The URL can be used to link to this page

Home My WebLink AboutHelicopter Lift Permit: 5 State Helicopters Inc 2/23/2022 7:30:00 AM - FAA ApprovalCAP#________ DATE: TO: FAA OFFICE REFERENCE: CONGESTED / CONTINGENCY - SAFETY PLAN ** SHOULD A WEATHER, MECHANICAL OR MATERIAL DELAY BE EXPERIENCED, THIS PLAN IS APPROVED FOR ABOVE LISTED DATE PLUS 14 CALENDAR DAYS. ** AIRCRAFT INFORMATION: N6BL N4XY SIKORSKY S-58T TRANSPORT CATEGORY SIKORSKY S-58T TRANSPORT CATEGORY SIKORSKY S-58T TRANSPORT CATEGORY N9VY N170MC N244AA MESSERSCHMITT TRANSPORT CATEGORY PILOT INFORMATION: ROBERT SMITH COMMERCIAL CERTIFICATE # 3493515 SHAWN HARRIS ATP # 2727633 ANDREW DALE COMMERCIAL CERTIFICATE # 3168484 PREPARED BY: APPROVED BY: OPERATING CERTIFICATE #LDUL599B 285 BLACKLAND ROAD FATE, TEXAS 75189 (972)636-4009 OFFICE@5STATE.COM WWW.5STATE.COM SIKORSKY UH-60A RESTRICTED CATEGORY JASON LACROSSE COMMERCIAL CERTIFICATE #2729162 Susan Bitros 022322 February 16, 2023 North Texas FSDO February 23, 2022 7:30AM 9:30AM Grapevine Mills Mall - RUE 213000 Grapevine Mills Pkwy Ste 416 Grapevine, TX 76051 Chris Welch 214-202-2592 Chris Welch 214-202-2592 Welch AC Inc.2501 Creswick Dr. Plano, TX 75093 285 BLACKLAND ROAD FATE, TEXAS 75189 (972)636-4009 WWW.5STATE.COM LOAD DESCRIPTION HAZMAT: YES _______ (DOT-SP 16606 & DOT-SP 20490) NO ________ ________ ROOFTOP UNITS ________ MATERIALS ________ EQUIPMENT ________ OTHER:_____________________ NUMBER OF TOTAL LIFTS (RANGE) ______ -_______ WEIGHT RANGE _________ - _________ PERCENTAGE OF LIFT ABILITY OF AIRCRAFT ________ LOAD AERODYNAMIC: YES _____ NO ______ LENGTH OF ATTACHING GEAR (FROM HOOK TO BOTTOM OF LOAD) _____________ BUILDING OCCUPIED DURING LIFT: YES _______ NO _______ *IF YES, ESTIMATED LOAD PENETRATION OF FLOORS _________ AREA CONSIDERED CONGESTED: YES _______ NO ________ OPERATING CERTIFICATE # LDUL599B IF YES SEE NARRATIVE xx XX 1 5 1,000 2,000 47% XX 85' XX XX 285 BLACKLAND ROAD FATE, TEXAS 75189 (972) 636-4009 WWW.5STATE.COM ______ CONGESTED COMMERCIAL AREA ______ CONGESTED RESIDENTIAL AREA ______ CONGESTED AREA PROBABILITY/POSSIBILITY This is congested area operations. Items are located in staging area(s) on either transportable vehicles or ground surface. Item(s) to be placed on building/structure roof top(s) or designated areas. Direct flight path(s) from staging area(s) to placement area(s) will occur unless otherwise notated on provided maps. Lift(s) amount(s), description(s), order and placement could be altered by contractor personnel, however, pick up site and drop site shall not be outside the parameter of this request. Helicopter landing area(s) will be secured at all times (prior, during and departure). Flight path(s) during lift operations inside the designated operational area(s) will remain clear of unauthorized personnel, equipment, obstacles at all times. Flight path(s) will remain within operational area(s) at all times. The operational area(s) has been surveyed for hazard(s) and mitigated to the lowest risk level acceptable to, or able to obtain, by both 5 State Helicopters, Inc. and contractor(s). Should a unforeseen, or additional hazard(s) surface, lifting will immediately halt till the hazard(s) have been rectified or mitigated. Primary means of communication