Pipistrel LSA-MRA Manual

R
Title or
Hard landing repair + oil thermostat addition
Task Description
(MRA request received 30
NOTE: Any external documents referenced on this form should include revision level, issue date, and title as appropriate.
BLOCK 1 – AIRCRAFT INFORMATION (to be filled out by the manufacturer)
S/N:
891 SNM 912 LSA
BLOCK 2 – OWNER INFORMATION (to be filled out by the manufacturer)
Name: Mr Joel Garris
Address: 129 Spinnaker Mall, Marina Del Rey, 90292 California
Equipment Manufacturer
Fuselage Pipistrel
Powerplant Rotax GmbH
Propeller Pipistrel
The Aircraft OEM confirms the
aircraft being repaired or altered
still meets the requirements of the
applicable ASTM design and
performance specification
subsequent to completion of the
repair or alteration specified in the
MRA
DISCLAIMER: It is the responsibility of the person that performs this MRA to ensure the equipment installed or item repaired functions properly and
doesn't negatively affect any other installations/equipment close to where the MRA was performed, as this is something the manufacture cannot check.
This MRA has been generated based on the aircraft configuration data provided by the owner/requester and is to be rendered invalid if the
owner/requester doesn't provide the manufacturer with any/all information regarding repairs/alterations performed on the aircraft prior to the issue of
this MRA. The information provided in this MRA is, by no means, task specific training and must not be considered as such.
BLOCK 5 - CONFORMITY STATEMENT - RETURN TO SERVICE (to be filled out by the customer)
I hereby certify the repair and/or alteration has been completed in accordance with this MRA and all
the referenced documents. Potentially unclear procedures have been clarified with the Aircraft OEM.
Certificate holder's name
and address
Return to service declaration
I, the signee and certificate holder,
hereby confirm that I meet the
minimum required level of
qualification as outlined in this
MRA, I have indicated completion
of this MRA in the aircraft's
logbook by referencing MRA011-21
and any/all national
requirements/regulations have
been adhered to
LSA Major Repair and/or
Alteration (MRA)
June 2021)
th
Registration:
N88NN
BLOCK 3 - AIRCRAFT DATA (to be filled out by the manufacturer)
Model
Sinus MAX
Rotax 912 UL2
VARIO D
BLOCK 4 - MRA APPROVAL (to be filled out by the manufacturer)
Date of approval:
16th September 2021
Name:
Andrej B Horvat
No issues were observed that might hinder return to service.
Required level of qualification.
(to be marked by manufacturer, multiple marks indicate
any may perform the MRA)
Pilot/Owner
LSA repairman
AMT
X Repair station
X Manufacturer
Other:
Date
Engine time/Hobbs: 261
Total time
since new
n/a
n/a
n/a
Certificate type and number
Signature
Doc#: MRA011-21
Rev: A00
Replaces: n/a
Date: 16.09.2021
Total time
since overhaul
n/a
n/a
n/a
Digitally signed by
ANDREJ BERNARD
HORVAT
Reason: Engineering office
Location: Nova Gorica,
Slovenia, EU
Date: 2021/09/16 21:59
+02'00'
Rating
Airframe class 1
Powerplant class 1
Propeller class 1
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