Form AV-4 "Application for New Airport/Heliport Site Approval" - Pennsylvania

What Is Form AV-4?

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-4 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-4 "Application for New Airport/Heliport Site Approval" - Pennsylvania

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APPLICATION FOR NEW AIRPORT/HELIPORT
AV-4 (10-15)
SITE APPROVAL
www penndot gov
APPLICATION FEE: $50
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 an Airport/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
EMAIL
DAYTIME PHONE NUMBER
DAYTIME PHONE NUMBER
STREET ADDRESS/P.O. BOX
STREET ADDRESS/P.O. BOX
CITY
STATE
ZIP CODE
CITY
STATE
ZIP CODE
AIRPORT/HELIPORT INFORMATION
NAME OF AIRPORT/HELIPORT
HELIPORT RATING CATEGORY
AIRPORT RATING CATEGORY (see instructions)
Public General Aviation Airport
Private Group Airport
Public Heliport
Public Basic Utility Airport
Private Individual Airport
Private Heliport
Public Light Sport/Ultralight Airport
Private Light Sport/Ultralight Airport
Public Seaplane Base
Private Seaplane Base
PHYSICAL ADDRESS OF AIRPORT/HELIPORT (Street/RR/SR)
TOWNSHIP
COUNTY
LATITUDE (Deg.-Min.-Sec.)
LONGITUDE (Deg.-Min.-Sec.)
ALTITUDE ABOVE SEA LEVEL (Ft.)
RUNWAY DIMENSIONS
RWY MAGNETIC HEADINGS
LENGTH
WIDTH
TYPE SURFACE
APPROACH OBSTRUCTIONS (Yes/No)
/
/
/
HELIPORT DIMENSIONS – TAkEOFF / LANDING AREA (FATO)
DIAMETER*
LENGTH
WIDTH
TYPE SURFACE
APPROACH / DEPARTURE HEADINGS
/
/
1
2
/
/
1
2
TOUCHDOWN PAD DIMENSIONS (TLOF – IF APPLICABLE)
DIAMETER*
LENGTH
WIDTH
TYPE SURFACE
DYNAMIC LOAD CAPACITY
(Elevated/Rooftop Pads Only)
*Diameter only if circular
1
APPLICATION FOR NEW AIRPORT/HELIPORT
AV-4 (10-15)
SITE APPROVAL
www penndot gov
APPLICATION FEE: $50
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 an Airport/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
EMAIL
DAYTIME PHONE NUMBER
DAYTIME PHONE NUMBER
STREET ADDRESS/P.O. BOX
STREET ADDRESS/P.O. BOX
CITY
STATE
ZIP CODE
CITY
STATE
ZIP CODE
AIRPORT/HELIPORT INFORMATION
NAME OF AIRPORT/HELIPORT
HELIPORT RATING CATEGORY
AIRPORT RATING CATEGORY (see instructions)
Public General Aviation Airport
Private Group Airport
Public Heliport
Public Basic Utility Airport
Private Individual Airport
Private Heliport
Public Light Sport/Ultralight Airport
Private Light Sport/Ultralight Airport
Public Seaplane Base
Private Seaplane Base
PHYSICAL ADDRESS OF AIRPORT/HELIPORT (Street/RR/SR)
TOWNSHIP
COUNTY
LATITUDE (Deg.-Min.-Sec.)
LONGITUDE (Deg.-Min.-Sec.)
ALTITUDE ABOVE SEA LEVEL (Ft.)
RUNWAY DIMENSIONS
RWY MAGNETIC HEADINGS
LENGTH
WIDTH
TYPE SURFACE
APPROACH OBSTRUCTIONS (Yes/No)
/
/
/
HELIPORT DIMENSIONS – TAkEOFF / LANDING AREA (FATO)
DIAMETER*
LENGTH
WIDTH
TYPE SURFACE
APPROACH / DEPARTURE HEADINGS
/
/
1
2
/
/
1
2
TOUCHDOWN PAD DIMENSIONS (TLOF – IF APPLICABLE)
DIAMETER*
LENGTH
WIDTH
TYPE SURFACE
DYNAMIC LOAD CAPACITY
(Elevated/Rooftop Pads Only)
*Diameter only if circular
1
AV-4 (10-15)
NEAREST PUBLIC OR PRIVATE USE LANDING AREAS
NAME
DIRECTION FROM SITE
DISTANCE FROM SITE (MILES)
Is the application being submitted due to change in landing area ownership? YES
NO
If yes, list previous owner and name of landing area.
__________________________________________________________________________________________________________________________
Are Commercial Operations planned at this facility? YES
NO
If yes, list activity: ________________________________________________
Do you anticipate night operations? YES
NO
MAkE AND MODEL OF AIRCRAFT TO BE BASED AT AIRPORT
MAkE
MODEL
REGISTRATION NUMBER
OWNER’S NAME
(Attach aircraft performance data for each aircraft; add additional sheets if necessary)
CERTIFICATION
I hereby certify that I am the owner, or authorized agent, of the above named airport/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 # ____________ REGION NUMBER _____________
AVN SPECIALIST REMARkS
____________________________________________________________________________________
WITHIN 2 MILES OF _______AIRPORT
____________________________________________________________________________________
WITHIN 5 MILES OF _______AIRPORT
____________________________________________________________________________________
MORE THAN 5 MILES OF AN AIRPORT
AVN SPECIALIST SIGNATURE __________________________________________________
DATE ____________________________________
AVN SPC SUPV CONCURRENCE ________________________________________________ DATE ____________________________________
2
AV-4 (10-15)
APPLICATION FOR NEW AIRPORT/HELIPORT INSTRUCTIONS
REFERENCES:
A. Department of Transportation Aviation Regulations, Chapter 471, Title 67, PA Consolidated Statutes.
B. FAA Advisory Circular 150/5300-13 (Airport Design)
C. FAA Advisory Circular 150/5390-2 (Heliport Design)
D. Federal Aviation Regulations Part 77 and Part 157
E. FAA Advisory Circulars: 150/5340-1; 150/5340-18; 150/5340-30; 150/5340-1; 150/5325-4
F.
Aviation Code, Act of October 10, 1984, P.L. 837, No. 164
1. Application packet must include the completed AV-4 Form and all attachments.
2. AV-4 Form – complete all sections of the application:
