The URL can be used to link to this page

Home My WebLink AboutFIR2011-00027 - FIR Permit / Conditions - 6/27/2011 E MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inspection Line(360)427-7262 Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Phone: (360)427-9670, ext. 352 NShelton, WA 98584 o, FIRE PROTECTION PERMIT FIR2011-00027 APPLICANT: ALDERBROOK RESORT RECEIVED: 6/6/2011 CONTRACTOR: ORION PYROTECHNICS 1.3960.790.3409 LICENSE: EXP: ISSUED: 6/27/2011 SITE ADDRESS: 10 E ALDERBROOK DR UNION EXPIRES: 12/27/2011 PARCEL NUMBER: 322335000014 LEGAL DESCRIPTION: SUNNY BEACH PCL 1 OF BLA#04-58 PROJECT DESCRIPTION: FIRWORKS DISPLAY LOCATED AT THE ALDERBROOK RESORT GENERAL INFORMATION System Information Type of Use: DIS Sprinkler Heads: Audible Switches: Pull Stations: Fire District: 6 Flow Switches: Visual Devices: Door Releases: Hood& Duct?: N Dry Chemical?: N Pressure Switches:: Smoke Detectors: Duct Detectors: Zones: Heat Detectors: Wet Chemical?: N r Sprinkler?: N Standpipe?: N SQUARE FOOTAGE FEES Monitoring Company: First Floor: Type Amount Due Amount Paid Monitoring Phone No.:() - Second Floor: Fireworks Display Permit $250.00 $250.00 Auto Fire Alarm?: Third Floor;: P y Total: $250.00 $250.00 FIR2011-00027 Please refer to the following pages for conditions of this permit. Page 1 of 4 I CASE NOTES FIR2011-00027 CONDITIONS FOR FIR2011-00027 1.) The access to the site must be in full compliance with ordinance 31-04 title 14 chapter 14.17 of the Mason County code fire apparatus access XgMuit�i�ents. Storage and use of fire works must be in full compliance with RCW70.77, WAC 212-17, NFPA 1123-06, NFPA 1124-06, NFPA 160-06 and chapter 33 of the 2009 International Fire code. X � Fire eZctinguishers must be provided on site per Chapter 9 of the 2009 International Fire code and NFPA 10. X�) 2.) Per the application: There will be no on site storage or fire works or explosives of any kind. The fireworks will arrive on site the morning of the display by truck at the marina justy.1�l awn the road. Loaded on to 2 barges an moved out to the location in hood canal 700 feet away from shore. x y 3.) Per section 3308.9 of the 2009 International Fire code. Post Fire works display inspection : After the fireworks display, the firing crew shall conduct an inspection of the fallout area for the purpose of location unexploded aerial shells or live components. This inspection shall be conducted before public access to the site shall be allowed. Where fireworks are displayed at night and it is not possible to inspect thoroughly, the operator or designated assistant shall inspect the entire site at first light. A report of the inspection shall be provide to the a on County fire Marshals office. X 4.) OWqk/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. X 5.) Vali ermit Must be on-site. X This permit becomes null and void if work or construction authorized is not commenced within 180 days, or if construction or work is suspended for a period of 180 days at any time after work is commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied. Proof of continuation of work is by means of a progress inspection. The owner or the agent on the owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the a cribed property and structure for review a d insp ction. OWNER OR AGENT: DATE: FIR2011-00027 Please refer to the following pages for conditions of this permit. Page 2 of 4 Mason County R r- Fireworks Permit Application PO BOX 186 Permit# FIR [`�`�- 2'� 426 W Cedar St Shelton WA 98584 (360) 427-9670 ext 273 Receipt RECEIVED CK # LOM JUN 0 6 2011 Date ReceivedLP 426 W. CEDAR ST, A Permit for the 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 I ormad _ 11 � Name: ro Id r0f'.r�-�'1 (1 W b� `T Mailing Address 1 — City: I State: Zip: Contact Number ( j ), Epp `7 y AID 1 Sponsor Information Name: e� �-- MailingAddress: KL, ;-I VE-_ City: State: ZIP. Contact Number Washington State Fireworks License Information (Copy Required) License No.: Date of r AIssue: ❑ Pyrotechnic Operator License ❑ Fireworks Stand License Bond or Certificate of Insurance (Copy of Certificate/Bond Required) Provider: Insured: Certified Holder: , Location of stand/di- play Address: �- Directions to Site: ,V Parcel Number: - - - Legal Description: r)rj _ — Legal Property Owner: iQ2 * * Please