HomeMy WebLinkAbout2. 1636 Lincoln Way West_COA 2022-0404 - SBFD Photos from 4 5 22South Bend Fire Department
Drone Photos from 4/5/2022
FAA REQUEST FORM FOR
EXPEDITED SGI WAIVER OR AUTHORIZATION FOR UAS OPERATION
Basic Qualifications
The requesting operator must possess a Certificate of Waiver or Authorization (COA) or Part 107 Pilot License
The UAS operation must support an emergency response or other effort being conducted to address exigent
circumstances and that will benefit the public good
The requested FAA approval cannot be secured via normal processes in time to meet urgent operational needs
Operator Information
Operator Organization (e.g., agency or company)
South Bend Fire Department
Operator Address
1222 S. Michigan St. South Bend IN. 46601
Operator Point-of Contact (including name, office + mobile phone number, and email)
John Nickison 574-876-9587 jnickiso@southbendin.gov
Pilot and Observers (including names, mobile phone numbers, and emails)
John Nickison (see above) Andy Petrie, Scott Mellen
Type of UAS and Registration Number
DJI Matrice 210 FA34TYLHAK
Documentation
If the requested UAS operation will be flown under a pre-existing COA, please attach it hereto and provide the COA
number below.
2019-CSA-3269-COA
If the requested UAS operation will be flown under Part 107, please provide the Part 107 Pilot License number below.
4169986
Requested Flight Details
Enter the date(s) of the proposed UAS operation (e.g., 03/18/2018 or 03/18/2018-03/21/2018) Mandatory entry
04/05/2022
Enter the times of the proposed UAS operation (be sure to confirm time zone; e.g., 1200L-1400L daily) Mandatory entry
1200-1600
Enter the location of the proposed flight (reference the nearest city or town, and state; e.g., Gulfport, MS)
South Bend, IN.
Enter the distance and direction from the nearest airport, and FAA identification of the same (e.g., 6 NM W of GPT)
2.5 miles SE of SBN Airport
Identify the class(es) of airspace in which the flight will be conducted (e.g., Class G/E/D/C/B/A)
Class C