Appendix A Appendix A. Example of Commercial Parts List STC # ST12345SE
COMMERCIAL PARTS LIST Affected Aircraft Type, Boeing Model 737-300 November 18, 2011 Revision #2 Article Article Manufacturer Electrical Specification Number Nomenclature Name Power sheet ABC1 – DIM 10203040 12345678 91827364 98765432 Light Dimmer Cabin Reading Light Bulb Curtain Rings Bathroom Door Hinge Sink Valve ACE Lighting Acme Electronics Acme Home Acme Bath Acme Kitchen Yes Yes No No No Yes Yes No Yes Yes
REVISION HISTORY Article Number Revision Date Revision Level Comment Article Added 91827364 10203040 October 21, 2011 November 18, 2011
(1)
(1)
(2) Article Deleted ABC9876 October 21, 2011 (1) No longer CP Superseded by A/D #123 Article Changed 12345678 November 18, 2011 (2) Nomenclature changed A-1
Hot (Blaek) Lina 120VAC, or 2nVAC 60Hz Whilo Noutr.al (Wh ita) I· "!
a, ex, ;;;- cl; (0 ,.;
:::::. e e ~ a, «> N ..,: ,.; ,.;
a Dimmer
1.75 (44.9) ~1 $ -EEi, - ~ i~ - ~ - EEi, $ I Lino 120VAC, ar277VAC , 60H.Z l N ut"'I (White) Matching Remote (with LEDs)
10/5/2010 D R A F T AC 21-45 Appendix B Appendix B. Example of Specification Sheet ABC Commercial Grade Light Controls Specification Sheet
ACCEPTABLE
MANUFACTURERS ACE Lighting Charlie Switches Delta Accessories ARTICLE NUMBER ABC1 – DIM XYZ2 – ON DD3 - SLIDE MATERIAL Plastic Aluminum Plastic RATING 600W-120VAC 400W-120 VAC 600W-120VAC STANDARDS UL 1472 UL Listed #41307 FCC Part 15 Class B NOM-057 UL 1472 UL Listed #41307 MIL. STD 105 ANSI Z1.4 UL 1472 UL Listed #41307 IEC Level 4 Surge CSA Certified #LR- 67412 DIMENSIONS As shown in diagram As shown in diagram As shown in diagram WEIGHT 1.2 Lbs 0.98 Lbs 1.3 Lbs
ADDITIONAL NOTES Must meet Class 1AA insulation requirement Must meet Class 1AA insulation requirement Must meet Class 1AA insulation requirement B-1
D D 10/5/2010 D R A F T AC 21-45 Appendix C Appendix C. Example of FAA Form 8110- 3 Statement of Compliance with the Federal Aviation Regulations Used for a Replacement Alternative Approval U.S. DEARTICLEMENT OF TRANSPORTATION
FEDERAL AVIATION ADMINISTRATION
STATEMENT OF COMPLIANCE WITH THE FEDERAL AVIATION REGULATIONS DATE November 18, 2010
AIRCRAFT OR AIRCRAFT COMPONENT IDENTIFICATION MAKE ABC (Aircraft Manufacturer) MODEL NO.
ABC 700-300 Aircraft TYPE (Airplane, Radio, Helicopter, etc.)
Airplane
NAME OF APPLICANT Joe’s Repair Shop
LIST OF DATA
IDENTIFICATION TITLE DEF Co.
BDP-S350 XYZ Inc.
LN22A650
- - -END- - - DEF Co. Cook top replaces 123 Cook top XYZ Oven replaces 789 Oven
PURPOSE OF DATA In support of a major alteration for S/N 123 under 14 CFR § 21.9(a)(4) for a replacement alternative.
APPLICABLE REQUIREMENTS (List specific sections) 14 CFR § 25.1365 (Insert all applicable airworthiness requirements and include amendment level) CERTIFICATION – Under authority vested by direction of the Administrator and in accordance with conditions and limitations of appointment under Article 183 of the Federal Aviation Regulations, data listed above and on attached sheets numbered N/A have been examined in accordance with established procedures and found to comply with applicable requirements of the Federal Aviation Regulations.
I (We) Therefore Recommend approval of these data X Approve these data
SIGNATURE(S) OF DESIGNATED ENGINEERING
REPRESENTATIVE(S)
DESIGNATION
NUMBER(S)
CLASSIFICATION(S) Joe Smith DERT-999999-NM Joe Smith C-1