Form Sh-80 - Application For Amusement Device, Viewing Stand Or Tent Operating Permit - New York State Department Of Labor Page 2
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1
2Permit Application Information
You must have a valid New York State (NYS) issued operating permit for each amusement device, viewing stand or tent
before it is used in New York State. They are good for one year.
However, even if you have a permit, you must NOT use any amusement device, viewing stand or tent, if it is not
properly assembled, is defective, is unsafe in any of its parts, components, controls or safety equipment.
Required inspections of a temporary or permanent amusement device, viewing stand or tent in NYS:
•
An inspection by the New York State Department of Labor (DOL) is mandatory before the first time use in NYS.
•
An annual inspection is mandatory every year
•
An amusement device, viewing stand or tent must be inspected by the DOL
For each Amusement Device Permit Application:
For each Viewing Stand or Tent Permit Application:
•
Submit a completed and signed application for each
•
Submit a completed and signed application for each
device to the:
viewing stand or tent to the:
New York State Department of Labor
NYS Department of Labor
Division of Safety and Health
Division of Safety and Health
License and Certification Unit
Engineering Services Unit
Harriman State Office Campus
Harriman State Office Campus
Building 12, Room 161A
Building 12, Room 154
Albany, NY 12240
Albany, NY 12240.
•
With each amusement device permit application
•
With each viewing stand or tent permit application
include the following:
include the following:
Forms:
Forms:
o
o
a)
Certificate of Liability Insurance
a – f)
All the forms listed in the amusement
b)
Certificate of Workers’ Compensation
devise section (a - f), plus:
(see list of acceptable forms below)
g)
Design plans
c)
Disability Insurance Coverage
h)
Application for Examination of Plans
(see list of acceptable forms below)
i)
For a permit renewal, see (f) in the
d)
Location Notice, and Equipment Inventory
amusement devise section
e)
Certificate of Flammability Test
Fee:
o
f)
For a permit renewal also include the
None, there is no required fee for viewing
affidavit of annual inspection if it was done by
stand or tent permits
a licensed architect, professional engineer, or
inspector for an insurance underwriter
•
Note for renewals:
You must submit your application and all required
Fee:
o
accompanying information 10 days prior to the
Include a non-refundable one hundred
permit issue date.
dollars, $100.00, fee with each application.
Please make your check or money order
payable to the Commissioner of Labor
•
Note for renewals:
You must submit your application, fee, and all required
accompanying information 10 days prior to the permit
issue date.
Proof of Workers’ Compensation Insurance forms
Proof of Disability Insurance forms
(only one is needed):
(only one is needed):
S-105.2
Certificate of Workers’ Compensation Insurance
CE-200
Certificate of Attestation of
CE-200
Certificate of Attestation of Exemption
Exemption
U-26.3
State Insurance Fund’s version of C-105.2
DB-120.1
Certificate of Disability
SI-12
Certificate of Group Workers’ Compensation Self-Insurance
Insurance
GSI-12
Certificate of Group Workers’ Compensation Self-Insurance
DB-155
Certificate of Disability
GSI-105.2
Certificate of Participation in Workers’ Compensation
Benefit Self-Insurance
Group Self-Insurance
Page 2 of 2
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