a. Applicant Information (licensee and point of contact if applicable).
b. Airport/Heliport Information – name of proposed site, rating category (see attached rating
categories below), physical address, and latitude/longitude/elevation of site, approach/departure
headings, and proximity to other known airports (public or private).
c. Make and Model of Aircraft to be Based at Airport (list all aircraft expected). For heliports, list the
design helicopter (largest aircraft expected to use the site).
d. Certification (owner/authorized agent signature).
3. Attach a fee of $50 paid to the Commonwealth of Pennsylvania (check, money order or bank draft).
One (1) site inspection and one (1) final inspection are covered by the fee. Any additional site or re-
inspection will require an additional $50 fee.
4. Attach a topographic map of the area depicting the geographic location of the site.
5. For proposed airports, provide a tax map or certified property map depicting the airport property lines
and general location of the runway on the property.
6. Attach an airport sketch plan or diagram with a scale of 1”=200’ (if a different scale is used, indicate
scale on the drawing). Depict the proposed runway(s), or heliport takeoff and landing area; annotate
runway headings and proposed dimensions; location of lighting and markings; existing structures such
as buildings, trees/shrubs, roads or railroad tracks; direction of prevailing winds; and for heliports, the
proposed approach/departure paths.
7. Attach the performance data (takeoff and landing data) of all aircraft expected to be based at the
facility (private airport applications only).
8. If the applicant is not the owner of the landing area property, attach a copy of the lease or agreement
granting use of the property to the applicant. Include name, address and phone number of property
owner.
9. Complete and forward FAA Form 7480-1 (Notice of Landing Area Proposal) to the FAA Eastern
Region. Attach a copy of the form with this application. NOTE: An Airport/ Heliport license will not be
issued before receipt of a determination of no adverse impact from the FAA.
PLEASE NOTE: The Bureau of Aviation cannot approve an airport within two (2) miles of an existing or
proposed airport on file with the Bureau. A public hearing is required if the proposed airport is within five
(5) miles of an existing or proposed airport on file with the Bureau (public hearings do not apply to
heliports or existing airports).
3
AV-4 (10-15)
NEW AIRPORT/HELIPORT APPLICATION PROCESS
Upon receipt of the application the Bureau will review the packet for completeness and contact the
applicant to schedule an initial on-site inspection. Applications must be complete before the initial site
inspection. When necessary, a public hearing will be conducted by the Bureau after the site inspection.
When site development is completed to licensing guidelines, the Sponsor must submit PA Form AV-6
(Airport/Heliport License Application) to the Bureau. A second site inspection will then be scheduled (if
necessary), and license issued.
AIRPORT RATING CATEGORIES
The following represents the rating categories used by the Bureau of Aviation for issuance of airport
licenses.
1. Public Airport – An airport which is either publicly or privately owned and which is
open to the general public.
(i) Scheduled Service/General Aviation – an airport with a paved or turf runway 2,200’ or
greater, and capable of night operations and instrument landing procedures.
(ii) Basic Utility – an airport with a paved or turf runway 1,600’ or greater, serving aircraft less
than 12,500 pounds max gross weight, and intended for daytime VFR conditions only.
(iii) Light Sport/Ultralight – an airport with a paved or turf runway 1,000’ or greater for the use
of sport and ultralight aircraft only.
(iv) Seaplane Base – an area of water at least 2,500’ in length or greater used as a public
landing area.
2. Private Airport – An airport which is not open or intended to be open to the public. Private
airports are prohibited from selling fuel or providing flight instruction to the general public.
(i) Group – an airport with a paved or turf runway 1,200’ or greater, capable of night
operations, and used exclusively by a partnership, organization, corporation.
(ii) Individual – an airport with a paved or turf runway 1,200’ or greater, intended for daytime
VFR conditions only, and used exclusively by the licensee.
(iii) Light Sport/Ultralight – an airport with a paved or turf runway 500’ or greater for the
private use of sport and ultralight aircraft.
(iv) Seaplane Base – an area of water at least 2,500’ in length or greater used as a private
landing area.
HELIPORT RATING CATEGORIES
The following represents rating categories to be used by the Bureau of Aviation for issuance of heliport
licenses.
1. Public Heliport – A heliport which is either publicly or privately owned and which is open to the
general public.
2. Private Heliport – A heliport which is either publicly or privately owned and which is closed to
the general public.
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