Par 6 Page 7
(3) Item C. Multiple Airworthiness Certificates. These certificates are issued to an applicant in the restricted category and one or more other categories except the primary category. Section 21.187 identifies the requirements an applicant must comply with before multiple airworthiness certificates are issued.
c. Section III. Owner’s Certification. Do not complete this section when application is being submitted for a special flight permit.
(1) Item A. Registered Owner.
(a) Enter the name and address exactly as shown on the aircraft registration certificate.
(Reference part 47.)
(b) If Dealer, Check Here. This block should be checked ONLY if the aircraft is registered under an aircraft dealer’s aircraft registration certificate. (Reference part 47, subpart C.)
(2) Item B. Aircraft Certification Basis.
(a) Aircraft Specification or TCDS and/or Aircraft Listing Block. This item should be completed when an application is submitted for a standard, primary, limited, provisional, restricted, or multiple airworthiness certificates.
(b) When application is submitted for multiple airworthiness certificates, the certification basis for each certificate should be entered.
(c) When a TCDS or specification for a new aircraft or model HAS BEEN APPROVED BUT NOT PUBLISHED, enter the date of approval, TC or specification number, and the word “preliminary.” This item is not applicable when submitting an application for an experimental certificate, therefore, “N/A” should be entered.
(d) Airworthiness Directives. This block should be checked to indicate compliance with all applicable Airworthiness Directives (AD). Enter the number of the last biweekly supplement to the Summary of Airworthiness Directives available as of the date of application. (For example, Biweekly Supplement 97-06 was published on March 24, 1997.)
NOTE: Each AD contains an applicability statement specifying the product to which it applies. Some aircraft owners and operators mistakenly assume that AD’s are not applicable to aircraft certificated in certain categories such as experimental or restricted. AD’s, unless specifically limited apply to the make and model set forth in the applicability statement regardless of category. The type certificate and airworthiness certification categories are used to identify the product affected. (Reference AC 39-7.)
Par 6Page 8
(e) Supplemental Type Certificate (STC). This block is applicable to all standard airworthiness certification; and special airworthiness certification in the restricted, limited, provisional, and primary categories, and should be completed at the time of application. The number of each installed STC should be entered. If more space is required, an attachment may be used.
(Reference part 21, subpart E.)
(3) Item C. Aircraft Operation and Maintenance Records.
(a) Maintenance records shall comply with section 91.417. This block is applicable to all aircraft and should be checked to indicate that the recordkeeping requirements of section 91.417 have been met. For example, section 91.417(a)(2)(i), requires the total service time of the airframe, each engine, propeller, and rotor. Compliance to section 91.417(a)(2)(ii), requires a maintenance record of the current status of life-limited parts of each airframe, engine, propeller, rotor, and appliance. All entries should be written in English and not with erasable materials such as lead/carbon pencils.
(b) Total Airframe Hours. The total service time of the aircraft, including production flight test time, should be entered.
(c) Experimental Only. When submitting an application for renewal of an experimental certificate, or when requesting a change back to a standard certificate, the hours flown since the previous experimental certificate was issued or renewed should be entered. If the application is for an original issuance of an experimental certificate, zero hours should be entered.
(4) Item D. Certification. If the signature is the owner’s agent, a notarized letter from the registered owner authorizing the agent to act on the owner’s behalf is required.
NOTE: The term AIRWORTHY, as stated in FAA Order 8130.2, Airworthiness Certification of Aircraft and Related Products, means (1) the aircraft conforms to its type design and (2) the aircraft is in a condition for safe operation. In the case of an application for an aircraft in the experimental category, only the “AIRCRAFT IS IN A CONDITION FOR SAFE OPERATION” portion of the definition would apply for the purpose of this application.
d. Section IV. Inspection Agency Verification. This section should be completed only if the application is for a standard airworthiness certificate in accordance with section 21.183(d). This section should be left blank for all other certification actions.
e. Section V. FAA Representative Certification. Applicants should not make any entries in this section. This information will be entered by the FAA Inspector/Designee who inspects the aircraft and issues the certificate.
f. Section VI. Production Flight Testing. This section should be completed ONLY BY A MANUFACTURER applying for a special flight permit for the purpose of flight testing production aircraft. (Reference section 21.197(a)(3).)
Par 6 Page 9
g. Section VII. Special Flight Permit Purposes other than Production Flight Test.
