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HomeMy WebLinkAboutFIR2022-00056 - FIR Permit / Conditions - 12/5/2022 ti Mason County Mason County - Division of Community Development 615 W. Alder St. Bldg.8 1 Shelton, WA 98584 360-427-9670 ext 352 www.co.mason.wa.us FIR2022-00056 FIREWORKS DISPLAY (PYROTECHNIC LICENSE REQUIRED) PROJECT DESCRIPTION: FIREWORKS DISPLAY— DATE OF DISPLAY ISSUED: 12/05/2022 12/311 022 MIDNIGHT SITE ADDRESS: 10 E ALDERBROOK DR UNION EXPIRES: 06/03/2023 PARCEL: 322335000014 APPLICANT: ALDERBROOK RESORT&SPA OWNER: NORTH FORTY LODGING 10 East Alderbrook Drive PO BOX 609 UNION,WA98592 UNION,WA98592 360-898-2252 GENERAL CONTRACTOR'S LICENSE: WOLVERINE WEST LLC License: C-04138 PO BOX 628 Expires: 01/31/2023 CHEHALIS,WA98532 1.206.459.0917 FEES: Paid Due Fireworks Display Permit $250.00 $0.00 Totals : $250.00 $0.00 REQUIRED INSPECTIONS Fireworks Inspection CONDITIONS * Failure to comply at any time with the provisions of this rule or any other applicable regulation shall constitute a violation of chapter 70.77 RCW and may result in the temporary suspension or immediate revocation of the license or permit, closure of the fireworks sales or storage structure,the seizure and/or forfeiture of some or all of the fireworks, and other criminal penalties as specified by law. * (3)A temporary fireworks storage facility or a temporary fireworks storage location shall be authorized as a part of a license and permit if it meets the requirements specified herein. Printed by:Genie Mcfarland on:12/05/2022 02:10 PM Page 1 of 3 Mason County mmllgm Mason County - Division of Community Development 615 W. Alder St. Bldg.8 Shelton, WA 98584 360-427-9670 ext 352 www.co.mason.wa.us FIREWORKS DISPLAY (PYROTECHNIC LICENSE REQUIRED) FIR2022-00056 * (6) Fireworks may be stored: (a) In a locked or secured retail fireworks stand; or (b) In a locked or secured truck, container,trailer, other vehicle or anything similar which is not less than twenty feet from the retail fireworks stand during hours of retail sales; or (c) In a locked or secured truck, container,trailer, other vehicle or anything similar which is not less than twenty feet from an inhabited building where the term "inhabited building" is defined as in the International Fire Code; or (d) In a magazine which meets the minimum standards of Type 4 as prescribed by the International Fire Code, and which is not less than ten feet from an inhabited building where the term "inhabited building" is defined as in the International Fire Code; or (e) In a locked or secured metal or wooden garage, shed, barn or other accessory building, or anything similar which is not less than: 20 feet from an inhabited building for storage of fireworks for one or two retail stands; or 30 feet from an inhabited building for storage of fireworks for three or more stands. The term "inhabited building" is defined as in the International Fire Code. * (4) No open flames nor any type of open flame equipment shall be allowed in any temporary fireworks storage structure. * (9)Temporary fireworks storage structures may be inspected prior to use and other inspections may occur on other days as warranted. There shall be no additional charge for all such inspections. * (2) Delivery of fireworks to a location, or storage of fireworks in a facility, not authorized by the license and permit is prohibited. If the approved storage location is outside the jurisdiction issuing the permit, the authority issuing the permit shall notify the appropriate authorities of the jurisdiction in which the storage is to be located. * Retailers of fireworks—Cleanup. (1)At the end of the legal selling period, all fireworks must remain in the retail fireworks stand,temporary