc ks an d com plete item s as indic ated) C. AIRCRAFT OPERATION AND MAINTENANCE RECORDS
CHECK IF RECORDS IN
COMPLIANCE WITH 14 CF R se ctio n 91 .417
TOTAL AIRFRAME HOURS 3
DATE OF APPLICATION D. CERTIFICATION - I hereby certify that I am the regi ster ed o wner (or his age nt) of t he a ircr aft desc ribe d ab ove, tha t th e ai r cra ft i s re gist ered wit h th e Fe dera l Av iati on A dmin istr atio n in acc orda nce with Title 49 of th e U nit ed Sta tes Co de 441 01 et seq . and appli cabl e Fe dera l Av iati on R egul atio ns, and that the air craf t ha s be en i nspe cted and is airw orth y an d el igib le f or t he airwo rthi ness cer tifi cate requ est ed.
A. THE AIRCRAFT DESCRIBED ABOVE HAS BEEN IN SPECTE D AND FO UND AIRWOR THY BY: (Complete this section only if 14 CFR part 21 . 183( d) app lies).
NAME AND TITLE (Print or type) SIGNATURE
DATE TITLE SIGNATURE INSTRUCTIONS - Print or type. Do not write in shaded areas; these are for FAA use only. Submit origi nal only to an authorized FAA Representative. If additional space is required, use attachment. For special flight permits complete Sections II, VI, and VII as applicable.
B. Insp ecti on f or a spe cial fli ght perm it u nder Sec tion VII wa s c ond uct ed by:
6. ENGINE BUILDER 'S NAME (M ake)
9. PROPELLER BUILDER'S NAME (M ake)
5. AIRCR AFT SER IAL NO.
8. NUMBER OF ENGINES
IF DEALER, CHECK HERE AIRCRAFT LISTING (Give page number(s)) SUPPLEMENTAL TYPE CERTIFICAT E (Li st number of each ST C inc orpor ated) AIRCRAFT MANUFACTURER (Give name or firm) U.S. D epa rtm ent of Tr ansp orta tion Federal Aviation Administration Certificate No.)
O.M.B. No. 2120-0018
NORMAL UTILITY ACROBATIC TRANSPORT COMMUTE R BALLOON FAA Form 8130-6 (5-01) Supersedes Previous Edition NSN: 0052-00-024-7006 C MULTIPLE AIR W ORTHINESS CERTIFICATE (Check ABOVE " Restr icted Oper ation " and "Sta ndard " or "Lim i ted" as ap plica ble.)
X
SPECIAL FLIGHT PERMIT (Indi cate oper ati on to be con duc ted , t hen com ple te S ecti on V I or VII as applica ble o n rev erse side)
LIM ITED PROVIS IONAL (Indicate class) RESTRICTED (Indi cate opera tion( s) to be c ond uct ed)
AGRICULTURE AN D PEST CONTROL FOREST (W ildlife c onservation)
CLAS S I
CLAS S II AERIAL
PATROLLING
AERIAL ADVER TISING
WEATHER CONTROL
AMATEUR BUILT
CREW TRAINING
EXHIBITION
MARKET SURVEY
DELIVERIN G OR EX PORTING
TO SHOW COMPLIAN CE WITH THE CFR
CUSTOMER DEMONSTRATION FLIGHTS
PRODUCTION FLIGHT TESTING X
FERRY FLIGHT FOR R EPAIRS, A LTERATION S, MAINT ENANCE, O R STORAGE
EVACUATE FROM AREA OF IMPENDING DANGER
OPERATION IN EX CESS OF MAX IMUM CERTIF ICATED TAKE -OFF W EIGHT
RESEA RCH AND D EVELOPMENT AIR RACINGEXPERIM ENTAL (Indica te op erati on(s) to b e c ond uct ed) OTHER (Specify) OPERATING (Primary Category) KIT BUILT AIRCRAFT
PRIMARY
FAA INSPECTOR 14 CFR par t 65
FAA DE SIGNEE 14 CFR part 121 O R 135 14 CFR pa rt 145
THE CERTIFICA TE REQUESTED
AMENDMENT OR MODIFICATION OF CURRENT AIRWORTHIN ESS CERTIFICATE
CERTIFICATE HOLDER UNDER OTHER1 14 3 6 4 2 5 3 4 8 3 6 3 2 5 1 2 4 1 0 1 4 0 7 6 4 3 2 1 5 7 2 5 6 5 2