SUPPLEMENTAL NOTICE Form Approved OMB No. 2120-0001 Expiration Date: 7/31/07 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. Notice of Actual Construction or Alteration (Ple ase Type or Print on this Form) U.S. Department of Transportation Federal Aviation Administration 1. Construction A. Type and Description of Construction B. Owner of Structure New Alteration 2. Construction Location -- Height A. Coordinates (To hundredths of seconds, if known) Latitude ° B. Location (City, State, include Street Address if any) Longitude ' " ° C. Construction Heights ' " Total Height (Structure & Site) Above Mean Sea Level Site Elevation Structure Height Ft. AMSL Ft. AGL Ft. AMSL E. Reference datum of coordinates D. Site Elevation Determined By NAD 27 NAD 83 Other (Specify) 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 B. Construction/Project A. Notification (Notice Is Critical to Flight Safety --- FAR Part 77 Required) Date (1) Construction will start (Submit at least 48 hrs. in advance Date (1) Project Abandoned (2) Estimated Completion (2) Construction Dismantled (3) Structure Reached Greatest Height (Submit within 5 days) 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 Submitted by: (If submitted by a proponent’s representative, please also complete item B.) 6. Preparer’s Certification A. Proponent’s Representative Name: B. Construction Proponent Name: Address: Address: Tel. No.: (Include Area Code) 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 American LegalNet, Inc. www.FormsWorkflow.com 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 American LegalNet, Inc. www.FormsWorkflow.com