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

OMB Approved
2120-0682
April 30, 2012

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
b. Location where business conducted

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

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

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

Airframe

Powerplant

Propeller

Radio

Instrument

Class 1

Class 1

Class 1

Class 1

Class 2
Class 3
Class 4

Class 2
Class 3

Class 2

Class 2
Class 3

Accessories
Class 1
Class 2
Class 3

Class 1
Class 2
Class 3
Class 4

Limited
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: 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 for this information collection is 2120-0682. Public
reporting for this collection of information is estimated to be approximately 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. All responses to this collection of information are required to obtain or retain benefits in accordance with 14 CFR Part 145. You may submit any comments regarding the
accuracy of this burden estimate or any suggestions for reducing the burden to the Federal Aviation Administration, Aircraft Maintenance Division, AFS-300, 800 Independence Ave, SW, Washington, DC 20591, Attention FAA
Form 8310-3.

FAA Form 8310-3 (12-2011) 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
APPROVED
as shown on certificate
issued on date shown.

CERTIFICATE ISSUED
Number

Inspector's Signature

Date

Inspector's Printed Name

Title

DISAPPROVED
FAA Form 8310-3 (12-2011) Supersedes Previous Edition

NSN: 0052-00-686-1002