Application for permit to operate
an Amusement Device
Amusement Device Regulations 1978
make application for a permit to operate
from to
And certify that having regard to the situation in which the device is erected, it can be operated
without danger to persons operating or using it on or in its vicinity. In support of this application,
there is attached:
The devices Certificate of Registration:
Name of Device
Registration No
The prescribed fee of $ is attached.
(NOTE: The Amusement Devices Regulations 1978 (Clause 4) fixed the following fees (excluding GST):
1. For one device; for the first 7 days, or part therefore - $10.00
2. For each additional device, for the first 7 days or part thereof - $2.00
3. For each device, $1.00 for each 7 days of part thereof).
Please inspect before:
(date and time)
Contact Telephone:
A current copy of the engineers certificate/registration must be attached to this application.
Amusement Devices Regulations 1978
(3) Every person inspecting an amusement device pursuant to subclause (2) of this regulation
shall have regard to whether:
(a) The ground on which the device is erected is capable of supporting it without risk of
(b) There is sufficient clearance between any part of the device and any fixed or moving
objects in its vicinity to prevent injury to any person when the device is in operation:
(c) Such protective fences or barriers as the local authority may require are erected:
(d) In all other respects, the erection and proposed operation of the device complies
with the local authority's bylaws.
(5) A local authority to which an application for a permit in respect of an amusement device
is made shall issue the permit if:
(a) The application is in accordance with these regulations; and
(b) The application is accompanied by the fee prescribed by subclause (6) of this
regulation; and
(c) The person who inspected the device was satisfied of the matters specified in
subclause (3) of these regulations.