Form AV-57 "Notice of Proposed Construction or Alteration" - Pennsylvania

What Is Form AV-57?

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 January 1, 2018;
  • 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-57 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-57 "Notice of Proposed Construction or Alteration" - Pennsylvania

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AV-57 (1-18)
NOTICE OF PROPOSED
CONSTRUCTION OR ALTERATION
www.penndot.gov
PLEASE TYPE OR PRINT ALL INFORMATION IN BLUE OR BLACK INK
DATE:
SPONSOR INFORMATION
NAME OF SPONSOR
SPONSOR'S REPRESENTATIVE (If different than Sponsor)
DAYTIME PHONE NUMBER
EMAIL OR FAX NUMBER
DAYTIME PHONE NUMBER
EMAIL OR FAX NUMBER
STREET ADDRESS/P.O. BOX
STREET ADDRESS/P.O. BOX
CITY
STATE
ZIP CODE
CITY
STATE
ZIP CODE
NATURE OF PROPOSAL
A. NOTICE OF:
B. DURATION:
C. WORK SCHEDULE DATES:
Permanent
New Construction
Beginning __________ End __________
Alteration
Temporary (____ months, ____ days)
D. DESCRIPTION OF PROPOSAL Include sketches, diagrams and/or maps as necessary to depict the location or structures.
Antenna Tower
Crane
Building
Landfill
Wind Turbine
Pole
MET Tower
Other
HEIGHT & ELEVATION
LOCATION OF STRUCTURE
(Complete to nearest foot)
A. ELEVATION OF SITE:
A. Coordinates:
B. Nearest City or Town, and State:
C. Name of nearest airport, heliport
(To nearest second)
or seaplane base:
(above mean seal level)
B. HEIGHT OF STRUCTURE:
'
"
D. County
Distance from C:
O
Including all appurtenances and
lighting (if any) above ground
LATITUDE
miles
level.
Direction from structure to airport:
'
"
C. OVERALL HEIGHT:
O
(above mean sea level (A + B))
LONGITUDE
CERTIFICATION
I HEREBY CERTIFY that all of the above statements made by me are true, complete, and correct to the best of my knowledge. In addition, I agree to obstruction mark
and/or light the structure in accordance with established marking and lighting standards if necessary.
DATE:
NAME/TITLE OF PERSON FILING NOTICE (Print):
SIGNATURE:
FOR BUREAU OF AVIATION USE ONLY
THE PROPOSAL:
IS NOT IDENTIFIED AS AN OBSTRUCTION under any
standard of FAR Part 77, Subpart C and PA Aviation Code,
Act 1984-164.
IS IDENTIFIED AS AN OBSTRUCTION under the standards of
FAR Part 77, Subpart C and PA Aviation Code, Act 1984-164.
Should be obstruction
marked,
lighted per FAA
Advisory Circular 70/7460-1. Chapter(s) 3 & 4.
Obstruction marking and lighting are not necessary.
Proposal was determined to be a NON-COMPATIBLE LAND
USE in accordance with Pennsylvania Airport Land Use
Compatibility Guidelines.
SIGNATURE: ____________________________________________________
DATE: _________________
AV-57 (1-18)
NOTICE OF PROPOSED
CONSTRUCTION OR ALTERATION
www.penndot.gov
PLEASE TYPE OR PRINT ALL INFORMATION IN BLUE OR BLACK INK
DATE:
SPONSOR INFORMATION
NAME OF SPONSOR
SPONSOR'S REPRESENTATIVE (If different than Sponsor)
DAYTIME PHONE NUMBER
EMAIL OR FAX NUMBER
DAYTIME PHONE NUMBER
EMAIL OR FAX NUMBER
STREET ADDRESS/P.O. BOX
STREET ADDRESS/P.O. BOX
CITY
STATE
ZIP CODE
CITY
STATE
ZIP CODE
NATURE OF PROPOSAL
A. NOTICE OF:
B. DURATION:
C. WORK SCHEDULE DATES:
Permanent
New Construction
Beginning __________ End __________
Alteration
Temporary (____ months, ____ days)
D. DESCRIPTION OF PROPOSAL Include sketches, diagrams and/or maps as necessary to depict the location or structures.
Antenna Tower
Crane
Building
Landfill
Wind Turbine
Pole
MET Tower
Other
HEIGHT & ELEVATION
LOCATION OF STRUCTURE
(Complete to nearest foot)
A. ELEVATION OF SITE:
A. Coordinates:
B. Nearest City or Town, and State:
C. Name of nearest airport, heliport
(To nearest second)
or seaplane base:
(above mean seal level)
B. HEIGHT OF STRUCTURE:
'
"
D. County
Distance from C:
O
Including all appurtenances and
lighting (if any) above ground
LATITUDE
miles
level.
Direction from structure to airport:
'
"
C. OVERALL HEIGHT:
O
(above mean sea level (A + B))
LONGITUDE
CERTIFICATION
I HEREBY CERTIFY that all of the above statements made by me are true, complete, and correct to the best of my knowledge. In addition, I agree to obstruction mark
and/or light the structure in accordance with established marking and lighting standards if necessary.
DATE:
NAME/TITLE OF PERSON FILING NOTICE (Print):
SIGNATURE:
FOR BUREAU OF AVIATION USE ONLY
THE PROPOSAL:
IS NOT IDENTIFIED AS AN OBSTRUCTION under any
standard of FAR Part 77, Subpart C and PA Aviation Code,
Act 1984-164.
IS IDENTIFIED AS AN OBSTRUCTION under the standards of
FAR Part 77, Subpart C and PA Aviation Code, Act 1984-164.
Should be obstruction
marked,
lighted per FAA
Advisory Circular 70/7460-1. Chapter(s) 3 & 4.
Obstruction marking and lighting are not necessary.