(1) Item A. Description of Aircraft. Entries in this section should be the same as the corresponding data recorded on the aircraft’s registration certificate and, as applicable, on the aircraft’s identification plate.
(2) Item B. Description of Flight. Enter the present location of the aircraft in the From box and the aircraft’s intended destination in the To box.
(a) The Via block should contain the name of an airport or city at some intermediate flight point to provide a general description of the route flown. For example, a flight from Kansas City, Missouri to Dallas, Texas may be flown via Wichita, Kansas and Oklahoma City, Oklahoma.
(Reference section 21.199(a)(2).)
(b) The Duration entry should reflect the overall duration of the special flight permit.
Factors such as fueling stops, weather conditions, overnight stops, or any other reasonable condition should be given consideration when establishing the duration. (Reference section 21.199(a)(2).)
(3) Item C. Crew Required to Operate the Aircraft and its Equipment. Self-explanatory.
(4) Item D. The Aircraft Does Not Meet the Applicable Airworthiness Requirements as Follows. This entry should contain in detail the conditions, if any, in which the aircraft does not comply with the applicable airworthiness requirements. (Reference section 21.199(a)(4).)
(5) Item E. The Following Restrictions are Considered Necessary for Safe Operation. This entry should contain in detail any restrictions the applicant considers necessary for safe operation of the aircraft (for example, reduced airspeed or operating weight, turbulence avoidance, crew limitations or qualifications, etc.). After review of the application, the FAA may prescribe additional conditions and/or limitations deemed necessary for safe operation. (Reference section 21.199(a)(5) and (6).)
(6) Item F. Certification. Self-explanatory.
h. Section VIII. Airworthiness Documentation. This section will be completed by the FAA Inspector/Designee who inspects the aircraft and issues the airworthiness certificate, and is not required when the applicant is submitting an application for a special flight permit.
7. INSTRUCTIONS FOR SUBMITTING THE COMPLETED FAA FORM 8130-6. When the applicant has completed the applicable sections and has signed the Form 8130-6, it should be submitted to the local MIDO or FSDO. The nearest MIDO or FSDO location can be determined by referencing the information in paragraph 5 of this AC. Other material may be required by the regulations for the final airworthiness certification. In the case of a manufacturer holding a FAA production approval, an application may be submitted to an authorized Designated Airworthiness Representative or Designated Manufacturing Inspection Representative.
Par 8Page 10
8. HOW TO OBTAIN THE REFERENCED PUBLICATIONS.
a. The CFR and those ACs for which a fee is charged may be obtained from the Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. A listing of the CFR and current prices is located in AC 00-44, Status of Federal Aviation Regulations, and a listing of all ACs is located in AC 00-2, Advisory Circular Checklist.
b. To be placed on the FAA’s mailing list for free ACs, contact: U.S. Department of Transportation, Subsequent Distribution Office, SVC-121.23, Ardmore East Business Center, 3341Q 75th Avenue, Landover, MD 20785.
c. The FAA website at: www.faa.gov.
/S/ Frank P. Paskiewicz Manager, Production and Airworthiness Division, AIR-200
Appendix 1 APPENDIX 1. SAMPLES OF FORM 8130-6, APPLICATION FOR AIRWORTHINESS
CERTIFICATE FIGURE 1. SAMPLE FAA FORM 8130-6, APPLICATION FOR A STANDARD AIRWORTHINESS CERTIFICATE – VERY LIGHT AIRCRAFT PRODUCED UNDER SECTION 21.183(a) (FACE SIDE ONLY)
APPLICATION FOR
AIRWORTHINESS
CERTIFICATE II . CERTIFICATION REQUESTED EXPERIMEN TAL ONLY (Enter hours flown s ince la st certificate CERTIFICATED R EPAIR STATION (Give CertificateCERTI FI CATED MECHANI C (Give AI RCRAFT 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 las t AD SUPPL EM ENT avai lable in the bi weekl y ser ies a s of the d ate o f app lication) 96- 23 issued or re newed) 0 N o.)
Revision No.)
