005-application-for-establishment-of-new-heliport-part-138

gaca_gov_sa · form · processed · 4 chunks

GACA
العلوميه العامه للطيران المدني
General Authority of Civil Aviation
[Non-Text]
APPLICATION FOR ESTABLISHMENT OF NEW HELIPORT
(GACAR PART 138)
<table><tr><td>ITEMS NO.</td><td colspan="2">DATA DESCRIPTOPN</td><td colspan="2">INFORMATION(information to be filled with by the Applicant/Operator)</td></tr><tr><td>1.0</td><td colspan="4">DETAILS OF APPLICANT/HELIPORT OPERATOR</td></tr><tr><td>1.1</td><td>Full name of Applicant/Heliport Operator</td><td colspan="3"></td></tr><tr><td>1.2</td><td>Address of Applicant/Heliport Operator</td><td colspan="3"></td></tr><tr><td>1.3</td><td>Nationality of the Applicant/Heliport Operator</td><td colspan="3"></td></tr><tr><td rowspan="2">1.4</td><td rowspan="2">Telephone and Email of Applicant/Heliport Operator</td><td>Tel/Mobile</td><td colspan="2"></td></tr><tr><td>Email</td><td colspan="2"></td></tr><tr><td rowspan="3">1.5</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>Email</td><td colspan="2"></td></tr><tr><td rowspan="2">2.0</td><td rowspan="2">APPROVALS/PERMISSIONS/NO OBJECTIONS</td><td colspan="2">Copy Attached</td><td rowspan="2">Give Reference for Attached Document Here</td></tr><tr><td>YES</td><td>NO</td></tr><tr><td>2.1</td><td>Heliport Land Ownership or Lease Agreement (Attach Ownership or Agreement copy)</td><td>□</td><td>□</td><td></td></tr><tr><td>2.2</td><td>Approval of the heliport site from Principality (Attach approval copy)</td><td>□</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><td></td></tr><tr><td>3.0</td><td>GENERAL DETAILS OF HELIPORT</td><td colspan="3">INFORMATION(information to be filled with by the Applicant/Operator)</td></tr><tr><td>3.1</td><td>Heliport Name that will be used after establishment</td><td colspan="3"></td></tr><tr><td>3.2</td><td>Location of proposed heliport site (Area/City/Province)</td><td colspan="3"></td></tr><tr><td>3.3</td><td>Name of the nearest airports</td><td colspan="3"></td></tr><tr><td>3.4</td><td>Classification of Heliport (Mark X)</td><td colspan="2">□ Public</td><td>□ General Aviation</td></tr><tr><td rowspan="2">3.5</td><td rowspan="2">Type of Heliport (Mark X)</td><td colspan="2">□ Surface</td><td>□ Elevated</td></tr><tr><td colspan="2">□ Helideck</td><td>□ Shipboard</td></tr><tr><td rowspan="2">3.6</td><td rowspan="2">Type of proposed operations (Mark X)</td><td colspan="2">□ VFR</td><td>□ Night VFR</td></tr><tr><td colspan="2">□ IFR</td><td>□ PinS Approach</td></tr><tr><td>3.7</td><td>Heliport Reference Point Data (WGS 84 Format)</td><td colspan="3"></td></tr><tr><td>3.8</td><td>Heliport Elevation Data</td><td colspan="3"></td></tr><tr><td>3.9</td><td>Probable Date of Completion of the Heliport Project</td><td colspan="3"></td></tr><tr><td rowspan="2">4.0</td><td rowspan="2">TECHNICAL SUBMISSIONS(Attach Report Copy)</td><td colspan="2">Copy Attached</td><td rowspan="2">Give Reference for Attached Document Here</td></tr><tr><td>YES</td><td>NO</td></tr><tr><td>4.1</td><td>Heliport Technical Feasibility Study/Design Report(Must include site selection, last five-year weather data, tabulated wind data, wind rose analysis, approach and take-off climb surfaces, FATO orientation, usability factor, low cloud and local turbulence consideration, master plan with drawings showing physical characteristics, dimensions and visual aids etc.(Ref. GACAR 138 &amp; ICAO Doc 9184-Table 5.1 Fig 5.1)</td><td>□</td><td>□</td><td></td></tr><tr><td>4.2</td><td>Obstacle Limitation Surfaces Survey Report</td><td>□</td><td>□</td><td></td></tr><tr><td>4.3</td><td>Aeronautical Study Report, if applicable</td><td>□</td><td>□</td><td></td></tr><tr><td>4.4</td><td>Heliport Environmental Impact Assessment Report</td><td>□</td><td>□</td><td></td></tr></table>
GACA-AVSES-AGA-F005
Rev: 7, Date: 21 Aug 25
Page 1 of 2

GACA
ال necesita للطيران المدني
General Authority of Civil Aviation
[Non-Text]
APPLICATION FOR ESTABLISHMENT OF NEW HELIPORT
(GACAR PART 138)
<table><tr><td>4.5</td><td>Statement of GACA Regulation Compliance (F138.102)</td><td>□</td><td>□</td><td></td></tr><tr><td>5.0</td><td>DETAILS OF CONSULTANT (If Consultant is appointed for Heliport)</td><td colspan="3">INFORMATION (information to be filled with by the Applicant/Operator)</td></tr><tr><td>5.1</td><td>Name and Address</td><td colspan="3"></td></tr><tr><td rowspan="2">5.2</td><td rowspan="2">Contact Details</td><td>Tel/Mobile</td><td colspan="2"></td></tr><tr><td>Email</td><td colspan="2"></td></tr><tr><td>5.3</td><td>Consultant Entity Acceptance from President of GACA (Attach Copy if consultant acceptance has been granted)</td><td colspan="3"></td></tr><tr><td>6.0</td><td colspan="4">DECLARATION BY THE APPLICANT/OPERATOR</td></tr><tr><td colspan="5">We hereby certify that</td></tr><tr><td>6.1</td><td colspan="4">The forgoing information is correct and complete in every respect and no relevant information has been withheld;</td></tr><tr><td>6.2</td><td colspan="4">We have read GACA Regulation Part 138, and the heliport design complies with all the applicable regulations and shall be constructed as per relevant requirements and provisions in GACAR Part 138. and</td></tr><tr><td>6.3</td><td colspan="4">We understand that the permission of establishment is for construction of the heliport, and we shall apply for authorization or certification of heliport before starting any operations as per GACAR 138 requirements</td></tr><tr><td colspan="2">Signature of Applicant/Heliport Operator</td><td colspan="3">Name</td></tr><tr><td colspan="2"></td><td colspan="3"></td></tr><tr><td colspan="2">Position held</td><td colspan="3">Date</td></tr><tr><td colspan="2"></td><td colspan="3"></td></tr></table>
GACA-AVSES-AGA-F005
Rev: 7, Date: 21 Aug 25
Page 2 of 2