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Light-Sport AircraftStatement ofCompliance |
INSTRUCTIONS – Print or type. Present original to an authorizedFAA Representative. If additional space is required, use anattachment. |
| I. Aircraft identification |
1. Manufacturer Name xxxxxx |
2. Manufacturer Address (street, city, zip) xxxxx |
| 3. Aircraft Serial No. xxxxx |
4. Date of Manufacture mm, dd, yyyy |
5. Aircraft Make xxxxxx |
6. Aircraft Model xxx |
| 7. Maximum Take-off Weight 1,000 lbs |
8. Maximum Number Occupants 2 |
9. VH xx KCAS |
10. VS1 N/A |
| Class of light-sport aircraft: (Check all applicable items) Operation on Water |
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Airplane |
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Powered Parachute |
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Weight-Shift Control |
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Glider |
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Lighter Than Air |
| II. Applicable User Manuals |
Consensus Standard(s) (list below or use attachment)ASTM Consensus Standard F 2244.05 Design and PerformanceASTM Consensus Standard F 2242-05 Production Acceptance Testing SystemASTM Consensus Standard F 2426-05a Guide on Wing Interface Documentation |
Revision N/A N/A
N/A |
Valid Until N/A N/A
N/A |
| Aircraft Operating Instructions (list applicable items)Infinity Aircraft Operating Instructions Manual for Commander C-582Consensus Standard: ASTM F 2243-05 Required Product Information |
Revision NONE N/A |
Date issued12-15-2006 N/A |
| Aircraft Maintenance and Inspection Procedures (list applicable items)Infinity Aircraft Maintenance Manual for Commander C-582Consensus Standard: ASTM F 2483-05 Maintenance and Maintenance Manual |
Revision NONE N/A |
Date issued12-15-2006 N/A |
| Aircraft Flight Training Supplement (list applicable items)Located in section 9 of the Aircraft Operating Instructions ManualConsensus Standard: ASTM F 2243-05 Required Product Information |
Revision NONE N/A |
Date issued12-15-2006 N/A |
III> Manufacturer’s Process
Documents |
Comments (any additional statements may be stated here or attached) xxxxxxxxxxxxxxxxxxxx manufactured and assembled XXXX MODEL, Serial Number XXXXX, N Number NXXXX, which was issued a special airworthiness certificate in the Light-Sport category on XX-XX-XXXX. This aircraft was manufactured as an E-LSA [Experimental Light Sport Aircraft] KIT”. It is the responsibility of the Purchaser/Owner to complete the “Kit Instruction Procedures”. The Purchaser/Owner must sign the Kit Instruction document and present it to the DAR [Designated Airworthy Inspector] along with this form 8130-15 when the aircraft is ready for it’s “Airworthiness Inspection”. |
| Manufacturer’s Quality Assurance System (list applicable items)Infinity Quality Assurance System manualConsensus Standard: ASTM F 2240-05 Quality Assurance Program |
Revision NONE N/A |
Date issued12-15-2006 N/A |
| Manufacturer’s Continued Airworthiness System (list applicable items)Infinity Continued Airworthiness System ManualConsensus Standard: ASTM F 2241-05a Continued Airworthiness System |
Revision NONE N/A |
Date issued12-15-2006 N/A |
| IV. Manufacturer’s Certification |
CERTIFICATION: I hereby certify that aircraft kit serial number ____________ complies with the ConsensusStandard(s) identified on this statement of compliance and that the Manufacturer’s Continued AirworthinessSystem will be adhered to support the aircraft throughout its life. This aircraft (1) was manufacturedfollowing the consensus standard(s) procedures and Manufacturer’s Quality Assurance System identifiedon this statement, (2) conforms to the manufacturer’s design data, (3) was ground and flight testedsuccessfully, and (4) is in a condition for safe operation. Additionally, at the request of the FAA, themanufacturer will provide unrestricted access to its facilities. |
| Name: XXX |
Signature: |
| Title: Manager |
Date: |
| Name: |
Signature: |
| Title: |
Date: |
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