<table>
<colgroup>
<col style="width: 2%" />
<col style="width: 4%" />
<col style="width: 5%" />
<col style="width: 3%" />
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<col style="width: 1%" />
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</colgroup>
<tbody>
<tr class="odd">
<td colspan="33"></td>
<td colspan="11">PAGE 1 of ______ PAGES</td>
</tr>
<tr class="even">
<td colspan="33"><strong>TYPE INSPECTION AUTHORIZATION</strong></td>
<td colspan="11">PROJECT NO.</td>
</tr>
<tr class="odd">
<td colspan="33">TO: FLIGHT ______________ MANUFACTURING
________________</td>
<td colspan="11">DATE</td>
</tr>
<tr class="even">
<td colspan="23">NAME OF APPLICANT</td>
<td colspan="21">ADDRESS (Number, street, city, and zip code)</td>
</tr>
<tr class="odd">
<td colspan="44">1. INSPECTION AUTHORIZATION FOR</td>
</tr>
<tr class="even">
<td></td>
<td colspan="5">AIRPLANE</td>
<td colspan="8">OTHER (specify)</td>
<td colspan="3"></td>
<td colspan="27">NEW MODEL (Give model no.)</td>
</tr>
<tr class="odd">
<td></td>
<td colspan="5">ENGINE</td>
<td colspan="8"></td>
<td colspan="3"></td>
<td colspan="27"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="5">PROPELLER</td>
<td colspan="8"></td>
<td colspan="3"></td>
<td colspan="18">ALTERED MODEL (Give name of original Manu. and model
no.)</td>
<td colspan="9">ORIGINAL T.C. DATA SHEET.</td>
</tr>
<tr class="odd">
<td></td>
<td colspan="5">ROTORCRAFT</td>
<td colspan="8"></td>
<td colspan="3"></td>
<td colspan="18"></td>
<td colspan="9"></td>
</tr>
<tr class="even">
<td colspan="44">2.0 CERTIFICATION BASIS</td>
</tr>
<tr class="odd">
<td colspan="44">3.0 CATEGORY - FOR AIRCRAFT ONLY (Check all applicable
items)</td>
</tr>
<tr class="even">
<td></td>
<td colspan="3">NORMAL</td>
<td colspan="3"></td>
<td colspan="6">UTILITY</td>
<td colspan="3"></td>
<td colspan="6">ACROBATIC</td>
<td colspan="2">X</td>
<td colspan="5">TRANSPORT</td>
<td colspan="2"></td>
<td colspan="6">RESTRICTED</td>
<td colspan="4"></td>
<td colspan="3">OTHER (specify)</td>
</tr>
<tr class="odd">
<td colspan="44">4. DESCRIPTION OF ALTERATION</td>
</tr>
<tr class="even">
<td colspan="14"><p>5. DESIGN SPEEDS - KNOTS</p>
<p>SEE PAGE *</p></td>
<td colspan="16"><p>6. MAXIMUM MACH NO (DESIGN)</p>
<p>SEE PAGE *</p></td>
<td colspan="14"><p>7. DESIGN WEIGHTS -</p>
<p>SEE PAGE *</p></td>
</tr>
<tr class="odd">
<td colspan="14"><p>8. MAXIMUM OPERATING ALT (Feet)</p>
<p>SEE PAGE *</p></td>
<td colspan="16"><p>9. MAXIMUM CABIN DIFF (psi)</p>
<p>SEE PAGE *</p></td>
<td colspan="14"><p>10. CG. LIMITS -</p>
<p>SEE PAGE *</p></td>
</tr>
<tr class="even">
<td colspan="23"><p>11. CARGO AND BAGGAGE COMPARTMENTS - LOCATION</p>
<p>AND MAXIMUM LOADS -</p>
<p>SEE PAGE *</p></td>
<td colspan="21"><p>12. STRUCTURAL/MANEUVER LIMITS -</p>
<p>SEE PAGE *</p></td>
</tr>
<tr class="odd">
<td colspan="44">13. OPERATING LIMITATIONS *</td>
</tr>
<tr class="even">
<td colspan="25">ENGINE MAKE AND MODEL (FOR TURBINE ENGINE SEE PAGE
)</td>
<td colspan="19">ENGINE DATA SHEET NO.</td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="3">TAKEOFF</td>
<td colspan="15">LOW RATIO SUPERCHARGER</td>
<td colspan="12">HIGH RATIO SUPERCHARGER</td>
<td colspan="10">Max. Allowable Temp.</td>
<td colspan="2">DegF</td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="3">(specify)</td>
<td colspan="6"></td>
<td colspan="9">ALT HEIGHT</td>
<td colspan="6">ALT (MIN.)</td>
<td colspan="6">ALT (MAX.)</td>
<td colspan="6">Cylinder Head</td>
<td colspan="4">Washer</td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="2">ITEM</td>
<td colspan="3"></td>
<td colspan="6">SEA LEVEL</td>
<td colspan="9">feet</td>
<td colspan="6">feet</td>
<td colspan="6">feet</td>
<td colspan="6">(or coolant outlet)</td>
<td colspan="4">Bayonet</td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="3">(minutes)</td>