storage location authorized by the retail permit or another location approved by the local authority having jurisdiction or his or her designee until returned to the suppliers from which they were obtained, or until transferred to an approved location. * STORAGE ASSOCIATED WITH RETAIL FIREWORKS: WAC 212-17-21517 Retailers of fireworks—Temporary fireworks storage associated with the retail fireworks stand operation. (1)Temporary fireworks storage is not permanent fireworks storage. Temporary fireworks storage is defined as storage associated with retail fireworks sales and may only be from June 13 through July 31 and from December 12 through January 10 of the following year. Permanent fireworks storage is associated with retail or wholesale fireworks activities when the period of time of storage is other than, or longer than that specified for temporary storage.Temporary fireworks storage shall be in accordance with this section. Permanent fireworks storage is subject to the International Fire Code and the and local ordinances. * (8) No cooking is permitted in a retail fireworks stand or in a temporary fireworks storage structure. * (3) In order to obtain return of a clean-up bond, cleanup of debris associated with the retail fireworks activity and the removal of all temporary structures authorized by the license and permit shall be completed no later than 11:59 p.m., July 15 for the Fourth of July selling period or no later than 11:59 p.m., January 10 for the New Year's selling season. * (2)Cities and counties may require a clean-up bond, not to exceed five hundred dollars, as a condition of the permit,to ensure the removal of all structures and debris from the site. * (7)The local authority having jurisdiction may reduce the minimum separation requirements of this section provided that safety of life and property is not diminished. Printed by:Genie Mcfadand on:12/05/2022 02:10 PM Page 2 of 3 Mason County gIIBBNINM Mason County - Division of Community Development 615 W. Alder St. Bldg.8 Shelton, WA 98584 360-427-9670 ext 352 www.co.mason.wa.us FIREWORKS DISPLAY (PYROTECHNIC LICENSE REQUIRED) FIR2022-00056 (5) Storage of fireworks authorized by a retail license and permit is legal only during the periods specified in this section. (4) Failure of the licensee to comply with subsection (3) of this section shall constitute forfeiture of the clean-up bond and the licensee shall be liable for any clean-up costs incurred by the city or county which exceed the amount of the bond. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of Laws and Ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state/local law regulating construction or the performance of construction. Issued By: C Contractor or Authorized Agent: ' `r(A_,L er'Q_ C�►��t � Date: r Printed by:Genie Mcfarland on:12/05/2022 02:10 PM Page 3 of 3 r ` MASON COUNTY (360)427-9670 Shelton ext.352 DEPARTMENT OF COMMUNITY DEVELOPMENT (360)275-4467 Belfairext. 352 BUILDING. PLANNING• FIRE MARSHAL (360)482-5269 Elma ext. 352 Mason County Bldg. III, 426 West Cedar Street PO Box 279, Shelton, WA 98584 www.co.mason.wa.us FIR20 Mason County Fireworks Permit Application Incomplete applications will not be accented A permit for retail sales or public display of fireworks is required. A completed application with required documentation and fees shall be submitted for Fire Marshal review. A permit will be issued upon satisfactory site inspection by the Fire Marshal. Applicant Information: Owner: Alderbrook Resort&Spa Mailing Address: 7101 E WA-106 City: Union State: WA Zip: 98592 Phone#: 360.303.8274 Email: eric.sundC@alderbrookresort.com Sponsor Information: Name: Alderbrook Resort&Spa Address: 7101 E WA-106 City: Union State: WA Zip: 