040-application-for-certification-or-authorization-of-heliports-part 138

gaca_gov_sa · form · processed · 6 chunks
document_type=form entity=format:application/pdf entity=language:ar language=en taxonomy_l1=transport taxonomy_l2=aviation taxonomy_l3=airport_operations validity=valid validity_confidence=0.6
GACA
ال necesita theorems للعلوم والتقنيه
General Authority of Civil Aviation
[Non-Text]
APPLICATION FOR CERTIFICATION OR AUTHORIZATION OF HELIPORTS
(GACAR PART 138)
<table><tr><td>ITEM S. No</td><td>DATA DESCRIPTION</td><td colspan="3">INFORMATION(Information to be filled with by the Applicant/Operator)</td></tr><tr><td rowspan="2">1.0</td><td rowspan="2">APPLICATION REQUIREMENT(Mark X in one of the options)</td><td colspan="2">Certification</td><td>Authorization</td></tr><tr><td>□ Initial</td><td>□ Re-issuance</td><td>□ Initial □ Re-issuance</td></tr><tr><td>2.0</td><td colspan="4">DETAILS OF APPLICANT OR HELIPORT OPERATOR</td></tr><tr><td>2.1</td><td>Full name of Applicant/Operator</td><td colspan="3"></td></tr><tr><td>2.2</td><td>Address of Applicant/Operator</td><td colspan="3"></td></tr><tr><td>2.3</td><td>Nationality of the Applicant/Operator</td><td colspan="3"></td></tr><tr><td rowspan="2">2.4</td><td rowspan="2">Telephone and Email of Applicant/Operator</td><td>Tel/Mobile</td><td colspan="2"></td></tr><tr><td>E-Mail</td><td colspan="2"></td></tr><tr><td rowspan="3">2.5</td><td rowspan="3">Name and Details of the Focal Point Person</td><td>Name</td><td colspan="2"></td></tr><tr><td>Tel/Mobile</td><td colspan="2"></td></tr><tr><td>E-Mail</td><td colspan="2"></td></tr><tr><td rowspan="3">3.0</td><td colspan="4">APPROVAL/ AGREEMENT/ NO OBJECTION</td></tr><tr><td rowspan="2"></td><td colspan="2">Copy Attached</td><td rowspan="2">Reasons if not attached/Remarks</td></tr><tr><td>Yes</td><td>No</td></tr><tr><td>3.1</td><td>Heliport Land Ownership proof or Lease Agreement (Attach copy)</td><td>□</td><td>□</td><td></td></tr><tr><td>3.2</td><td>Approval or NOC for the heliport from Principality or Municipality (Attach approval copy)</td><td>□</td><td>□</td><td></td></tr><tr><td>3.3</td><td>Agreement Letter or No-Objection from SANS (Attach copy of Agreement/NOC)</td><td>□</td><td>□</td><td></td></tr><tr><td>3.4</td><td>Environmental permit from National Center of Environmental Compliance (Attach permit copy)</td><td>□</td><td>□</td><td></td></tr><tr><td>3.5</td><td>Permission of Heliport Establishment from President of GACA, if available (Attach Copy)</td><td>□</td><td>□</td><td></td></tr><tr><td>4.0</td><td colspan="3">HELIPORT DATA</td><td></td></tr><tr><td>4.1</td><td>Heliport Name/Heliport ID Code</td><td colspan="2"></td><td></td></tr><tr><td>4.2</td><td>Location of the heliport site (Area/City)</td><td colspan="2"></td><td></td></tr><tr><td>4.3</td><td>Name of the nearby airport to the heliport site</td><td colspan="2"></td><td></td></tr><tr><td>4.4</td><td>Heliport Classification (Mark X in applicable