HomeMy WebLinkAboutBLD2009-00033 Fireworks Final - FIR Permit / Conditions - 6/28/2009 -
55
CD
m m
q / >
o 99 m O � ® r
� / \ ID 0 0 -10
co M
0_ Cl) >
■ �
e 9 \ k 21 D -i k k 7 k ¢
/ } � � � - - � 2 / k � (nx \ � /
� kUkkg � C ' E �
1p,
0 ¥ & 3 p
k 22222 " q ƒ � � q R � � Z
g > a
C � � � A 2coo
� 2R - rD 2L
k � 0 ¥ 32 � Z
@ � m2
0 / C: M / �
e . O Mxm •
a g
% co C) f --I
■ c x m m 0
0 k r- q
o w ƒ ® > ca0
-0 Mo
\ Eic
/ k al ) M'R co m A �
E ƒ ƒ m CD2 \ c
¢ \ ° R � f@ f E X z
20 0 =r / /
CD CD
q A o p
2 m
k O <
n 2 Z m
l o M
§ OD �
(A3 i
/
% § 2 � �° @ >
» < E e
] Cl)
k CD ƒ
F CL 7 7 2 ? o
CDg g 2 ƒ §
0 % § ¥ . /
E
m
m
0 9d \
2 $ k mmm
@00
c E0 22 3
CD �
� � � g0 � k % � k
O ;u % @@
gcDE moo X k /
� 0 \ k / � � � p kco 88
o p C)
/ o CD O & v
w �
� @ � 3q
� . .
-n
N
0
0
m
0
0
0
w
w
0
o_ n
-7 0 '1 n
z
ov_ oN
-� m
� o oz
oZ o0
CA
o w 00 C4
X
N
R
5
N
N
'i O
70 v
N
o
Xo 3 D XO X ° D X9' D X5• Z X ? 27 XK X °- -I X � � 0 D XO X � � C- n
(D (D _0 = n = O (O O (D � c (D c c c O
o CD �O ? 3. > j c Q cn w Q cD cci N `< N N Cn
o -° ° 3 5CD m nfDi CA M 3 3 5' 0 �' 3 c m NNE
CD e o m w' o d ° it m m ° � (,�ow3
o 0 3 3 co ,_, �' cn _ 3 Cn cr S ? ? m
.+ cn - c4 O •c
N = N O 3 (Op O O y � (D w 3 w -4 w rt 2 3 C 0Q. --�+
(D � (D N � (D CD � rN. � CD
N (D D) � X � 7 O (D 3 �
w X A = W,=Dr �_ 7 O w _n O N n 7 D Cr O
�f m N �' 6 ._�-� N a 0O Q (o O cn N cn N O- to = N �
n N 7 O w O co n cr N. N O N
(06
.(n' cn cn' w N C N 'O = (D .G �! n (D S (D :3 -• cn
O O co —(D r .3 O an � � v .. -00
y czry m am CL 03r Q ° � � ,� =r o
o 6 o m � 0. CA
O 3' CD 3 a v y fD no w � o w 3 v o
� 3 Q r. �, w o v °
m Q � No 0. � CD
a� c % o-0 CD m uni ,0 CD N CCD m
3 3 N N ° O_ � w w w3 0 °
c� m c cn O fu o
N f�D Q. :3 ° N c 3 N O (D O(D 0 to
° :3N `'< O CD O O
^� n D) n w Cl. Vl O0 j w CD CD N CD p w
► O O (D cn n .+ n .+ (�D
O o m w o NCQ ° 5'cn o � ° 3
Q N p
Q. (D CD O cn SOD S .ter Q (D �, (D ? � =+f ,
7 ° m x nfDi °' (D ° �' � m w 3 °� °' m 3
_ fD Cl.(p N (D a' cn =' O_ P. � a' 3 (D
CA O O � N cn n 0 cn
fD fD D O w p O °
C "'
C (D (n c
S O Q r C N cnca cn CD w d N
(Qcn 0
=r (D -n (p fp c N � 0 O w N
° Co ° c CD m c° �► 7 ° c �c
(gyp v .N+ CD Cl. w c n n N f6D � Q
7 w (D — cn
(D
ch a ° > > - CD x O O ° cn cn
O O n w Z SAD `< "' N O_
N y cr CD c (D ? CD TI -a to n Cl.