<td colspan="6"></td>
<td colspan="9"></td>
<td colspan="6"></td>
<td colspan="6"></td>
<td colspan="10">Cylinder Base</td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="2">IN Hg</td>
<td colspan="3"></td>
<td colspan="6"></td>
<td colspan="9"></td>
<td colspan="6"></td>
<td colspan="6"></td>
<td colspan="10">Oil Inlet</td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="2">RPM</td>
<td colspan="3"></td>
<td colspan="6"></td>
<td colspan="9"></td>
<td colspan="6"></td>
<td colspan="6"></td>
<td colspan="10">Minimum Carburetor Heat</td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="2">HP</td>
<td colspan="3"></td>
<td colspan="6"></td>
<td colspan="9"></td>
<td colspan="6"></td>
<td colspan="6"></td>
<td colspan="10">Rise at %MC Power</td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="44">14. PROPELLER N/A</td>
</tr>
<tr class="odd">
<td colspan="24">MAKE AND MODEL</td>
<td colspan="12">DATA SHEET NO.</td>
<td colspan="8">DIAMETER</td>
</tr>
<tr class="even">
<td colspan="9">HUB MODEL NO.</td>
<td colspan="15">BLADE MODEL NO.</td>
<td colspan="20">LIMITATIONS - SEE PAGE</td>
</tr>
<tr class="odd">
<td colspan="14">15. ROTORCRAFT N/A</td>
<td colspan="5">MAXIMUM</td>
<td colspan="5">MINIMUM</td>
<td colspan="20">16. INSPECTION REPORT N/A</td>
</tr>
<tr class="even">
<td colspan="14">POWER ON ROTOR LIMITS - RPM</td>
<td colspan="5"></td>
<td colspan="5"></td>
<td colspan="15">100 HOUR INSPECTION COMPLETED</td>
<td colspan="4"></td>
<td>YES</td>
</tr>
<tr class="odd">
<td colspan="14">POWER OFF ROTOR LIMITS - RPM</td>
<td colspan="5"></td>
<td colspan="5"></td>
<td colspan="15"></td>
<td colspan="4"></td>
<td>NO</td>
</tr>
<tr class="even">
<td colspan="18">17. EQUIPMENT LIST</td>
<td colspan="26">18 TYPE INSPECTION REPORT</td>
</tr>
<tr class="odd">
<td colspan="10">IS EQUIPMENT LIST CORRECT AS TO</td>
<td colspan="2"></td>
<td colspan="6">YES</td>
<td colspan="2"></td>
<td colspan="24">COMPLETE APPLICABLE PORTIONS OF TYPE INSPECTION REPORT,
PART 1</td>
</tr>
<tr class="even">
<td colspan="10">WEIGHT AND ARM OF EACH ITEM?</td>
<td colspan="2"></td>
<td colspan="6">NO</td>
<td colspan="2"></td>
<td colspan="24">COMPLETE APPLICABLE PORTIONS OF TYPE INSPECTION REPORT,
PART 2</td>
</tr>
<tr class="odd">
<td colspan="3">EQUIPMENT</td>
<td colspan="2"></td>
<td colspan="3">YES</td>
<td colspan="10">MFGR. REPORT NO.</td>
<td colspan="2"></td>
<td colspan="24">SEE ATTACHED PAGES FOR INSTRUCTIONS</td>
</tr>
<tr class="even">
<td colspan="3">LIST ATTACHED</td>
<td colspan="2"></td>
<td colspan="3">NO</td>
<td colspan="10"></td>
<td colspan="2"></td>
<td colspan="24">SEE ATTACHED PAGES FOR SPECIAL TEST (Define divisions
of responsibilities)</td>
</tr>
<tr class="odd">
<td colspan="8">ORIGINATED BY</td>
<td colspan="36">CONCURRENCES</td>
</tr>
<tr class="even">
<td colspan="8">ROUTING SYMBOL</td>
<td colspan="7">ROUTING SYMBOL</td>
<td colspan="6">INITIALS</td>
<td colspan="7">ROUTING SYMBOL</td>
<td colspan="6">INITIALS</td>
<td colspan="6">ROUTING SYMBOL</td>
<td colspan="4">INITIALS</td>
</tr>
<tr class="odd">
<td colspan="8"></td>
<td colspan="7"></td>
<td colspan="6"></td>
<td colspan="7"></td>
<td colspan="6"></td>
<td colspan="6"></td>
<td colspan="4"></td>
</tr>
<tr class="even">
<td colspan="8"></td>
<td colspan="7"></td>
<td colspan="6"></td>
<td colspan="7"></td>
<td colspan="6"></td>
<td colspan="6"></td>
<td colspan="4"></td>
</tr>
<tr class="odd">
<td colspan="44">APPROVAL</td>
</tr>
<tr class="even">
<td colspan="8">DATE</td>
<td colspan="19">TITLE Project Manager</td>
<td colspan="17">SIGNATURE</td>
</tr>
<tr class="odd">
<td colspan="8"></td>
<td colspan="19"></td>
<td colspan="17"></td>
</tr>
</tbody>
</table>

FAA Form 8110-1 (3-66) FORMERLY FAA FORM 316 FAA AC 71-6232
0052-025-2008

(Computer Generated Form)