box)</td><td colspan="2">□ Public Heliport</td><td>□ General Aviation Heliport</td></tr><tr><td>4.5</td><td>Type of Heliport (Mark X in applicable box)</td><td>□ Surface</td><td>□ Elevated</td><td>□ Helideck □ Shipboard</td></tr><tr><td>4.6</td><td>Type of Operations (Mark X in applicable box)</td><td>□ VFR</td><td>□ Night VFR</td><td>□ IFR □ PinS Approach</td></tr><tr><td>4.7</td><td>Heliport proposed Operation Hours (From To )</td><td colspan="3"></td></tr><tr><td>4.8</td><td>Probable date of start of Heliport Operation</td><td colspan="3"></td></tr><tr><td>4.9</td><td>Type of Pavement Surface (Asphalt/PCC/Metal/Grass)</td><td colspan="3"></td></tr><tr><td>4.10</td><td>Type of Load Bearing (Dynamic or Static)</td><td colspan="3"></td></tr><tr><td>4.11</td><td>Heliport FATO Orientation</td><td colspan="3"></td></tr></table>
GACA-AVSES-AGA-F040
Rev: 6, Date: 28 Apr 26
Page 1 of 5

GACA
العلنيه العامه للطيران المدني
General Authority of Civil Aviation
[Non-Text]
APPLICATION FOR CERTIFICATION OR AUTHORIZATION OF HELIPORTS
(GACAR PART 138)
<table><tr><td>4.12</td><td>Heliport FATO Usability Factor (%)</td><td colspan="3"></td></tr><tr><td>4.13</td><td>Geodetic Coordinates of Heliport (WGS 84)</td><td colspan="3"></td></tr><tr><td>4.13.1</td><td>Heliport Reference Point Data</td><td colspan="3"></td></tr><tr><td>4.13.2</td><td>Heliport Elevation Data</td><td colspan="3"></td></tr><tr><td>4.13.3</td><td>Helicopter Stands Reference Data</td><td colspan="3"></td></tr><tr><td>4.13.4</td><td>MAG VAR/Annual change</td><td colspan="3"></td></tr><tr><td>4.14</td><td>Heliport Declared Distance</td><td colspan="3"></td></tr><tr><td>4.14.1</td><td>Landing Distance Available (LDAH)</td><td colspan="3"></td></tr><tr><td>4.14.2</td><td>Take-Off Distance Available (TODAH)</td><td colspan="3"></td></tr><tr><td>4.14.3</td><td>Rejected Take-Off Distance Available (RTODAH)</td><td colspan="3"></td></tr><tr><td>5.0</td><td colspan="4">DETAILS OF CRITICAL HELICOPTER (Attach manufacturer helicopter manual-HFM)</td></tr><tr><td>5.1</td><td>Helicopter Model/Type</td><td colspan="3"></td></tr><tr><td>5.2</td><td>Maximum Length (D in meters)</td><td colspan="3"></td></tr><tr><td>5.3</td><td>Rotor Diameters (RD in meters)</td><td colspan="3"></td></tr><tr><td>5.4</td><td>Maximum Take-Off Mass (MTOM in Kgs)</td><td colspan="3"></td></tr><tr><td>5.5</td><td>Length and width of under carriage (UCL and UCW)</td><td colspan="3"></td></tr><tr><td>5.6</td><td>Performance Class of Helicopter operations (PC-1/2/3)</td><td colspan="3">☐ PC 1 ☐ PC 2 ☐ PC 3</td></tr><tr><td>6.0</td><td colspan="4">HELIPORT PHYSICAL CHARACTERISTICS AND VISUAL AIDS</td></tr><tr><td>6.1</td><td>FATO (Dimensions/Slope/Surface)</td><td colspan="3"></td></tr><tr><td>6.2</td><td>TLOF (Dimensions/Slope/Surface)</td><td colspan="3"></td></tr><tr><td>6.3</td><td>Safety Area (Dimensions/Slope/Surface)</td><td colspan="3"></td></tr><tr><td>6.4</td><td>Clearway (Dimensions/Slope)</td><td