TBC use only Date received: Fee received: $ Receipt no: Received by (TBC staff name): This form is used for the registration of a plant design in accordance with Regulation 243 of the Work Health and Safety (National Uniform Legislation) Regulations. Please refer to the guide to plant design registration for further information. Application fee: $105.00 Type of application: New design Alteration of design Applicant details Designer Person with management or control of item of plant Company name: ABN: Trading name: Contact person: Position title: Business address: Suburb: State: Postcode: Is your postal address the same as above? (If no, complete below) Yes No Postal address: Suburb: Postcode: Work number: Mobile number: Email address: Plant details Name of manufacturer: Description of Name of plant (e.g. amusement device name): Model no: Date of design or alteration: Information required for representation drawing(s) Title: Drawing number: Revision number: Location If applicant/body corporate is located outside the Northern Territory, please provide circumstance to justify the grant of registration:
Class according to AS 1210: (select one or provide details in from the standard used) 1 1H 1S 2A 2B 2H 2S 3 Other (specify): Volume (m3): Minimum design pressure (kPa): Maximum (kPa): Minimum design temperature (°C): Maximum (°C): Vessel contents (select one): Liquid Gas Type of vessel (select one): Steam vessel Miscellaneous vessel Transportable pressure vessel Steam vessel (select one): Steam jacketed vessel Steam vessel with quick actuating closure De-aerator Other (specify): Miscellaneous vessel (select one): Air receiver Auxiliary vessel Static storage (corrosive) Buried or mounded vessel Static storage (non-corrosive) Fire heaters/convection bank Process vessel (including corrosive) Vacuum vessel heater Static law temperature vessel Refrigeration and air conditioning Heated vessel than steam) with quick actuating closure Transportable pressure vessel (select one): Bulk (LPG, ammonia) quenched and tempered construction Bulk (LPG, ammonia) carbon steel construction Low temperature (less than 10°C) Powder discharge – aluminium construction Powder discharge – carbon steel construction (specify): 4.2. Gas cylinder Design pressure (MPa)(if applicable): Test pressure (MPa): Design Temperature: (°C) Volume: (m3) Content (select one): Permanent Medical gases Mixtures HP liquefied gases LP liquefied gases Material Type (select one): Steel Aluminium Other (specify): Construction Type (select one): Welded Seamless Composite 4.3. Tower crane
Type (select one): Non luffing Luffing – Winch Luffing – Hydraulic cylinder Maximum rated capacity: (t) Maximum boom length: (m) Maximum radius: (m) Maximum installed height: (m) Support: Free standing Tied to structure Type (select one): Self-erecting Fixed Rail mounted Internal climber Articulated jib Trolley jib 4.4. Lift Maximum rated load: (kg) Maximum travel: (m) Maximum speed: (m/s) Car maximum floor area:(m2) Maximum passengers: Number of levels serviced: Number of openings: type (Select Appropriate): Water Electric Hydraulic Lift mechanism (Select One): Traction Screw Drum Oil hydraulic Water hydraulic Electric motor direct drive Suspension wire rope type: Yes No Control Type (Select One): Automatic Non Automatic Lift motor control type: (select one) Single Speed AC Two Speed AC Variable voltage AC Variable Frequency Variable voltage DC - Static Variable Frequency DC – Motor Generator Other (specify): Lift Type (select one): Goods Stairway Service Inclined Special Purpose Industrial People with limited mobility Low rise platform for passengers 4.5. Escalator or moving walkway Rated capacity (maximum number of persons per hour): Maximum speed (m/s): Maximum rated capacity: (kg) Maximum working height: (m) 4.6. Building maintenance unit Type (select one or provide details in from Standard used): A B C (according to AS 1418.13) (specify): Maximum capacity (kg): Maximum working height: (m)