Please Type or Print on This Form Form Approved OMB No. 2120-0001

 

 


U.S. Department of Transportation

Federal Aviation Administration

Failure To Provide All Requested Information May Delay Processing of Your Notice

Notice of Proposed Construction or Alteration

FOR FAA USE ONLY

Aeronautical Study Number

   -     -      -

1. Sponsor (person, company, etc. proposing this action) :

Attn. of:      

Name:      

Address:      

     

City:       State:       Zip:      

Telephone:       Fax:      

 

2. Sponsor's Representative (if other than #1) :

Attn. of:      

Name:      

Address:      

     

City:       State:       Zip:      

Telephone:       Fax:      

 

3. Notice of: New Construction Alteration Existing

 

4. Duration: Permanent Temporary (   months,   days)

 

5. Work Schedule: Beginning       End      

 

6. Type: Antenna Tower Crane Building Power Line

Landfill Water Tank Other      

 

7. Marking/Painting and/or Lighting Preferred:

Red Lights and Paint Dual - Red and Medium Intensity White

White - Medium Intensity Dual - Red and High Intensity White

White - High Intensity Other      

 

8. FCC Antenna Structure Registration Number (if applicable):

 

     

 

 

9. Latitude: ______      ______     ' ______     . ______     "

 

10. Longitude: ______      ______     ' ______     . ______     "

 

11. Datum: NAD 83 NAD 27 Other     

 

12. Nearest: City:       State:     

 

13. Nearest Public-use (not private-use) or Military Airport or Heliport:

 

     

 

14. Distance from #13. to Structure:      

 

15. Direction from #13. to Structure:      

 

16. Site Elevation (AMSL):       ft.

 

17. Total Structure Height (AGL):       ft.

 

18. Overall height (#16. + #17.) (AMSL):       ft.

 

19. Previous FAA Aeronautical Study Number (if applicable):

 

      - OE

 

20. Description of Location: (Attach a USGS 7.5 minute

Quadrangle Map with the precise site marked and any certified survey.)

 

     

21. Complete Description of Proposal:

 

     

Frequency/Power (kW)

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

Notice is required by 14 Code of Federal Regulations, part 77 pursuant to 49 U.S.C., Section 44718. Persons who knowingly and willingly violate the notice requirements of part 77 are subject to a civil penalty of $1,000 per day until the notice is received, pursuant to 49 U.S.C., section 46301 (a).

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 mark and/or light the structure in accordance with established marking and lighting standards as necessary.

Date

     

Typed or Printed name and Title of Person Filing Notice

     

Signature

FAA Form 7460-1 (2-99) Supercedes Previous Edition NSN: 0052-00-012-0008