98592 Phone #: 360.303,8274 Email: eric.sund(�alderbrookresort.com Washington State Fireworks License Information (Copy Required): License Number: P-04311 Date of Issuance 5/13/22 ^Pyrotechnic Operator License ❑ Fireworks Stand License Bond or Certificate of Insurance (Copy of Certificate/Bond Required): Provider: The Partners Group, Ltd. Insured: Wolverine West,LLC Certified Holder: Alderbrook Resort&Spa Location of Stand/Display: Site Address: 7101 E WA-106, Union,WA 98592 Directions to Site: see attached d, 5C) Parcel Number: (twelve digit number) - -Fired from dock Legal Property Owner n/a "Please see reverse side to complete your application" The following pertinent information MUST be provided on the site diagram below Location and Setback distances from the back, sides and front of retail sales stands or designated display areas to: Fire Hydrants Property Lines Mortar separation distance Combustibles Parking Designated landing area Fire Lanes Public Roads and Right of Ways Trees/Brush Private Roads and Right of Ways Utilities Landmarks see attached aerial Applicants Affidavit I certify that the information provided herein is accurate and that compliance with all County, State and Federal laws pertaining to the sales or discharge of fireworks shall be maintained. Rodney F. Digitally signed by Rodney F.Hash DN:cn=Rodney F.Hash,o=Wolverine Signed West,"C,ou, _ Date 12/1/2022 Has'11 Date:2022.12.01 13:45:16-08'00' PART I �'® APPLICATION DATE OF APPLICATION FOR PUBLIC FIREWORKS DISPLAY PERMIT 12/1/22 TO: Governing body of city, town, or county in which display is to be conducted. APPLtCANT NAME ADDRESS PHONE Wolverine West Fireworks PO Box 628-Chehalis,WA 98532 206.459.0917 SPONSOR ADDRESS PHONE Alderbrook Resort&Spa 7101 E WA-106, Union WA 98592 360.898.2252 PYROTECHNIC OPERATOR - NAME ADDRESS LICENSE# Aaron Webb 17704 Crowder Rd.,Tenino,WA 98589 P-04311 NAME OF ASSISTANTS: at least one required) - NAME ADDRESS AGE Nicholas Wolfe-Webb 7013 Timberlake Dr.SE, Lacey,WA 98503 24 NAME ( ADDRESS AGE EXACT LOCATION OF PROPOSED DISPLAY _ LOCATION From the dock in front of Alderbrook Resort, 7101 E WA-106, Union WA 98592 DATE 12/31/2022 TIME midnight NUMBER AND KINDS OF FIREWORKS TO BE DISPLAYED Not to exceed; [301 2.5" shells- [151 3"shells-[1014"shells- [131 multi-shot cakes Call Aaron Webb to schedule an inspection 360.790.3409 MANNER&PLACE OF STORAGE PRIOR TO DISPLAY(Subject to approval of Local Fire Authority In our approved magazines ye�o : --( — ISIGNATUIRE OF APPLICANT FINANCIAL RESPONSIBILITY BONDING OR INSURANCE COMPANY (Mark One) The Partners Group ® Bond or certificate of insurance attached ADDRESS ❑ Bond or certificate of insurance on file with State Fire Marshal 11225 SE 6th St.,Suite 110 Bond or certificate of insurance shall provide minimum coverage of Bellevue,WA 98004 $50,000/$1,000,000 bodily injury liability for each person and event, respectively,and$25,000 property damage PART II PERMIT PERMIT# DATE: In accordance with the provisions of RCW 70.77 and applicable local ordinances, this permit is granted to conduct a fireworks display as per the above application. NAME: (Full name of person,firm,or corporation granted permit) RESTRICTIONS: Permit not valid without verification of (Signature of Official granting permit) the appropriate State Fireworks License (Title) LICENSE NUMBER: (Instructions on reverse side) 3000-420-050(R 02/05) Distribution: WHITE (A): Local Fire Authority; YELLOW (B): Permitee 7�( Ucense Number: P-04311 Washington State Patrol Fire Protection Bureau Pyrotechnic Open Licensing Typal January 31 , � L Current and lid UntO Aaron Webb Pyrotechnic Ope Licensee Signature State Fire MV ; i i jJ '40 - 3 0 18 CERTIFICATE OF LIABILITY INSURANCE