7 'O fD ° N Cl. O O S N N CD
N °lnN X. 3 CD N = � 0 — CD w
a N N N ccn O � m cn cn 3cr
3 (n w n (D O 7C' CA CD,
w 7' 7 w
fn N .► a n 7 0 (D — cix
0 N d
N o CT 0 S cc CD (D O N
'� lD 9 cn
3 CD
w (Q O 'O Q.
O =h ' 7 (D w '�
cr
O 54 � (D ? CL O0 `� O
X � o Cl. 3 0 c=n CDws6
cn n �' N O OO ;° m
0
0- CD o o n mm 3
D Cl. � _" m C n caCD
m �
m m _ � 3 0
O � O n N cn = c co w N �
C � N w y d m .� nc�
'p Cl.cn cn _ (D
� j (D p C w O fD
(n n � O0 n cn N 7r S 3 0
O Q N to ° N
S Q S CD CD cn 0 w 0 (�—D CD cA
pl O 3 cn 0 — ••r
C (D "O N N N a M ;w :3
Q. (aN am„ (�D (p 3 CA O O
cn — w O (D �
w C M 3 w � fD (O m
N N O o
0
w
O
3 �
I
TI p a Cr A � ca N
N '< O = :_ I:_
3tn
CD
3
O v o >« xOxa m =� x � D xaa' -n x� -n xo x -I xp u
O a Za � m o m N = N .« m N m o O � O m
o -8v5g O ° N = Boni c. 3 � 3cr mom,
Q _ m 3 Co y o 0 3 N no
W Z _ ,CD
n cn3 P� cn (n n N yySl mc �
O _ fmD
CD ° D mCL
-
M nmy y pO % U
OC=Dr
cc O D N CL
cn ?< (D O 3 cn om $ -am 03
— 403)
cu
I:r
o p a ID N (�_ (D C -` O O m Ei m=
N S O O n 0-`< C f�D <<CO m fD 8 g C O
5. m o o can y > >' CD � z m o n c m 3 2
Q o -g 3
o O? q cD 3 c0n cn cD Oo Om O pT Nm O
y 1 0 cD
O -hy p O O
U C m 3
C . n S�
CA
r . D w m O - O O nn N 3 3 n O
m m to O CD n N 3 0 � N 3
> > a N O cn N O m p� ` m
F �' o. cQ' � � O � cn c c 3 -1
m � m 3' °� � cn v m m M' fD co m
cc _ m _
jy m CL 3a oa � � o 0
CD 3 3 'a 3
y . o mod 0) O Opp On 3 a
� 90 Ocn ,« 3 _ < m
� cn CD
C m o � v, co °o N' co
c3 c n 3 .� CD O - (D 'a N
o y m � o gym ° ms � �' :3 o-
m 6 cr
n8 ° o = cn m �
cD m Qe
p oN 0
3 > `< O' CA= Z L
+y rt N 7
T m = cn CD cn vc 0 mcco fD 3
Qi 3 CD
3 a o 3 3 3 n O � a cD O to
A o a g N 'a O' 3 S N 0 cn G.cn coE
Z O cn
'O 3 fl+1 S (n m 3 0) N CO) lij N 3
(A OL co) o• CD n Er m N SOD O N m ?
O ,.
CO) N CD
y. 9 O co
00 _� O cc CO) m (D O CD N
N m cn CD �' N a-
N' 3 n CO)
vOi s' h a S m co m (D CD O
Cl m D) Q- m O =Co -r — O2 � •► �
3 fD 0) O CD
y m O N O- N Cr co) n N
3 _
m � m O F.
