Form AV-10 "Request for Non-aeronautical Use of a Public Airport" - Pennsylvania

What Is Form AV-10?

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 May 1, 2017;
  • 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-10 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-10 "Request for Non-aeronautical Use of a Public Airport" - Pennsylvania

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REQUEST FOR NON-AERONAUTICAL USE
AV-10 (5-17)
OF A PUBLIC AIRPORT
www penndot gov
APPLICANT INFORMATION
AIRPORT NAME:
Airport Manager/Representative
Event Sponsor (if different than Licensee)
Phone Number
Email
Phone Number
Email
Mailing Address (Street/PO Box)
Mailing Address (Street/PO Box)
City, ST ZIP Code
City, ST ZIP Code
EVENT INFORMATION
Event Name:
Event Date(s):
Description of the Proposed Activity (i.e. where on airport/expected attendance):
Runway or Taxiway Closure?
Yes
No
Describe why the activity, event, or occupancy must take place at the airport:
Identify the Emergency Services available during the event (Check all that apply):
Police
Medical Personnel
Ambulance
Fire truck
Other ________________________________
Required Attachments:
- Sketch Map showing affected locations, security measures, control procedures and location of emergency services.
- Event contract/agreement with event sponsor (which includes requirement for restoration of airport to original condition).
- Event specific liability insurance policy (listing the Pennsylvania Department of Transportation as additional insured)
- Safety Plan or Safety Phasing Plan
- Signed Certifications for Partial Closing of an Obligated Airport *
- Copy of tenant notifications. *
* NPIAS Airports only
CERTIFICATION
I hereby certify that I am the owner, or authorized agent, of the above named airport, that the information contained herein is true and correct, and that I am
familiar with the Bureau of Aviation’s procedures and guidelines for conducting non-aeronautical events, and understand that failure to comply with Federal
and State grant assurances, as well as that required for non-aeronautical use approval, may affect our ability to compete for funding of future airport
development projects.
__________________________________________________
__________________________________________________
______________________
Name (print)
Signature
Date
__________________________________________________
Title
Complete and mail to:
PennDOT Bureau of Aviation
FOR BUREAU OF AVIATION USE ONLY
Attn: Airport Licensing and Safety
P.O. Box 3151
Received __________ Region _________
Harrisburg, PA 17105-3151
REQUEST FOR NON-AERONAUTICAL USE
AV-10 (5-17)
OF A PUBLIC AIRPORT
www penndot gov
APPLICANT INFORMATION
AIRPORT NAME:
Airport Manager/Representative
Event Sponsor (if different than Licensee)
Phone Number
Email
Phone Number
Email
Mailing Address (Street/PO Box)
Mailing Address (Street/PO Box)
City, ST ZIP Code
City, ST ZIP Code
EVENT INFORMATION
Event Name:
Event Date(s):
Description of the Proposed Activity (i.e. where on airport/expected attendance):
Runway or Taxiway Closure?
Yes
No
Describe why the activity, event, or occupancy must take place at the airport:
Identify the Emergency Services available during the event (Check all that apply):
Police
Medical Personnel
Ambulance
Fire truck
Other ________________________________
Required Attachments:
- Sketch Map showing affected locations, security measures, control procedures and location of emergency services.
- Event contract/agreement with event sponsor (which includes requirement for restoration of airport to original condition).
- Event specific liability insurance policy (listing the Pennsylvania Department of Transportation as additional insured)
- Safety Plan or Safety Phasing Plan
- Signed Certifications for Partial Closing of an Obligated Airport *
- Copy of tenant notifications. *
* NPIAS Airports only
CERTIFICATION
I hereby certify that I am the owner, or authorized agent, of the above named airport, that the information contained herein is true and correct, and that I am
familiar with the Bureau of Aviation’s procedures and guidelines for conducting non-aeronautical events, and understand that failure to comply with Federal
and State grant assurances, as well as that required for non-aeronautical use approval, may affect our ability to compete for funding of future airport
development projects.
__________________________________________________
__________________________________________________
______________________
Name (print)
Signature
Date
__________________________________________________
Title
Complete and mail to:
PennDOT Bureau of Aviation
FOR BUREAU OF AVIATION USE ONLY
Attn: Airport Licensing and Safety
P.O. Box 3151
Received __________ Region _________
Harrisburg, PA 17105-3151
NON-AERONAUTICAL USE POLICY
REFERENCES:
A. Department of Transportation Aviation Regulations, Chapter 471, Title 67, PA Consolidated
Statutes. §471.7 (b)(7). Non-aeronautical uses of a public airport’s aviation related area require the airport
sponsor to obtain Bureau approval by means of advance written notice.
B. FAA Order 5190.6B – Airport Compliance Manual – An airport developed or improved with federal funds may
not be closed for special outdoor events, such as sports car races, county fairs, parades, car testing, model air
plane events, etc., without FAA approval.
C. Pennsylvania Bureau of Aviation Administrative Procedure #A-98-35 – Non-Aeronautical Land Use. All
non-aeronautical activity on publically operated airports requires Bureau of Aviation approval. Airport sponsors
must submit their request in writing at least sixty (60) days prior to the activity. All revenue generated by the
non-aeronautical use of airport property must be used for the operation, maintenance, or development of
the airport.
REQUEST FOR NON-AERONAUTICAL USE INSTRUCTIONS (AV-10)
Applicant Information
1. List the Airport Name in the top block as it appears on the license.
2. Enter the name, mailing address, phone number and email address of the airport representative submitting the
request. Enter the name, mailing address, phone number and email address of the event sponsor.
Event Information
3. Enter the event name and date(s) of occurrence.
4. Provide description of the proposed event. Describe where on the airport the event will occur, anticipated
number in attendance. If not sponsored by the airport, identify sponsoring agency. Use additional pages if
necessary.
5. Annotate whether the runway or taxiway must be closed anytime during this event.
6. Describe why the event/activity must take place at the airport.
7. Annotate if emergency personnel or services will be present for the event.
8. Attach all required documents.
a. Sketch map showing affected locations on the airport, location of emergency personnel and services,
physical controls measures to be in place.
b. Event contract/agreement with the event sponsor, which includes requirement for the restoration of the
airport back to the original condition after the event.
c. Event specific liability insurance policy which lists the Pennsylvania Department of Transportation as an
additional insured.
d. Safety plan detailing responsibilities and control procedures (Safety phasing plan for NPIAS airports)
e. Signed certifications (NPIAS airports only)
f. Copy of tenant notifications (NPIAS airports only)
Certification
9. The owner, or authorized agent for the owner, must sign and date the application. Print or type the signatory’s
name. If appropriate list the signatory’s title.
Forward the non-aeronautical use application to:
PennDOT Bureau of Aviation
Attn: Airport Licensing and Safety
P.O. Box 3151
Harrisburg, Pa 17105-3151
Policy and information concerning non-aeronautical use of an airport can be found at the Pennsylvania Bureau of
Aviation’s website www.penndot.gov or by calling the Bureau at (717) 705-1200.
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