Attachment__4_-_FA4418-17-R-0003_FAA_Form_7460-2_dated_Oct_2013.pdf

SUPPLEMENTAL NOTICEForm Approved OMB No. 2120-0001 Expiration Date: 10/31/2017

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.

Aeronautical Study No.

U.S. Department of Transportation Federal Aviation Administration

Notice of Actual Construction or Alteration (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

Site Elevation Ft. AMSL Structure Height Ft. AGL

Total Height (Structure & Site)

Above Mean Sea Level

Ft. AMSL D. Site Elevation Determined By

Actual Survey USGS 7.5’ Quad Chart Other (Specify)

E. Reference datum of coordinates

NAD 27

NAD 83

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) Date

(1) Construction will start (Submit at least 48 hrs. in advance

(2) Estimated Completion

(3) Structure Reached Greatest Height (Submit within 5 days)

B. Construction/Project

Date

(1) Project Abandoned

(2) Construction Dismantled

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

Su bm itt ed b y:

(If s ub m itt ed b y a pr op on en t’s re pr es en ta tiv e, pl ea se al so c om pl et e ite m B

A. Call Sign B. Frequency C. Date Applied for FCC Construction Permit D. Date Construction Permit Issued

6. Preparer’s Certification A. Proponent’s Representative Name:

Address:

Tel. No.: (Include Area Code)

B. Construction Proponent Name:

Address:

Tel. No.: (Include Area Code)

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

Signature Title Date

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 Part 1

SUBMIT WITHOUT DELAY

Taylor CTR Dahl Text Box 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, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information. A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information 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, AES-200.