Free Supplemental Notice - Federal

Form Approved OMB No. 2120-0001 Expiration Date: 9/30/2010

SUPPLEMENTAL NOTICE
Aeronautical Study No.

Submission Instructions: For Advance Notice of Actual Construction or Alteration. Complete items 1, 2, 3A (1), 3A(2), and 6. If applicable, also complete items 4 and 5. Detach Part 1. Fold and tape at bottom. Mail to the FAA Regional Office for your area. Part 1A is provided for your file.

Notice of Actual Construction or Alteration
U.S. Department of Transportation Federal Aviation Administration

(Ple ase Type or Print on this Form)

1. Construction
A. Type and Description of Construction New Alteration B. Owner of Structure

2. Construction Location -- Height
A. Coordinates (To hundredths of seconds, if known)

Latitude

Longitude

B. Location (City, State, include Street Address if any)

°
C. Construction Heights

'

"

°

'

"

Total Height (Structure & Site) Above Mean Sea Level Ft. AMSL Ft. AGL Ft. AMSL E. Reference datum of coordinates NAD 27 NAD 83 Other (Specify)

Site Elevation Structure Height

D. Site Elevation Determined By Actual Survey USGS 7.5' Quad Chart Other (Specify)

F. Name of Nearest Public-Use or Military Airport (include Distance and Direction from the Airport)

3. Construction Notifications
A. Notification (Notice Is Critical to Flight Safety --- FAR Part 77 Required) (1) Construction will start (Submit at least 48 hrs. in advance (2) Estimated Completion (3) Structure Reached Greatest Height (Submit within 5 days) (2) Construction Dismantled Date (1) Project Abandoned B. Construction/Project Date

4. Marking and Lighting
A. Marked Yes No Temporary B. Lighted Medium Intensity White Dual (Medium Intensity White & Red) High Intensity White Dual (High Intensity White & Red) Red None

5. Antenna Requiring FCC License
A. Call Sign B. Frequency C. Date Applied for FCC Construction Permit D. Date Construction Permit Issued

6. Preparer's Certification
Submitted by: (If submitted by a proponent's representative, please also complete item B.) A. Proponent's Representative Name: Address: B. Construction Proponent Name: Address:

Tel. No.: (Include Area Code) Signature Title

Tel. No.: (Include Area Code) Date

I hereby certify that the information provided is true, complete, and correct to the best of my knowledge.

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. & C., Section 46301(a).
FAA Form 7460-2
(7-98)

SUPERSEDES PREVIOUS EDITION

ADVANCE NOTICE OF CONSTRUCTION
SUBMIT WITHOUT DELAY

Part 1


Paperwork Reduction Act Statement: This information is collected to process obstruction data that is critical to flight safety and is not confidential. Providing this information is mandatory for anyone proposing construction or alteration that meets or exceeds the criteria contained in 14 CFR, part 77. We estimate that the burden of this collection is an average 15 minutes per response. 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 2120-0001. 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