3 0 0 m 0 O S
N m m m CD
C C lD D) CD M (C . U
O m= cn o
y o � m
AOo < Cr 0 M a
3 3 n n N 3 CL
N
mQp m CD N (D C
� a Cl) 3 � D l< c CD CD cmn m v
� cS � 3 3 m � = o cD d N Q
v, n m o m T CD
nv o 30OCD
_ -a 3 � �
$ m 3 3 m N a �
m _� � O m y ? O cn
n A = n N 3 00 3 - U) m R Ma
p O 3 CD — cD 'yS m 3 n C.
A M mCD
5' N n 7 N.� a
O N a O N 3 N
cnc CDn
CL
moo 00Q cfl 3Un
go v mvir n fu
A 0 —
0
0 TF
'; rn
j
i
1'I
N
O '
O
t�
O
O
O
W
W
e�
�i
eD
�'
O
Q.
n
'o:
3
N
.�►
S
N
O
February 24, 2009
REF: WWM6505 ***URGENT***
Randy Neatherlin
NE 291 Roy Boad Rd.
Belfair, WA 98528
Dear Randy Neatherlin,
Enclosed are your City/County permit application, State permit, and insurance. You
are required to file with your local authorities as soon as possible. You must have the
following items:
® Permit Fee $100.00 (NEEDED)
® Washington State Fireworks License
® Insurance
® Stand Diagram
® Local Application (fill out)
• Deadline for filing is June 18th or earlier, LICENSING IS ON A FIRST
COME BASIS! Late filing will cause non-issuance of your permit.
Should you have any questions or concerns, please feel free to contact me at (253)
922-0800. Thank you for your time and attention to this matter. Have a great
season!
Sincerely,
Brenda Merritt
Licensing & Permits
Enclosure(s)
AMERICAN PROMOTIONAL EVENTS, INC.
2120 MILWAUKEE WAY •TACOMA,WA 98421
TACOMA(253)922-0800 -SEATTLE (253)838-1099
FAX(253)830-2930
www.tnffireworks.com
ACORD,�
CERTIFICATE OF INSURANCE ISSUE DATE
11/04/2008
PRODUCER This certificate is issued as a matter of information only and confers no rights
MCGRIFF,SEIBELS 8 WILLIAMS,INC. upon the Certificate Holder. This Certificate does not amend,extend or alter the
P.O.Box 10265 coverage afforded by the policies below.
Birmingham,AL 35202
205-252-9871 COMPANIES AFFORDING COVERAGE
ComApany Columbia Casualty Insurance Company
INSURED Company
American Promotional Events,Inc. B
dba TNT Fireworks
P.O.Box 1318 Company
Florence,AL 35631 C
Company
D
Company
E
This is to certify that the policies of insurance described herein have been issued to the Insured named herein for the policy period indicated. Notwithstanding
any requirement,term or condition of 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,conditions and exclusions of such policies. Limits shown may have been reduced by paid claims.
CO TYPE OF INSURANCE POLICY NUMBER EFFECTIVE LIMITS OF LIABILITY
LT EXPIRATION
A GENERAL LIABILITY PCL0223304725 11/01/2008 EACH OCCURRENCE $ 1,000,000
®Commercial General Liability 11/01/2009 FIRE DAMAGE $ 100,000
❑Claims Made ®Occurrence
❑Owners'and Contractors'Protection MEDICAL EXPENSE $ EXCLUDED
®$5,000 Deductible Per Occ PERS.AND ADVERTISING INJURY $ 1,000,000
❑ GENERAL AGGREGATE $ 2,000,000
General Aggregate Limit applies per: PRODUCTS AND COMP.OPER.AGG. $ 2,000,000
❑Policy ❑Project ®Location
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
❑Any ll Owned Auto BODILY INJURY Per erson $
❑All Owned Automobiles
❑Scheduled Automobiles BODILY INJURY Per accident) $
❑Hired Automobiles PROPERTY DAMAGE $
❑Non-owned Automobiles COMPREHENSIVE
❑ COLLISION
WORKERS'COMPENSATION WC Statutory Limit Other
AND EMPLOYERS'LIABILITY EL EACH ACCIDENT $
EL DISEASE Each em to ee $
EL DISEASE(Policy Limit $
EXCESS LIABILITY EACH OCCURRENCE $
❑Occurrence ❑Claims Made AGGREGATE $
This certificate only applies to Re:QFC located at 1403 Old Belfair Hwy in Belfair,WA (loc#WWM6505);.
