Airworthiness Certificate Application
Program Letter

To _Carl Gerker  Duty Officer
Van Nuys MIDO                                                                Date July 12, 2004
7120 Havenhurst Ave.
Van Nuys Ca. 91406

In accordance with Section 21.193, I request a Special Airworthiness Certificate for my aircraft for the purpose of operating amateur-built aircraft.  The aircraft description is as follows:

Builder:               Charles L. Scrivner
Registration Number:  N69QT
Model :               Quicksilver MX
Number of seats      :   1
Design Criteria:   Built from a kit

The Aircraft is complete and the following items have been accomplished:

I enclose FAA form 8130-6 with sections I, II and III complete.

I enclosed FAA form 8130-12 with sections I, II and III complete and notarized in Section IV.

I possess AC form 8050-3 (copy enclosed, original in aircraft).

I enclose photographic identification of the Aircraft.

I have weighed the aircraft to determine that the most forward and aft center of gravity positions are within the established limits.  A copy is submitted, original in aircraft.

I have maintained a construction log including photographs showing methods of construction and workmanship. 

The marking requirements of Part 45 have been complied with, including permanent attachment of a fireproof identification plate, permanent application of appropriate registration marks, and the word "EXPERIMENTAL" displayed near each entrance to the cockpit.

           The aircraft will be available for inspection at the below location:

4040 Knox Ave.
Rosamond Ca.  93560
In my residence Hanger Located at:
Rosamond SkyPark  ( L00 )

I request airworthiness certification and operating limitations consistent with Glider / Ultralight Phase One flight testing guidelines as per 8130-2E and AC 20-27E 13(a) for the recommended 10 hours Phase One period permitting me to operate the aircraft within the following geographic area.
            A 25 statute mile radius of Rosamond Skypark (L00)
            Lat  34-52-14.918N     Long.118-12-33.270W
            Rosamond,  California  93560

 Avoiding flight in congested airways or overflight of any congested areas, cities, towns or assembly of persons and only over sparsely populated areas during that Phase one testing period.

I also request that (glider) in parentheses, be appended to the Special Airworthiness Certificate, Section A, after Category/Designation as per 8130-2E,  paragraph 239 Section A (1) and Paragraph121(d).

       As per "additional guidance" refereed to in 8130-2E, paragraph 121(d) and found in AC 21.17-2, Design Criteria for Standard Airworthiness (type Certificated) powered gliders; 

      N69QT is an EXPERIMENTAL aircraft and as per AC 20-27-E no required design criteria has been  established "nor does the FAA intend to establish design criteria for the multitude of experimental aircraft designs that may be presented".   The numerous "guidances" found in AC21.17-2 including (Maximum Weight / Wingspan  Squared < .62. is intended for Type Certificated, STANDARD AIRWORTHY powered gliders that may be used for commercial and training purposes under Part 21.

An Experimental aircraft (glider) is not required to have any Type Certificated equipment such as engine, Propellor, seatbelts, brakes, tires, instruments or radios, nor stress structural testing as required by AC21.71-2. 

   As per 8130-2E, Para 121 (d), this aircraft "clearly" exhibits the qualities of a "glider" as defined in the FAA Glider Flying Handbook - 8083-13, Chapter I, page 1-1

    Operating limitations shall limit flight of this aircraft to only those Pilots that meet the requirements of $61.31 (e), (f), (g), (h0, and (j) as appropriate.   The aircraft and pilot operations to conform to all related FAR limitations/privilages for that Category/Class/Designation.

    Initial flights will determine engine reliability, flight control characteristics, computations of minimum sink, L/D ratios, thermal soaring, orographic lift and wave soaring.

   A flight test plan has been developed using guidance in AC 90-89 and is available for review.  After Phase One flight test is completed, I plan to operate the aircraft under VFR conditions only, limited to Glider (self launch) Category/Class/Designation.

   At this time, I also request application for a Repairman Certificate for the above noted aircraft.

This aircraft kit is listed with FAA as meeting the requirements of Amateur Built status.

My residence telephone number is 661-



Charles L. Scrivner - Owner/Builder