Form FAA-8310-3 Application for Repair Station Certificate and/or Rating

OMB Approved
2120- 0682
02/28/2009

If additional space is required for any item, attach additional sheets of paper.

U.S. Department of Transportation
Federal Aviation Administration
1. Repair Station Name, Number, Location and Address

Application for
Repair Station Certificate and/or Rating
2. Reasons for Submission
Number

a. Official Name of Station

Original Application for Certificate and Rating
Change in Rating
Change in Location or Housing and Facilities
Change in Ownership
Other (Specify)

b. Location where business conducted

c. Official Mailing Address of Repair Station (Number, Street, City, State & ZIP)

d. Doing Business As:
3. Ratings Applied for:

Airframe

Powerplant
Class 1
Class 2
Class 3

Class 1
Class 2
Class 3
Class 4

Accessories

Propeller

Radio

Instrument

Class 1

Class 1

Class 1

Class 2

Class 2
Class 3

Class 2
Class 3
Class 4

Limited

Class 1
Class 2
Class 3

Airframe
Engine
Propeller
Instrument

Accessories
Landing Gear
Float
Radio

Rotor Blades
Fabric

Emergency Equip.
Non-Dest. Test

Specialized Services (specify)

4. List of Maintenance Functions Contracted to Outside Agencies:

5. Applicant's Certification
Name of Owner (Include name(s) of individual owner, all partners, or corporation name giving state and date of incorporation)

I hereby certify that I have been authorize by the repair station identified in Item 1 above to make this application

and that statements and attachments hereto are true and correct to the best of my knowledge.

Date

Authorized Signature

Printed Name of Authorized Signer

Title

Paperwork Reduction Act Statement: The FAA is required to submit this information to US Space Command. This form is sent to US Space Command 15 days prior to the planned launch date. The FAA estimates it will take a licensee 4 hours
to complete this form. This information is mandatory for the FAA and US Space Command. The FAA will treat this information as confidential if requested by the applicant in accordance with 14 CFR §413.9. An agency may not conduct or
sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number associated with this collection is 2120-0682. Comments concerning the accuracy
of this burden and suggestions for reducing the burden should be directed to the FAA at: 800 Independence Ave SW, Washington, DC 20591, Attn: Information Collection Clearance Officer, ABA-20

FAA Form 8310-3 (6-95) Supersedes Previous Edition

NSN: 0052-00-686-1002

Record of Action Repair
Station Inspection

For FAA Use Only

For FAA Use Only

6. Remarks (identify by item number. Include deficiencies found, ratings denied.)

8. Date of Inspection

7. Findings - Recommendations
A. Station was found to comply with requirements of FAR 145.
B. Station was found to comply with requirements of FAR 145 except for deficiencies listed in Item 6.
C. Recommend certificate with rating applied for on application be issued.
D. Recommend Certificate with rating applied for on application (EXCEPT those listed in item 6) be issued.
9.

Office

Signature(s) of Inspector(s)

Printed Name(s) of Inspector(s)

10. Supervising or Assigned Inspector
ACTION TAKEN

CERTIFICATE ISSUED
Number

Inspector's Signature

Date

Inspector's Printed Name

APPROVED
as shown on certificate
issued on date shown.

Title

DISAPPROVED
FAA Form 8310-3 (6-95) Supersedes Previous Edition

NSN: 0052-00-686-1002