Proposal was determined to be a NON-COMPATIBLE LAND
USE in accordance with Pennsylvania Airport Land Use
Compatibility Guidelines.
SIGNATURE: ____________________________________________________
DATE: _________________
NOTICE OF PROPOSED DEVELOPMENT OR ALTERATION (AV-57)
PURPOSE:
A person who plans to erect a new structure, to add to an existing structure, or to erect or maintain any object (natural or man-
made), as defined in 14 Code of Federal Regulations Part 77.9 (as amended or replaced, shall first obtain approval from the
Department by submitting a written notice (Form AV-57) to the Department at least thirty (30) days prior to commencement
thereof.
Developers who do not meet the notification requirements of FAR Part 77 may use this form to voluntarily notify the Bureau of
Aviation of the existence, or proposed erection of Meteorological Towers (MET), and/or other tall structures. Structures will be
added to the State’s tower database and depicted electronically on the Bureau’s website for flight hazard awareness.
REFERENCES:
A. Department of Transportation Aviation Regulations, Chapter 479, Title 67, PA Consolidated Statutes.
Sec. 479.4. AIRPORT OBSTRUCTIONS
B. Federal Air Regulation, Part 77 and Part 157
§77.9 CONSTRUCTION OR ALTERATION REQUIRING NOTICE
If requested by the FAA, or if you propose any of the following types of construction or alteration, you must file notice with
the FAA of:
(a) Any construction or alteration of more than 200 feet in height above the ground level at its site.
(b) Any construction or alteration of greater height than an imaginary surface extending outward and upward at one of the
following slopes:
(1) 100 to 1 for a horizontal distance of 20,000 feet from the nearest point of the nearest runway of each airport
described in subparagraph (d) of this paragraph with at least one runway more than 3,200 feet in actual length.
(2) 50 to 1 for a horizontal distance of 10,000 feet from the nearest point of the nearest runway of each airport described
in subparagraph (d) of this paragraph with its longest runway no more than 3,200 feet in actual length.
(3) 25 to 1 for a horizontal distance of 5,000 feet from the nearest point of the nearest point of the nearest landing and
takeoff area of each heliport described in subparagraph (d) of this paragraph.
(c) Any highway, railroad, or other traverse way for mobile objects, of a height which, if adjusted upward 17 feet for an
interstate Highway that is part of the National System of Military and Interstate Highways where overcrossings are
designed for a minimum of 17 feet vertical distance, 15 feet for any other public roadway, 10 feet or the height of the
highest mobile object that would normally traverse the road, whichever is greater, for a private road, 23 feet for a railroad,
and for a waterway or any other traverse way not previously mentioned, an amount equal to the height of the highest
mobile object that would normally traverse it, would exceed a standard of subparagraph (a) or (b) of this paragraph.
(d) Any construction or alteration on any of the following airports (and heliports):
(1) A public use airport listed in the Airport/Facility Directory or Chart Supplement of the U.S. Government Flight
Information Publications;
(2) An airport under construction, that is the subject of a notice or proposal on file with the Federal Aviation
Administration, and except for military airports, it is clearly indicated that that airport will be available for public use;
(3) An airport that is operated by a Federal agency or the Department of Defense;
(4) An airport or heliport with at least one FAA-approved instrument approach procedures.
INSTRUCTIONS:
1. Complete all applicable sections of the form:
a. Sponsor Information (and point of contact if different than sponsor).
b. Nature of Proposal. List type of notice, duration of proposal, work dates, and full description of the proposal (include
sketches, diagrams and/or maps, as necessary to depict the location of the structures.)
c.
Location of Structure. Enter exact latitude/longitudinal coordinates of the structure(s). Indicate County, nearest city or
town, and proximity to nearest airport (public or private).
d. Height & based elevation: Enter the base elevation of the site, the height of the structure, and the overall height
projected above mean sea level – to the nearest foot.
e. Certification: Owner/authorized agent must sign and date.
Please mail the completed notice to:
PA Department of Transportation
Bureau of Aviation
P.O. Box 3151
Harrisburg, PA 17105
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