DATE E/17/Zo2zm) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Janet Nau The Partners Group Ltd PHONE FAX 11225 SE 6th St., Suite 110 (AC. AC No Ext:425-455-5640 MC. /C No):425-455-6727 Bellevue WA 98004 AbDRess: jnau@tpgrp.com INSURER(S)AFFORDING COVERAGE NAIC 0 INSURER A:Everest Indemnity Insurance Co 10851 INSURED 15539 INSURER B:Everest Denali Insurance Company 16044 Wolverine West, LLC Wolverine West Fireworks INSURER C:AXIS Surplus Lines Insurance Company 26620 PO Box 628 INSURER D:Alaska National Ins Co 38733 Chehalis WA 98532 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:1021760399 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE NR ADDL UBR POLICY NUMBER MM POLICY/DD/YYYY MM DD/YYYY LIMITS A GENERAL LIABILITY Y SIBML02443221 2/1/2022 2/1/2023 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMA E T RENTED PREMISES Ea occurrence $500,000 CLAIMS-MADE PC]OCCUR MED EXP(Any one person) $Excluded PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X PRO-JECT LOC $ B AUTOMOBILE LIABILITY S18CA00276221 2/1/2022 2/1/2023 COMBINED SINGLE LIMIT Ea accident $7 000 000 IX ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS IX NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident C UMBRELLA LIAB X OCCUR P00100080541701 2/1/2022 2/1/2023 EACH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED I I RETENTION$ $ D WORKERS COMPENSATION 21FWU09079 6/24/2021 6/24/2022 WC STATU- OTH-I ERUSL&H ONLY AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT 1$1.000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate holder is included as Additional Insured on General Liability as their interest may appear as respects operations performed by or on behalf of the Named Insured,as required by written contract. Alderbrook Resort&Spa,Mason County&its employees ATIMA are Additional Insured as respects the 7/3/22, 11/25/22, 12/31/22 Aerial Fireworks Displays located at Alderbrook Resort&Spa,7101 E State Highway 106,Union,WA 98592. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Alderbrook Resort&Spa 7101 E State Highway 106 AUTHORIZED REPRESENTATIVE Union WA 98592 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Alderbrook Resort o� . . 0 _ ,r a o u �f o FIRE WORKS 'Awl Mry date: 5;`5:2013 18t 47.350 7 1� ei,� 0 Washington State Patrol Fire Protection Bureau G22437 Office of the State Fire Marshal General Display Fireworks License ��IfN�i'11� Licensee Data Operational Data Wolverine West, LLC In State Agent: Rodney F. Hash ' Post Office Box 628 Phone Number: (206) 459-0917 Chehalis, WA 08532 Email Address: rod@wolverinewest.com License Number: C-04138 v_ , Date of Issue:January 14, 2022 Date of pist on:January 31, 2023 State Fire Marshal Licensee Signature 3006-420-041(10118) Washington State Patrol Fire Protection Bureau 10724P Office of the State Fire Marshal Pyrotechnic Operator License Licensee Data Rodney F. Hash Phone Number: (206) 459-0917 P.O. Box 628 Email Address:rod@wolverinewest.com Chehalis, WA 98632 Date of Issue: January 14, 2022 License Number: P-04255 Date of Expiration:January 31, 2023 �.-­ - ;;S—� - Q,,,,, t A��= State Fire Marshal Licensee Signature 3000-420-043(IOM8) Licensee Wal!Mount Card Mod OOZES M-214M MIML. U a I INSPECTION CARD Mason County 615 W. Alder St. Bldg.8, Shelton, WA 98584 NOW 360-427-9670 ext 352 www.co.mason.wa.us PERMIT# FIR2022-00056 PROJECT ADDRESS 10 E ALDERBROOK DR UNION, WA 98592 PARCEL# 322335000014 PROJECT DESCRIPTION FIREWORKS DISPLAY— DATE OF DISPLAY 12/31/2022 MIDNIGHT OWNER NORTH FORTY LODGING ADDRESS PO BOX 609 PHONE CONTRACTOR WOLVERINE WEST LLC ADDRESS PO BOX 628 PHONE 1.206.459.0917 CONTRACTOR LICENSE C-04138 LENDER INSPECTION INSP DATE Comments INSPECTION INSP DATE Comments Fireworks Inspection