colspan="3"></td></tr><tr><td>6.5</td><td>Taxiway (Dimensions/Slope/Surface)</td><td colspan="3"></td></tr><tr><td>6.6</td><td>Helicopter Stands (Dimensions/Slope/Surface)</td><td colspan="3"></td></tr><tr><td>6.7</td><td>Wind Direction Indicator (Location/Dimensions)</td><td colspan="3"></td></tr><tr><td>6.8</td><td>Details of Markings and Markers (Attach Drawings) (Mark X in appropriate Check Box)</td><td>Provided</td><td>Not Provided/Applicable</td><td>Give Reasons if Not Provided/Applicable. (Give Ref No of Drawing Here)</td></tr><tr><td>6.8.1</td><td>Heliport Identification Marking</td><td>☐</td><td>☐</td><td></td></tr><tr><td>6.8.2</td><td>Maximum Allowable Mass Marking</td><td>☐</td><td>☐</td><td></td></tr><tr><td>6.8.3</td><td>D-Value Marking</td><td>☐</td><td>☐</td><td></td></tr><tr><td>6.8.4</td><td>FATO Dimension(s) Marking</td><td>☐</td><td>☐</td><td></td></tr><tr><td>6.8.5</td><td>FATO Perimeter Marking</td><td>☐</td><td>☐</td><td></td></tr><tr><td>6.8.6</td><td>FATO Perimeter Markers</td><td>☐</td><td>☐</td><td></td></tr><tr><td>6.8.7</td><td>FATO Designation Marking (Runway type FATO)</td><td>☐</td><td>☐</td><td></td></tr></table>
GACA-AVSES-AGA-F040
Rev: 6, Date: 28 Apr 26
Page 2 of 5

GACA
الهييه العامه للطيران المدني
General Authority of Civil Aviation
[Non-Text]
APPLICATION FOR CERTIFICATION OR AUTHORIZATION OF HELIPORTS
(GACAR PART 138)
<table><tr><td>6.8.8</td><td>Aiming Point Marking</td><td>□</td><td>□</td><td></td></tr><tr><td>6.8.9</td><td>TLOF Perimeter Marking</td><td>□</td><td>□</td><td></td></tr><tr><td>6.8.10</td><td>Touchdown Position Marking</td><td>□</td><td>□</td><td></td></tr><tr><td>6.8.11</td><td>Heliport Name Marking</td><td>□</td><td>□</td><td></td></tr><tr><td>6.8.12</td><td>Helicopter Ground Taxiway Marking and Markers</td><td>□</td><td>□</td><td></td></tr><tr><td>6.8.13</td><td>Helicopter Air Taxiway Marking and Markers</td><td>□</td><td>□</td><td></td></tr><tr><td>6.8.14</td><td>Helicopter Stand Markings</td><td>□</td><td>□</td><td></td></tr><tr><td>6.8.15</td><td>Flight Path Alignment Guidance Markings</td><td>□</td><td>□</td><td></td></tr><tr><td>6.8.16</td><td>Obstacle Denoting Marking</td><td>□</td><td>□</td><td></td></tr><tr><td>6.8.17</td><td>Helideck Obstacle Free Sector Marking</td><td>□</td><td>□</td><td></td></tr><tr><td>6.8.18</td><td>Helideck and Shipboard Heliport Surface Marking</td><td>□</td><td>□</td><td></td></tr><tr><td>6.8.19</td><td>Helideck Prohibited Landing Sector Markings</td><td>□</td><td>□</td><td></td></tr><tr><td>6.8.20</td><td>Winching Area Marking, in case of shipboard heliport</td><td>□</td><td>□</td><td></td></tr><tr><td>6.9</td><td>Details of Heliport Lighting (Attach Drawings) (Mark X in appropriate Check Box)</td><td>Provided</td><td>Not Provided/Applicable</td><td>Give Reasons if Not Provided/Applicable. (Give Ref No of Drawing Here)</td></tr><tr><td>6.9.1</td><td>Wind Direction Indicator</td><td>□</td><td>□</td><td></td></tr><tr><td>6.9.2</td><td>Heliport