see the reverse side to complete your application y The followin pertinent information MUST be provided on the site diagram below Pdesi cations and Setback distances from the back, sides and front of retail sales stands or ated display areas to: • Fire Hydrants T Property Lines • Buildings parking • Combustibles Public Roads and Right of Ways • Fire Lanes Private Roads and Right of Ways Trees /Brush • Landmarks • Utilities and Gas • Mortar separation distance • Desi ated landing area 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. Signed Date FOR OFFICIAL USE ONLY BELOW THIS LINE Accepted By: Date: Aaron Webb/Operations Manager Orion Pyrotecnics 712 36th Ave NE Olympia WA,98506 360-790-3409 aaronw@orionpvro.com Please accept this as our application for a fireworks display application for the Alderbrook Resort in Union WA.The display will occur on the 1st of July.The display will be in the same location as last year. The shoot is scheduled for 10:15pm.There will be 800 aerial shells between the size of 3" and 6". Please contact with any questions or concerns. MASON COUNTY (360)427-9670 Shelton ext.352 DEPARTMENT OF COMMUNITY DEVELOPMENT (360) 275-4467 Belfair ext. 352 BUILDING• PLANNING• FIRE MARSHAL (360)482-5269 Elma ext. 352 } Mason County Bldg. III, 426 West Cedar Street 1854 PO Box 279, Shelton, WA 98584 www.co.mason.wa.us FIR20 I Lf - Mason County Fireworks Permit Application Incomplete applications will not be accepted 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 #: 360.898.2252 Email: cindy.sund@alderbrookresort.com Sponsor Information: Name: Alderbrook Resort & Spa Address: 7101 E WA-106 City: Union State: WA Zip: 98592 Phone#: 360.898.2252 Email: cindy.sund@alderbrookresort.com Washington State Fireworks License Information (Copy Required): License Number: C-04138 Date of Issuance 2/3/14 Pyrotechnic Operator License ❑ Fireworks Stand License Bond or Certificate of Insurance (Copy of Certificate/Bond Required): Provider: Professional Program Insurance Brokerage Insured: Wolverine Fireworks Display, Inc. Certified Holder: Adam & Anne Farrens Location of Stand/Display: 10 E A0zA-1Pmo►-, w-- U n i o n Site Address: 7101 E WA-106, Union, WA 98592 Directions to Site: see attached O a33- '60 - boo l Parcel Number: (twelve digit number) - - Fired on Puget Sound Legal Property Owner n/a "Please see reverse side to complete your application" The following ertinent 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 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. Digitally signed by Signed Rodney Hash Date 7/30/14 Date: Yy pLYERIlyE. Alderbrook Resort & Spa VWipEYTV Wedding Fireworks Display •LA Tb h� r E 013iG0og!e a "i9sn - � te /5/201 n -12mr APPLICATION PART I iIf��i DATE OF APPLICATION war FOR PUBLIC FIREWORKS DISPLAY PERMIT 7/15/14 TO: Governing body of city,town, or coun in which display is to be conducted. APPLICANT _ NAME ADDRESS —� PHONE Wolverine West Fireworks PO Box 99095 - Seattle, WA 98139 206.459.0917 SPONSOR ADDRESS PHONE Farrens Wedding @ Alderbrook Resort 7101 E Hwy 106, Union, WA 98592 '360'898.5529 PYROTECHNIC OPERATOR NAME ADDRESS LICENSE# _Chad Beebe 11210 Saskatoon Ln SE,Olympia WA 98508 P-04245 *ME OF ASSISTANTS: (at least one required) NAME I ADDRESS AGE Aaron Webb '800 Yauger Way SW E-208, Olympia WA 98502 P-04311 NAME ADDRESS AGE EXACT LOCATION OF PROPOSED DISPLAY I LOCATION Alderbrook Resort & Spa - 7101 E Hwy 106, Union, WA 98592 DATE TIME 8/8/14 10pm+/- NUMBER AND KINDS OF FIREWORKS TO BE DISPLAYED (40) Multi-Shot Cakes MANNER& PLACE OF STORAGE PRIOR TO DISPLAY(Subject to approval of Local Fire Authors In our approved magazines lAz SIGNAT E OF APPLICANT FINANCIAL RESPONSIBILITY BONDING OR INSURANCE COMPANY (Mark One) Professional Program Insurance Brokerage ® Bond or certificate of insurance attached ADDRESS ❑ Bond or certificate of insurance on file with State Fire Marshal 371 Bel Marin Keys Blvd. Ste. 220 Bond or certificate of insurance shall provide minimum coverage of Novato, CA 94949 $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 02105) Distribution: WHITE(A): Local Fire Authority; YELLOW(B): Permitee Certificate of Insurance 4501 Issue Date: 7/8/2014 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF Professional Program Insurance Brokerage INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE 