Form AV-3 "Application for Airport/Heliport License Renewal" - Pennsylvania

What Is Form AV-3?

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-3 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-3 "Application for Airport/Heliport License Renewal" - Pennsylvania

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ApplicAtion for Airport/heliport
AV-3 (10-15)
license renewAl
www penndot gov
renewAl fee: $75 - 3 YeAr license
APPLICANT INFORMATION
i/we hereby make application for renewal of the license to operate the below listed private Airport/heliport and affirm that i am (we are) the
owner(s)
lessee(s) of the property.
Airport/heliport name:
Date
fAA iD
name of licensee
point of contact (if different than licensee)/or Additional licensee
Daytime phone number
email Address
Daytime phone number
email Address
Mailing Address (street/po Box)
Mailing Address (street/po Box)
city
state
Zip code
city
state
Zip code
AIRPORT/HELIPORT INFORMATION
physical Address of Airport/heliport (street/rr/sr)
township/Borough
state
Zip code
county
Airport
heliport
runway length: _______________ ft.
width: ______________ ft.
Diameter/Dimensions of landing Area: ______________ ft _____________ ft
runway Magnetic headings: _______________ / ________________
primary Appr/Dep headings: _______________ / _______________
type runway:
paved
turf
secondary Appr/Dep headings: _______________ / _______________
is the runway lighted?
Yes
no
is heliport lighted?
Yes
no
Are commercial activities planned for or occurring at this facility?
Yes
no
[Maintenance, flight instruction, fueling]
were any significant changes made to the facility since last inspection?
Yes
no if yes, please describe:
list All BAseD AircrAft (Attach Additional Sheets if Necessary)
MAnUfActUrer
MoDel
reGistrAtion #
owner
CERTIFICATION
i hereby certify that i am the owner, or authorized agent, of the above named airport/heliport, that the information contained herein is true
and correct, and that i am familiar with the commonwealth of pennsylvania regulations governing licensing and operation of private
Airports and/or heliports.
Name (Print)
Signature
Date (mm/dd/yyyy)
Title
complete and mail to:
pennDot Bureau of Aviation
for BUreAU of AviAtion onlY
Attn: licensing coordinator
license fee pAiD $___________ lic#______________
p.o. Box 3151
initiAl _______________ DAte _______________
harrisburg, pA 17105-3151
ApplicAtion for Airport/heliport
AV-3 (10-15)
license renewAl
www penndot gov
renewAl fee: $75 - 3 YeAr license
APPLICANT INFORMATION
i/we hereby make application for renewal of the license to operate the below listed private Airport/heliport and affirm that i am (we are) the
owner(s)
lessee(s) of the property.
Airport/heliport name:
Date
fAA iD
name of licensee
point of contact (if different than licensee)/or Additional licensee
Daytime phone number
email Address
Daytime phone number
email Address
Mailing Address (street/po Box)
Mailing Address (street/po Box)
city
state
Zip code
city
state
Zip code
AIRPORT/HELIPORT INFORMATION
physical Address of Airport/heliport (street/rr/sr)
township/Borough
state
Zip code
county
Airport
heliport
runway length: _______________ ft.
width: ______________ ft.
Diameter/Dimensions of landing Area: ______________ ft _____________ ft
runway Magnetic headings: _______________ / ________________
primary Appr/Dep headings: _______________ / _______________
type runway:
paved
turf
secondary Appr/Dep headings: _______________ / _______________
is the runway lighted?
Yes
no
is heliport lighted?
Yes
no
Are commercial activities planned for or occurring at this facility?
Yes
no
[Maintenance, flight instruction, fueling]
were any significant changes made to the facility since last inspection?
Yes
no if yes, please describe:
list All BAseD AircrAft (Attach Additional Sheets if Necessary)
MAnUfActUrer
MoDel
reGistrAtion #
owner
CERTIFICATION
i hereby certify that i am the owner, or authorized agent, of the above named airport/heliport, that the information contained herein is true
and correct, and that i am familiar with the commonwealth of pennsylvania regulations governing licensing and operation of private
Airports and/or heliports.
Name (Print)
Signature
Date (mm/dd/yyyy)
Title
complete and mail to:
pennDot Bureau of Aviation
for BUreAU of AviAtion onlY
Attn: licensing coordinator
license fee pAiD $___________ lic#______________
p.o. Box 3151
initiAl _______________ DAte _______________
harrisburg, pA 17105-3151
ApplicAtion for license renewAl instrUctions (Av-3)
references:
Department of Transportation Aviation Regulations, Chapter 471, Title 67, PA Consolidated Statutes.
pUrpose:
This form is used to renew airport/heliport licenses.
instrUctions:
Applicant information
1.
Indicate whether the applicant is the owner or lessee of the physical property where the airport/heliport is located.
2.
List the airport/heliport name in the top block as it appears on the previous license.
3.
Enter the name, mailing address, phone number and email address of the airport/heliport owner(s). List the point
of contact name, mailing address, phone number and email address (if different than owner).
Airport/heliport information
1.
Enter the physical address of the airport/heliport (street, rural route, state route address).
2.
Enter the Township/Borough where the airport/heliport is located.
3.
Enter the County where the airport/heliport is located.
4.
Indicate the runway length and width (or heliport dimensions).
5.
Indicate the runway magnetic headings (or heliport approach/departure routes)
6.
Indicate if the airport/heliport is lighted for night operations.
7.
Indicate if commercial operations are currently occurring at, or planned for, the airport/heliport (commercial
operations include flight instruction, aircraft maintenance, sale of aircraft, parts and/or fuel sales).
8.
Describe any changes made at the site since the previous license application. Provide a sketch or site plan
indicating all changes or modifications to the airport or runway environment.
9.
List the make, model, registration number and owner of all aircraft based at the airport (based aircraft are
airplanes parked/stored at the facility for more than 30 days in the year).
certification
1.
The owner, or authorized agent for the owner(s), must sign and date the application. Print or type the signatory’s
name. If appropriate list the signatory’s title.
The license fee for private airport/heliports is $25 per year and payable in 3-year intervals ($75 for a 3-year renewal).
Checks or money orders should be made out to the PA Department of Transportation.
Forward the license renewal application and fee to:
PennDOT Bureau of Aviation
Attn: Licensing Coordinator
P.O. Box 3151
Harrisburg, Pa 17105-3151
PLEASE NOTE: The AV-3 shall not be used to change ownership. Bureau Form AV-4 (Application for New
Airport) is used for initiate a change of ownership. Bureau forms and regulations can be obtained at the
Bureau’s website www.dot.state.pa.us.
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