Beacon</td><td>□</td><td>□</td><td></td></tr><tr><td>6.9.3</td><td>Approach Lighting System</td><td>□</td><td>□</td><td></td></tr><tr><td>6.9.4</td><td>Flight Path Alignment Guidance Lighting System</td><td>□</td><td>□</td><td></td></tr><tr><td>6.9.5</td><td>Visual Alignment Guidance System</td><td>□</td><td>□</td><td></td></tr><tr><td>6.9.6</td><td>Visual Approach Slope Indicator</td><td>□</td><td>□</td><td></td></tr><tr><td>6.9.7</td><td>FATO Lighting System</td><td>□</td><td>□</td><td></td></tr><tr><td>6.9.8</td><td>TLOF Lighting System</td><td>□</td><td>□</td><td></td></tr><tr><td>6.9.9</td><td>Aiming Point Lights</td><td>□</td><td>□</td><td></td></tr><tr><td>6.9.10</td><td>Flood Lighting System</td><td>□</td><td>□</td><td></td></tr><tr><td>6.9.11</td><td>ASPSL or LP Lighting</td><td>□</td><td>□</td><td></td></tr><tr><td>6.9.12</td><td>Flood Lighting of Obstacle</td><td>□</td><td>□</td><td></td></tr><tr><td>6.9.13</td><td>Obstacle Identification Lighting</td><td>□</td><td>□</td><td></td></tr><tr><td>6.9.14</td><td>Winching Area Flood Lighting, if shipboard heliport</td><td>□</td><td>□</td><td></td></tr><tr><td>7.0</td><td colspan="4">OBSTACLE LIMITATION SURFACES (Attach Drawing)</td></tr><tr><td>7.1</td><td>FATO Approach Surfaces (Dimensions, Divergence &amp; Slopes)</td><td colspan="3"></td></tr><tr><td>7.2</td><td>FATO Take-off Climb Surfaces (Dimensions, Divergence &amp; Slopes)</td><td colspan="3"></td></tr></table>
GACA-AVSES-AGA-F040
Rev: 6, Date: 28 Apr 26
Page 3 of 5

GACA
العلنيه العامه للطيران المدني
General Authority of Civil Aviation
[Non-Text]
APPLICATION FOR CERTIFICATION OR AUTHORIZATION OF HELIPORTS
(GACAR PART 138)
<table><tr><td>7.3</td><td>FATO Transitional Surfaces (Dimensions &amp; Slopes)</td><td colspan="3"></td></tr><tr><td>7.4</td><td>Details, type and height of the Obstacles, if any</td><td colspan="3"></td></tr><tr><td>7.5</td><td>Location reference point data of the Obstacles, if any</td><td colspan="3"></td></tr><tr><td>8.0</td><td colspan="4">DETAILS OF RESCUE AND FIRE FIGHTING SERVICES (RFFS)</td></tr><tr><td>8.1</td><td>Category of RFFS (H0/H1/H2/H3/H4)</td><td colspan="3"></td></tr><tr><td>8.2</td><td>Type and Capacity of Extinguisher agents</td><td colspan="3"></td></tr><tr><td>8.3</td><td>Available Capacity of Water/Foam/Hydrant System</td><td colspan="3"></td></tr><tr><td>8.4</td><td>Details of rescue equipment&#x27;s</td><td colspan="3"></td></tr><tr><td>8.5</td><td>Response Time</td><td colspan="3"></td></tr><tr><td>9.0</td><td colspan="4">DETAILS OF OTHER HELIPORT FACILITIES</td></tr><tr><td>9.1</td><td>ATC Facility</td><td colspan="3"></td></tr><tr><td>9.2</td><td>MET Facility</td><td colspan="3"></td></tr><tr><td>9.3</td><td>Fueling Facility</td><td colspan="3"></td></tr><tr><td>9.4</td><td>Drainage System</td><td colspan="3"></td></tr><tr><td>9.5</td><td>Security Fence and Access Control</td><td colspan="3"></td></tr><tr><td>9.6</td><td>Power