A2W I Rev-1 14 C F R par t 121 C ER T IFIC A TE H O LD ER (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 CERTIFICATION IV. INSPECTION 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 18C E APPLICAT ION IS H EREBY MA DE FOR: (Check a pplicabl e item s)
2. AI RCRAFT BU I LDER'S NAME (M ake) Lite -Fligh t C orp FAA CODI NG3. AI RCRAFT MODEL DESI GNATI ON L F-1-A
4. YR . M FR .
7. ENGINE MODEL DE SIGNATION 912
10. PRO PELLER MODEL DESIG NATION Go od-1 IM POR T
11. AIRC RAFT IS (Check if appl icable) DATE DI STRI CT OFFI CE 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 Lite F light Corp
ADDRESS 1801 Airpo rt Rd W ichi ta, KS 67 209 B. AI RCRAFT CERTI FICATI ON BASI S (C heck appli cable bloc ks an d com plete item s as indic ated) X C. AI RCRAFT OPERATI ON AND MAI NTENANCE RECORDS
CHECK I F RECORDS I N
COMPLI ANCE WI TH 14 CF R se ctio n 91 .417
TOTAL AI RFRAME HOURS
2.0 3
DATE OF APPLICATION 11/2 5/98 D. CERTIFICATION - I hereby certify that I am the regi ster ed o wner (or his age nt) of the 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 w ith Title 49 of th e U nited 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 craft ha s be en i nspe cted and is airw orth y an d el igib le for the a irwo rthi ness cer tifi cate requ ested.
A. THE AI RCRAFT DESCRI BED ABOVE HAS BEEN I N SPECTE D AND FO UND AI RWOR THY BY: (Complet e t his sect ion only if 14 CFR part 21 . 183( d) app lies).
NAME AND TI TLE (Print or t ype) K.D. Go od, D irector 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 for a spe cial fli ght perm it u nder Sec tion VII wa s c ond ucted by:
6. ENGINE BUILDER 'S NAME (M ake) R otax
9. PROPELLER BUI LDER'S NAME (M ake) W o od B uilt
5. AIRCR AFT SER IAL NO.
LF 010
8. NUMBER OF ENGINES One
I F DEALER, CHECK HERE AI RCRAFT LI STING (Give page number(s)) N/ A SUPPLEMENTAL TYPE CERTIFICAT E (Li st number of each ST C inc orpor ated) N/ A AI R CRAFT MANU FACTURER (Give name or f irm) U.S. D epa rtm ent of Tr ansp orta tion Federal Aviation Administration Certificate No.)
OM B. N o. 212 0-0 018
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 , then com ple te S ecti on V I or VII as applica ble o n rev erse side)
LIM ITED PR OVIS ION AL (Indicate class) RESTRI CTED (Indi cate opera tion( s) to be c ond ucted)
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 TRAI NI NG
EXH IBITION
MARKET SURVEY
DELIVERIN G OR EX PORTING
TO SHOW COMPLIAN CE WITH THE CFR
CUSTOMER DEMONSTRATI ON FLI GHTS
PRODUCTI ON FLI GHT TESTI NG
FERRY FLIGHT FOR R EPAIRS, A LTERATION S, MAINT ENANCE, O R STORAGE
EVACUATE FROM AREA OF I MPENDI NG DANGER
OPERATION IN EX CESS OF MAX IMUM CERTIF ICATED TAKE -OFF W EIGHT
RESEA RCH AND D EVELOPMENT AI R RACI NGEXPERIM ENTAL (Indica te op erati on(s) to b e c ond ucted) OTHER (Specify) OPERATING (Prim ary Category) KI T BUI LT AI RCRAFT
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 MODI FI CATI ON OF CURRENT AI RWORTHI N ESS CERTIFICATE
CERTI FI CATE HOLDER UNDER Very Light Aircraft 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 2. SAMPLE FAA FORM 8130-6, APPLICATION FOR A STANDARD AIRWORTHINESS CERTIFICATE – AIRCRAFT PRODUCED IN THE
TRANSPORT 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.)
A16W E 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 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 NI2 345 APPLICAT ION IS H EREBY MA DE FOR: (Check a pplicabl e item s)
2. AIRCRAFT BU ILDER'S NAME (M ake)
B OEING FAA CODING3. AIRCRAFT MODEL DESIGNATION 73 7-20 0
4. YR. M FR.
19 68
7. ENGINE MODEL DESIGNATION JT8D-9
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 Shortha ul A irli nes, Inc
ADDRESS 111 Airpo rt W ay, St L ouis , M i ssou ri 5 8010 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 8: 45 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 Doe , V P O per ati ons
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) Pra tt & W hi tney
9. PROPELLER BUILDER'S NAME (M ake) N/A
5. AIRCR AFT SER IAL NO.
19 714
8. NUMBER OF ENGINES 2
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. 2120-00180
NORMAL UTILITY ACROBATIC X 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 W ITH 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 6 2 5
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