371 Bel Marin Keys Blvd., Suite#220 CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT Novato,California 94949 AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED INSURER A: Underwriter's at Lloyd's, London Wolverine Fireworks Display, Inc. INSURER B: 205 W.Seidlers Road Kawkawlin, MI 48631 INSURER C: INSURER D: COVERAGES: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE NAMED INSURED ABOVE FOR THE 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(DD/MM/YY) DATE(DD/MM/YY) A GENERAL LIABILITY PY/14-0013 2/1/2014 2/1/2015 EACH ACCIDENT $5,000,000 CLAIMS MADE MEDICAL EXP(any one person) FIRE LEGAL LIABILITY $50,000 GENERAL AGGREGATE $5,000,000 PRODUCTS-COMP/OPS AGG DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate holder is additional insured as respects the following: Date(s)of Display: 8/8/2014 Location: 7101 E State Highway 106 Union,WA 98592 Additional Insured: Adam&Anne Farrens;Alderbrook Resort&Spa,Mason County&its employees ATIMA Rain Date(s): 8/8/2014 Type of Display: Aerial Fireworks Display CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXIPIRATION DATE THEREOF,THE ISSUING INSURERE WILL ENDEAVOR TO MAIL 10 DAYS Adam&Anne Farrens WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 1002 North Park Drive SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,tTS AGENTS OR REPRESENTATIVES. Tacoma WA 98403 ' AUTHORIZED REPRESENTATIVE �fpLVERiHE, Alderbrook Resort & Spa WEST Wedding Fireworks Display Y4 `O ``I f . �� 0. Into _.v Date: 5,5:20 13 !at �r.349 837� loll, -12 Washington State Patrol 15865 Fire Protection Bureau Office Of The State Fire Marshal Washington State Fireworks License Importer License Importer: Wolverine West,L. L. C. Post Office Box 99095 Seattle,WA 981390095 Detach this wallet card and carry with you for verification of certification. In-State Representative: Rodney F. Hash Washington State Patrol Fire Protection Bureau 15865 Phone Number: (206)459-0917 I Office Of Ime State Fire Marshal I Importer: est,L.L.C.o License Number: Date of Issue Expiration Date License Number I Tune of License: February 3,2014 January 31,2015 C-04138 j shone Number: j I /EXRlration Date- 15 I I 3000-420-012(R 9/05) I State Fire Mars licensee Signature i Washington State Patrol 15864 Fire Protection Bureau Office Of The State Fire Marshal Washington State Fireworks License Wholesaler License Wholesaler: Wolverine West, L. L. C. Post Office Box 99095 Seattle, WA 981390095 Detach this wallet card and carry with you for verification of certification. In-State Representative: RodneyF. Hash Washington Patrol Protection su 15864 Phone Number: (206)459-0917 office Of The state�re Marshal I Wholesaler: est,L.L.C. Date of Issue Expiration Date License Number I L_;) o Number: �r I Tyw pe of License• February 3,2014 January 31,2015 C-04138 Phone Number: . EApiration D te• 15 I 3000-420-012(R 9/05) Sty Fire V Lcensee Signature Washington State Patrol Fire Protection Bureau 15863 Office Of The State Fire Marshal Washington State Fireworks License General Display License General Display: Wolverine West,L. L. C. Post Office Box 99095 Seattle, WA 981390095 Detach this wallet card and carry with you for verification of certification. In-State Reoresentative: Rodney F. Hash -- Washington State Patrol ' Fire Protection Bureau 15863 Phone Number: (206)459-0917 Office Of The State Fire Marshal I General Display: W, West,L.L.C. Date of Issue Expiration Date License Number I License Number: I Tvce of License ` Y February 3,2014 January 31,2015 C-04138 Phone Number: Expiration Date: 15 I ,t Je�o I 3000 420-012(R 9/05) State hire ture Liaosee Signature Washington State Patrol 15856 Fire Protection Bureau Office Of The State Fire Marshal Washington State Fireworks License Pyrotechnic Operator License Pyrotechnic Operator: Rodney F. Hash Detach this wallet card and carry with you for Licensee Location: Post Office Box 99095 verification of certification. Seattle, WA 981390095 Washington State Patrol Fire Protection Bureau 15856 Phone Number: (206)459-0917 Office Of The State Fire Marshal I Pyrotechnic O erat T .Hash Date of Issue Expiration Date License Number i Lin a•. n T e of Li c Operator January 31,2014 January 31, 2015 P-04255 i Ez iration Da 12015 I 30on-420-012(R 9ro5) State Fire A.W146re l3ceosee signature