Supply System including Standby Power</td><td colspan="3"></td></tr><tr><td>9.7</td><td>Heliport Approach/Access Road/City Connectivity</td><td colspan="3"></td></tr><tr><td>9.8</td><td>Any other Facility</td><td colspan="3"></td></tr><tr><td rowspan="3">10.0</td><td colspan="4">For Heliports Established after obtaining the Permission from the President of GACA (Submit documents from 10.1 to 10.6)</td></tr><tr><td rowspan="2"></td><td colspan="2">Documents Attached</td><td rowspan="2">Give Reasons if Not Provided/Applicable. (Give Ref No of document Here)</td></tr><tr><td>Yes</td><td>No</td></tr><tr><td>10.1</td><td>Heliport Operation Manual (Customized if Authorization)</td><td>☐</td><td>☐</td><td></td></tr><tr><td>10.2</td><td>Safety Management Manual/Procedures, as applicable</td><td>☐</td><td>☐</td><td></td></tr><tr><td>10.3</td><td>Heliport Emergency Plan, as applicable</td><td>☐</td><td>☐</td><td></td></tr><tr><td>10.4</td><td>Heliport Security Manual/Procedures, as applicable</td><td>☐</td><td>☐</td><td></td></tr><tr><td>10.5</td><td>Statement of GACA Regulation Compliance (Form: ASD-138-102)</td><td>☐</td><td>☐</td><td></td></tr><tr><td>10.6</td><td>Nomination Forms of Heliport Management Personnel (Form No: ASD-138-104)</td><td>☐</td><td>☐</td><td></td></tr><tr><td rowspan="3">11.0</td><td colspan="4">For Heliports Established without obtaining the Permission from the President of GACA (Submit documents from 10.1 10.6 and also Documents from 11.1 to 11.5)</td></tr><tr><td rowspan="2"></td><td colspan="2">Copy Attached</td><td rowspan="2">Give Reasons if Not Provided/Applicable. (Give Ref No of document Here)</td></tr><tr><td>Yes</td><td>No</td></tr><tr><td>11.1</td><td>Obstacle Limitation Surfaces Survey Report</td><td>☐</td><td>☐</td><td></td></tr><tr><td>11.2</td><td>Aeronautical Study Report, if applicable</td><td>☐</td><td>☐</td><td></td></tr></table>
GACA-AVSES-AGA-F040
Rev: 6, Date: 28 Apr 26
Page 4 of 5

GACA
ال necesita للطيران المدني
General Authority of Civil Aviation
[Non-Text]
APPLICATION FOR CERTIFICATION OR AUTHORIZATION OF HELIPORTS
(GACAR PART 138)
<table><tr><td>11.3</td><td>Aeronautical/Topographical Area Map of Area 2 and 3 showing all obstacles.</td><td>☐</td><td>☐</td><td></td></tr><tr><td>11.4</td><td>Heliport Design Report with General Layout</td><td>☐</td><td>☐</td><td></td></tr><tr><td>11.5</td><td>Any other relevant documents</td><td>☐</td><td>☐</td><td></td></tr></table>
1. We hereby certify that the forgoing information is correct in every respect and no relevant information has been withheld.
2. We have read the requirements and the provisions prescribed in GACAR Part 138 and other associated GACARs.
<table><tr><td>Signature of Applicant / Accountable Executive</td><td>Name</td></tr><tr><td></td><td></td></tr><tr><td></td><td></td></tr><tr><td>Position held</td><td>Date</td></tr><tr><td></td><td></td></tr></table>
GACA-AVSES-AGA-F040
Rev: 6, Date: 28 Apr 26
Page 5 of 5