via radio will be maintained constantly during the operation. Secondary means of communication via hand signals will be immediately incorporated should radio communications fail. Appropriate ATC communications will be maintained by pilot in all possible and/or feasible situations. Narrative: Due to the job-site being a Mall in a residential and commercial area we classify this to be a potential congested area. However, all entrances will be blocked and controlled by security personnel so that no unauthorized persons shall enter or cross the operational area. The building will be vacant inside the operational area during operations. XX 285 BLACKLAND ROAD FATE, TEXAS 75189 (972) 636-4009 office@5state.com www.5state.com Notification of Grapevine City Officials 5 State Helicopters has contacted the following city officials about the lift to be performed on February 23, 2022: City Manager: Natasha Gale 817-410-3155 Your message has been delivered to the following recipients: nlgale@grapevinetexas.gov Subject: 5 State Helicopter Lift of HVAC Equipment February 23, 2022 in Grapevine, Texas at approximately 7:30AM-9:30AM Police: Mike Hamlin 817-410-3225 Your message has been delivered to the following recipients: 'mhamlin@grapevinetexas.gov' (mhamlin@grapevinetexas.gov) Subject: 5 State Helicopter Lift of HVAC Equipment 23 February 2022 in Grapevine, Texas at approximately 7:30AM-9:30AM. Fire Chief: Darrell Brown 817-410-4400 Your message has been delivered to the following recipients: dbrown@grapevinetexas.gov (dbrown@grapevinetexas.gov) rbatchelor@grapevinetexas.gov (rbatchelor@grapevinetexas.gov) Subject: 5 State Helicopter Lift of HVAC Equipment 23 February 2022 in Grapevine, Texas at approximately 7:30AM-9:30AM. ATC: Dallas Fort Worth Intl. Airport 972-615-2605 Your message has been delivered to the following recipients: Segleski, Matthew Y (FAA) (matthew.y.segleski@faa.gov) Lantz, Dallas W (FAA) (dallas.w.lantz@faa.gov) Subject: 5 State Helicopters lift operations 4 miles North of DFW on February 23, 2022. Best Regards, 5 State Helicopters Operational Area Flight Path Landing Area Staging area Emergency Area Blocked Areas Grapevine Mills Mall Rue 21 3000 Grapevine Mills Pkwy Ste. 416 Grapevine, TX 76051 Date of Lift: 2/23/2022 Time: 7:30AM 32°58’ 05.6”N 97°02’ 36.9”W Grapevine Mills Mall Rue 21 3000 Grapevine Mills Pkwy Ste. 416 Grapevine, TX 76051 Date of Lift: 2/23/2022 Time: 7:30AM 32°58’ 05.6”N 97°02’ 36.9”W Helicopter will not Be more than 125’ Above a 40’ building When air lifting Equipment to the Roof. Pilot will contact Dallas Fort Worth Airport. Grapevine Mills Mall Rue 21 3000 Grapevine Mills Pkwy Ste. 416 Grapevine, TX 76051 Date of Lift: 2/23/2022 Time: 7:30AM 32°58’ 05.6”N 97°02’ 36.9”W POLICY NO.: NAF6045920 ATTACHED TO CERTIFICATE # 1 Certificate # 1 Page 1 of 2 CERTIFICATE OF INSURANCE THIS IS TO CERTIFY TO: City of Grapevine 200 S. Main Street Grapevine, TX 76051 THAT THE FOLLOWING POLICY OF INSURANCE HAS BEEN ISSUED TO: 5-State Helicopters, Inc.; California Helicopter Airways, Inc. dba Centerpointe Aerospace and Aviation Resources Holdings LLC 285 Blackland Road Royse City, TX 75189-4746 POLICY NUMBER:NAF6045920 POLICY PERIOD:From February 15, 2022 To February 15, 2023 INSURANCE COMPANY:Endurance American Insurance Co. DESCRIPTION OF COVERAGES AND LIMITS OF LIABILITY: Please refer to attached schedule which is incorporated as a part hereof. This certificate is issued as Evidence of Coverage only. Subject to Date Change Recognition Endorsement. Data included in this Certificate valid as of February 15, 2022. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions and conditions of such policies. Should the described policy be cancelled before the expiration date hereof, the issuing company will endeavor to give 30 days (10 days for non-payment) notice to the certificate holder named herein. However, failure to mail such notice shall not impose any obligation nor any liability of any kind upon the Company, its representatives or agents. By:______________________________________Date of Issue: February 15, 2022 W. Brown & Associates Insurance Services Certificate No.: 1 POLICY NO.: NAF6045920 ATTACHED TO CERTIFICATE # 1 Certificate # 1 Page 2 of 2 SCHEDULE OF LOCATIONS Location of Aviation premises owned, rented to or occupied by the Named Insured: 279 Blackland Road, Fate, TX, 75189-4746 Including those premises necessary and incidental to the Aviation Operations of the Named Insured 285 Blackland Road, Fate, TX, 75189-4746 Type of Coverage: LIMITS OF LIABILITY General Aggregate Limit (Other than Products-Completed Operations and Hangarkeepers’)$10,000,000 Products-Completed Operations Aggregate Limit $10,000,000 Personal Injury & Advertising Injury Aggregate Limit $10,000,000 Each Occurrence Limit $10,000,000 Fire Damage Limit (Any One Fire)$500,000 Medical Expense Limit (Any One Person)$10,000 Property Damage Deductible(s): $10,000 per claim/$10,000 as respects aircraft Operational Area Flight Path Landing Area Staging area Emergency Area Blocked Areas Grapevine Mills Mall Rue 21 3000 Grapevine Mills Pkwy Ste. 416 Grapevine, TX 76051 Date of Lift: 2/23/2022 Time: 7:30AM 32°58’ 05.6”N 97°02’ 36.9”W Grapevine Mills Mall Rue 21 3000 Grapevine Mills Pkwy Ste. 416 Grapevine, TX 76051 Date of Lift: 2/23/2022 Time: 7:30AM 32°58’ 05.6”N 97°02’ 36.9”W Helicopter will not Be more than 125’ Above a 40’ building When air lifting Equipment to the Roof. Pilot will contact Dallas Fort Worth Airport. Grapevine Mills Mall Rue 21 3000 Grapevine Mills Pkwy Ste. 416 Grapevine, TX 76051 Date of Lift: 2/23/2022 Time: 7:30AM 32°58’ 05.6”N 97°02’ 36.9”W Operational Area Flight Path Landing Area Staging area Emergency Area Blocked Areas Grapevine Mills Mall Rue 21 3000 Grapevine Mills Pkwy Ste. 416 Grapevine, TX 76051 Date of Lift: 2/23/2022 Time: 7:30AM 32°58’ 05.6”N 97°02’ 36.9”W Grapevine Mills Mall Rue 21 3000 Grapevine Mills Pkwy Ste. 416 Grapevine, TX 76051 Date of Lift: 2/23/2022 Time: 7:30AM 32°58’ 05.6”N 97°02’ 36.9”W Helicopter will not Be more than 125’ Above a 40’ building When air lifting Equipment to the Roof. Pilot will contact Dallas Fort Worth Airport. Grapevine Mills Mall Rue 21 3000 Grapevine Mills Pkwy Ste. 416 Grapevine, TX 76051 Date of Lift: 2/23/2022 Time: 7:30AM 32°58’ 05.6”N 97°02’ 36.9”W Grapevine Mills Mall - RUE 21 Ste. 4163000 Grapevine Mills ParkwayGrapevine, TX 76051 February 23, 2022 March 5, 2022 217thFebruary Shawn Harris TEXAS ROCKWALL 17th February TEXAS 08-26-2024