Form AV-2 "Application for Temporary Heliport License" - Pennsylvania

What Is Form AV-2?

This is a legal form that was released by the Pennsylvania Department of Transportation - a government authority operating within Pennsylvania. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2015;
  • The latest edition provided by the Pennsylvania Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form AV-2 by clicking the link below or browse more documents and templates provided by the Pennsylvania Department of Transportation.

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Download Form AV-2 "Application for Temporary Heliport License" - Pennsylvania

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APPLICATION FOR
AV-2 (10-15)
TEMPORARY HELIPORT LICENSE
www penndot gov
APPLICATION FEE: $25
PLEASE TYPE OR PRINT IN BLUE OR BLACK INK
SHADED AREAS ARE FOR BUREAU USE ONLY
APPLICANT INFORMATION
I, (We), hereby make application for license to operate a Heliport and affirm that I am (we are)
DATE
the Owner(s)
Lessee(s)
of the property.
POINT OF CONTACT (if different than Licensee)
NAME OF LICENSEE
EMAIL
DAYTIME PHONE NUMBER
EMAIL
DAYTIME PHONE NUMBER
STREET ADDRESS/P.O. BOX
STREET ADDRESS/P.O. BOX
CITY
STATE
ZIP CODE
STATE
ZIP CODE
CITY
HELIPORT INFORMATION
DATE(S) REQUESTED
PHYSICAL ADDRESS OF HELIPORT (Street/RR/SR)
TOWNSHIP
COUNTY
LATITUDE (Deg.-Min.-Sec.)
LONGITUDE (Deg.-Min.-Sec.)
ALTITUDE ABOVE SEA LEVEL (Ft.)
HELIPORT DIMENSIONS – LANDING AREA (FATO)
DIAMETER*
LENGTH
WIDTH
TYPE SURFACE
APPROACH / DEPARTURE HEADINGS
/
/
1
2
/
/
1
2
HELIPAD DIMENSIONS (TLOF – IF APPLICABLE)
DIAMETER*
LENGTH
WIDTH
TYPE SURFACE
DYNAMIC LOAD CAPACITY
(Elevated/Rooftop Pads Only)
*Diameter only if circular
Is heliport planned for operations at a Fair or event?
YES
NO
If yes, list name of event: ______________________________
____________________________________________________________________________________________________________
Briefly describe purpose of temporary heliport: ________________________________________________________________________
Do you anticipate night operations?
YES
NO
If yes, describe lighting: ____________________________________________
HELICOPTER INFORMATION
MAKE
MODEL
1
APPLICATION FOR
AV-2 (10-15)
TEMPORARY HELIPORT LICENSE
www penndot gov
APPLICATION FEE: $25
PLEASE TYPE OR PRINT IN BLUE OR BLACK INK
SHADED AREAS ARE FOR BUREAU USE ONLY
APPLICANT INFORMATION
I, (We), hereby make application for license to operate a Heliport and affirm that I am (we are)
DATE
the Owner(s)
Lessee(s)
of the property.
POINT OF CONTACT (if different than Licensee)
NAME OF LICENSEE
EMAIL
DAYTIME PHONE NUMBER
EMAIL
DAYTIME PHONE NUMBER
STREET ADDRESS/P.O. BOX
STREET ADDRESS/P.O. BOX
CITY
STATE
ZIP CODE
STATE
ZIP CODE
CITY
HELIPORT INFORMATION
DATE(S) REQUESTED
PHYSICAL ADDRESS OF HELIPORT (Street/RR/SR)
TOWNSHIP
COUNTY
LATITUDE (Deg.-Min.-Sec.)
LONGITUDE (Deg.-Min.-Sec.)
ALTITUDE ABOVE SEA LEVEL (Ft.)
HELIPORT DIMENSIONS – LANDING AREA (FATO)
DIAMETER*
LENGTH
WIDTH
TYPE SURFACE
APPROACH / DEPARTURE HEADINGS
/
/
1
2
/
/
1
2
HELIPAD DIMENSIONS (TLOF – IF APPLICABLE)
DIAMETER*
LENGTH
WIDTH
TYPE SURFACE
DYNAMIC LOAD CAPACITY
(Elevated/Rooftop Pads Only)
*Diameter only if circular
Is heliport planned for operations at a Fair or event?
YES
NO
If yes, list name of event: ______________________________
____________________________________________________________________________________________________________
Briefly describe purpose of temporary heliport: ________________________________________________________________________
