056-mechanics-application-for-inspection-authorization

gaca_gov_sa · form · processed · 1 chunks
document_type=form entity=format:application/pdf entity=language:ar language=en taxonomy_l1=transport taxonomy_l2=aviation taxonomy_l3=aircraft_certification validity=valid validity_confidence=0.6
GACA
الهييه العامه للطيران المدني
General Authority of Civil Aviation
[Non-Text]
MECHANIC'S APPLICATION FOR INSPECTION AUTHORIZATION
<table><tr><td colspan="5">1. Name (Last, first, middle)</td><td colspan="2">2. Mechanic Certificate No.</td></tr><tr><td colspan="5"></td><td colspan="2"></td></tr><tr><td colspan="3">3. Mailing Address(Number, street, City, State/County, ZIP Code) (Place at which you desire to receive Airworthiness Directives, etc.)</td><td colspan="2">4a. Fixed Base Of OperationsPlace At Which You May Be Located In PersonDuring Normal Working Week.</td><td colspan="2">4b. Telephone NoPlace At Which You May Be Located By Telephone During Normal Working Week.</td></tr><tr><td colspan="3"></td><td colspan="2"></td><td colspan="2"></td></tr><tr><td colspan="5">5. Have You Held A Mechanic Certificate With Both Airframe and Powerplant Ratings For The 3 Years Preceding The Date of This Application?</td><td>□ Yes</td><td>□ No</td></tr><tr><td colspan="5">6. Have You Been Actively Engaged, For At Least The 2-Year Period Before The Date Of Application, In Main- Training Aircraft Certificated And Maintained In Accordance With The FARs?</td><td>□ Yes</td><td>□ No</td></tr><tr><td colspan="5">7. Has Your Mechanic Certificate and/or Ratings Been Revoked During The 3-Year Period Preceding This Application?</td><td>□ Yes</td><td>□ No</td></tr><tr><td colspan="5">8. Has An Inspection Authorization Been Denied You Within 90 Days Previous 10 This Application? If Answer Is &#x27;Yes&#x27;, Explain In Remarks.</td><td>□ Yes</td><td>□ No</td></tr><tr><td colspan="5">9. Have You Met The Minimum Requirements For Renewal of Inspection Authorization? (For Renewal Only)</td><td>□ Yes</td><td>□ No</td></tr><tr><td colspan="7">10. Basis For Renewal (Number Performed)</td></tr><tr><td>Alterations</td><td>Repairs</td><td>Annual Inspections</td><td colspan="2">Progressive Inspections</td><td colspan="2">Recent Issuance In Effect Less Than 90 Days Before Expiration Date</td></tr><tr><td></td><td></td><td></td><td colspan="2"></td><td colspan="2"></td></tr><tr><td colspan="7">11. Aircraft Maintenance Activity During Last 2 Years</td></tr><tr><td colspan="2">Dates</td><td colspan="2">Name and Address of Repair Station, Facility, Manufacturer, Operator, Etc.</td><td colspan="3">Description Of Activity</td></tr><tr><td>From</td><td colspan="2"></td><td colspan="2"></td><td colspan="2"></td></tr><tr><td>To Present</td><td colspan="2"></td><td colspan="2"></td><td colspan="2"></td></tr><tr><td>From</td><td colspan="2"></td><td colspan="2"></td><td colspan="2"></td></tr><tr><td>To</td><td colspan="2"></td><td colspan="2"></td><td colspan="2"></td></tr><tr><td>From</td><td colspan="2"></td><td colspan="2" colspan="3"></td></tr><tr><td>To</td><td colspan="2"></td><td colspan="2"></td><td colspan="2"></td></tr><tr><td colspan="7">12. Remarks</td></tr><tr><td colspan="7"></td></tr><tr><td colspan="7">13. Certification: I certify that the statements made above and in all attachments hereto are correct and true.</td></tr><tr><td colspan="2">Date</td><td colspan="5">Signature of Applicant</td></tr><tr><td colspan="2"></td><td colspan="5"></td></tr><tr><td colspan="7">14. Record of Action</td></tr><tr><td colspan="2">□ Issuance</td><td>□ Voluntary Surrender</td><td colspan="2">Inspector Signature</td><td colspan="2">Official Identification</td></tr><tr><td colspan="2">□ Endorsement</td><td>□ Renewal</td><td colspan="2"></td><td colspan="2"></td></tr></table>
GACA-AVSES-AIR-F056
Rev: 3, Date: 14 Sep 25
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