Application for Establishment or Use of Temporary Heliport

gaca_gov_sa · form · processed · 4 chunks

GACA
(اللغه العربيه)
Bureau Authority of Civil Aviation
APPLICATION FOR ESTABLISHMENT OR USE OF TEMPORARY HELIPORT
<table><tr><td>ITEM S. No</td><td>DATA DESCRIPTION</td><td colspan="2">INFORMATION(Information to be filled by the Applicant/Operator)</td></tr><tr><td>1.0</td><td colspan="3">DETAILS OF APPLICANT/HELIPORT OPERATOR</td></tr><tr><td>1.1</td><td>Full name of Applicant/Operator</td><td colspan="2"></td></tr><tr><td>1.2</td><td>Address of Applicant/Operator</td><td colspan="2"></td></tr><tr><td>1.3</td><td>Nationality of the Applicant/Operator</td><td colspan="2"></td></tr><tr><td>1.4</td><td>Telephone and Email of Applicant/Operator</td><td colspan="2">Email/Mobile: /</td></tr><tr><td>1.5</td><td>Name and Details of the Focal Point Person</td><td colspan="2">Name: Email/Mobile: /</td></tr><tr><td>1.6</td><td>Name and Details of the Accountable Executive</td><td colspan="2">Name: Email/Mobile: /</td></tr><tr><td rowspan="2">2.0</td><td rowspan="2">APPROVAL/PERMISSIONS/NO OBJECTION</td><td colspan="2">Copy Attached</td></tr><tr><td>Yes</td><td>No Reasons if not attached)</td></tr><tr><td>2.1</td><td>Heliport Ownership or Heliport Lease Agreement or Heliport Operation Authorization</td><td>□</td><td>□</td></tr><tr><td>2.2</td><td>Approval for the heliport site or permission of heliport operation from Principality/Ports Authority</td><td>□</td><td>□</td></tr><tr><td>2.3</td><td>No-Objection Certificate or Agreement Letter from SANS (Attach NOC/Agreements copy)</td><td>□</td><td>□</td></tr><tr><td>3.0</td><td>DETAILS OF TEMPORARY HELIPORT</td><td colspan="2">INFORMATION(Information to be filled by the Applicant/Operator)</td></tr><tr><td>3.1</td><td>Heliport Name that will be used for establishment/Use</td><td colspan="2"></td></tr><tr><td>3.2</td><td>Location of the proposed heliport site (Area/City/Ship)</td><td colspan="2"></td></tr><tr><td>3.3</td><td>Probable Hours and Days of operations</td><td colspan="2"></td></tr><tr><td>3.4</td><td>Reference Point Coordinates of Temporary heliport/Site</td><td colspan="2">Latitude: ° &#x27; &#x27;&#x27; N;. Longitude: ° &#x27; &#x27;&#x27; E.</td></tr><tr><td>3.5</td><td>Type of Use (Mark X)</td><td>Public Heliport □</td><td>General Aviation Heliport □</td></tr><tr><td>3.6</td><td>Type of Heliport (Mark X)</td><td>Surface □ Elevated □ Helideck □ Shipboard □</td><td></td></tr><tr><td>3.7</td><td>Type of proposed operations (Mark X)</td><td>VFR □ Night VFR □ IFR □ PinS Approach □</td><td></td></tr><tr><td>4.0</td><td>DETAILS OF INTENDED OR CRITICAL DESIGN HELICOPTER</td><td colspan="2">INFORMATION(Information to be filled by the Applicant/Operator)</td></tr><tr><td>4.1</td><td>Helicopter Model/Make</td><td></td><td></td></tr><tr><td>4.2</td><td>Maximum Length (D)</td><td></td><td></td></tr><tr><td>4.3</td><td>Rotor Diameters (RD)</td><td></td><td></td></tr><tr><td>4.4</td><td>Maximum Take-Off Mass (MTOM)</td><td></td><td></td></tr><tr><td>4.5</td><td>Length and width of under carriage (UCL and UCW)</td><td></td><td></td></tr><tr><td>4.6</td><td>Performance Class of Helicopter operations (PC-1/2/3)</td><td></td><td></td></tr><tr><td>5.0</td><td>HELIPORT PHYSICAL CHARACTERISTICS AND VISUAL AIDS</td><td colspan="2">INFORMATION(Information to be filled by the Applicant/Operator)</td></tr><tr><td>5.1</td><td>Heliport FATO Orientation</td><td></td><td></td></tr><tr><td>5.2</td><td>FATO (Dimensions/Slope/Surface)</td><td></td><td></td></tr><tr><td>5.3</td><td>TLOF (Dimensions/Slope/Surface)</td><td></td><td></td></tr><tr><td>5.4</td><td>Details of helicopter parking stands, if provided</td><td></td><td></td></tr><tr><td>5.5</td><td>Details and description of Markings and Markers</td><td></td><td></td></tr><tr><td>5.6</td><td>Details and description of Lighting, if provided</td><td></td><td></td></tr><tr><td>5.7</td><td>Details and description of Wind Direction Indicator</td><td></td><td></td></tr><tr><td>5.8</td><td>Type of Pavement Surface (Asphalt/PCC/Metal/Grass)</td><td></td><td></td></tr><tr><td>6.0</td><td>HELIPORT OPERATION REQUIREMENTS(RESCUE AND FIRE FIGHTING SERVICES)</td><td colspan="2">INFORMATION(To be filled/provided by the Applicant/Operator)</td></tr><tr><td>6.1</td><td>Category of RFF (H0/H1/H2/H3/H4)</td><td></td><td></td></tr><tr><td>6.2</td><td>Type and Capacity of Extinguisher agents</td><td></td><td></td></tr></table>
GACA_AVS_AGA_F-138-108_V2.0 (06-September-2021)
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<table><tr><td>6.3</td><td>Capacity of Water/Foam/Hydrant System</td><td colspan="3"></td></tr><tr><td>6.4</td><td>Details of rescue equipment&#x27;s</td><td colspan="3"></td></tr><tr><td>6.5</td><td>Emergency Response Time</td><td colspan="3"></td></tr><tr><td>6.6</td><td>Provisions of Security Arrangements/Program</td><td colspan="3"></td></tr><tr><td rowspan="2">7.0</td><td rowspan="2">MANDATORY TECHNICAL SUBMISSIONS (Attach Report Copy)</td><td colspan="2">Report Copy Attached</td><td rowspan="2">Provide Ref of Attached documents here (Give Reasons if not attached)</td></tr><tr><td>Yes</td><td>No</td></tr><tr><td>7.1</td><td>Risk Assessment Study</td><td></td><td></td><td></td></tr><tr><td>7.2</td><td>Heliport Layout Plan with dimensions</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 hereby testify that the heliport is suitable and safe in terms of physical and operational characteristics for the intended type of helicopter operations.
3. We hereby undertake the responsibility to conduct heliport operations as per the GACA Regulations.
(....)
Signature of Heliport Operator/Accountable Executive
Name: ....
Date: ....
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GACA_AVS_AGA_F-138-108_V2.0 (06-September-2021)
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