Do you anticipate night operations?
YES
NO
If yes, describe lighting: ____________________________________________
HELICOPTER INFORMATION
MAKE
MODEL
1
AV-2 (10-15)
NAME OF LICENSEE
ADDITIONAL INFORMATION:
CERTIFICATION
I hereby certify that I am the owner, or authorized agent, of the above-named heliport, that the information contained in this application
and any accompanying documents is true and correct.
Name (Print)
Signature
Title
Date (mm/dd/yyyy)
PennDOT Bureau of Aviation
Complete and mail to:
Attn: Licensing Coordinator
P.O. Box 3151
Harrisburg, PA 17105-3151
FOR BUREAU OF AVIATION USE ONLY
LICENSING COORDINATOR
LICENSING FEE PAID $ ___________ DATE RCVD___________
CHECK/MONEY ORDER # _____________ __________________ LICENSE #
AVN SPECIALIST REMARKS
HELIPORT MEETS SIZE REQUIREMENTS?
YES
NO
__________________________________________________
HELIPORT AFFORDS CLEAR APPROACHES?
YES
NO
__________________________________________________
HELIPORT MARKED APPROPRIATELY?
YES
NO
__________________________________________________
GROUND COORDINATION/SECURITY PROVIDED?
YES
NO
N/A
__________________________________________
EMERGENCY RESPONSE EQUIPMENT/MEASURES IN PLACE?
YES
NO
__________________________________________________
REMARKS ________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
AVN SPECIALIST SIGNATURE __________________________________________________
DATE ____________________________________
AVN SPC SUPV CONCURRENCE ________________________________________________ DATE ____________________________________
2
AV-2 (10-15)
APPLICATION FOR TEMPORARY HELIPORT (AV-2) INSTRUCTIONS
REFERENCES:
A. Department of Transportation Aviation Regulations, Chapter 471, Title 67, PA Consolidated Statutes.
B. FAA Advisory Circular 150/5390-2 (Heliport Design)
C. Aviation Code, Act of October 10, 1984, P.L. 837, No. 164
1. Application packet must include the completed AV-2 Form and all attachments.
2. AV-2 Form – complete all sections of the application:
a. Applicant Information (site owner and point of contact if applicable).
b. Heliport Information:
- enter dates requested for temporary site
- location of proposed site (physical address, latitude/longitude/elevation of site)
- landing area dimensions
- proposed approach departure routes
c. Make and Model of largest helicopter expected to use the site.
d. Indicate if the heliport is planned for operations at a Fair or event. If so, list name of event.
e. Certification (owner/authorized agent signature).
3. Attach a sketch plan or diagram of the landing area with a scale of 1”=200’ (if a different scale is
used, indicate scale on the drawing). Depict the heliport takeoff and landing area; annotate heliport
dimensions, approach headings; location of lighting and markings; existing structures such as wires,
buildings, trees/shrubs, roads or railroad tracks.
4. Attach the fee of $25 paid to the Commonwealth of Pennsylvania (check, money order or bank draft).
APPLICATION FOR TEMPORTARY HELIPORT PROCEDURE
Upon receipt of the application for temporary heliport license the Bureau will review the packet
for completeness and contact the applicant to schedule an on-site licensing inspection.
Applications must be complete before scheduling the site inspection. When the heliport is found
to meet licensing guidelines, the Bureau will issue a temporary license.
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