The Certificate Holder is named as Additional Insured with respect to General Liability as required by written contract subject to policy terms,conditions,and
exclusions.
CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO
MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF
North Mason Pee Wees ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES.
QFC
Mason County Authorized Representative
PO BOX 186 .._._
426 W Cedar _
Shelton,WA 98584 .: S
Page 1 of 1 Certificate 10# 72RTOU4X
APPLICATION
FOR RETAIL FIREWORKS STAND PERMIT
WWM6505
TO: Governing body of city, town, or county in which DATE OF JAN. 02, 2009
fireworks stand will be located. APPLICATION:
Applicant Name: Address, City, State:
NORTH MASON PEE WEES 2120 MILWAUKEE WAY, TACOMA„ WA 98421
Sponsor(If other than applicant): Address, City, State:
RANDY NEATHERLIN 2120 MILWAUKEE WAY, TACOMA„ WA 98421
Location of proposed fireworks stand: [Enclose drawing of stand location]
NE 1403 OLD BELFAIR HWY QFC
BELFAIR, WA
Manner and place of storap-e prior, during, and after sales dates:
ON SITE WITH SECURITY
State Licensed Fireworks Supplier:
American Promotional Events NW 2120 Milwaukee Way, Tacoma, WA 98421
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
MIRE WOIU7%1-S STAND PERMIT
For The Fireworks Sales Year Of 2009
(Must be conspicuously displayed at all times while the stand is open to the public)
By virtue of having been granted a license by the State of Washington and this permit from
MASON COUNTY the local governing authority, the named person, firm or organization is hereby
authorized to sell U.N. 0336 I AG Consumer fireworks at the location designated herein between the
following date and times:
Sales For July 4th Sales For December 31St
From: From:
To: To:
Sponsor: NORTH MASON PEE WEES
Location: QFC NE 1403 OLD BELFAIR H�WJY BELFAIR WA
/s/ /s/ "_`` FOR RANDY NEATHERLIN
Signature of Official Granting Permit Signa e of Applicant
Title: Agency:
Date: Permit Number:
Licensee Name: NORTH MASON PEE WEES License Number:C�joLP
3000-420-013(Rm 2/05) �,
rA
oMot0M CD
00
z p C
0 0 C)
w CD y -
o• ~• ►r1 p �
eD cc
eb
0CD
0 �•
cr00
ft
r
o �--- ----------- - �' O
o mv'ro r i o
coo y
o a z eD fD Z co
-9 z 121
n w O
� .. � a. r°pq o V
f � A
�f° m o
°a s ,
"�s7 ov
c"p O A CDd m
P7 C A.
9
OD cm
co co
to cc
Mason County
Fireworks Permit Application
W
PO BOX 186 426 W Cedar St Permit# FIR
Shelton WA 98584 Receipt # S �a�
(360) 427-9670 ext 273
CK #
Date Received (0_4
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 Information _.
Name: RANDY NEATHERLIN
Mailing Address: PO BOX 445
City: BELFAIR State: WA Zip: 98528
Contact Number (360 ) 731-3849
Sponsor Information
Name: NORTH MASON PEE WEES
Mailing Address: PO BOX 445
City: BELFAIR _ State: WA Zip: 98528
Contact Number (360 ) 731-3849
Washington State Fireworks License information (copy Required)
License No.: Date of
WSPFL-00506 Issue: 02/19/09
❑ Pyrotechnic Operator License x❑ Fireworks Stand License
Bond or Certificate of Insurance
(Copy of Certificate/Bond Required)
Provider: SEE ATTACHED
Insured:
Certified Holder:
Location of stand/display ----
Address: QFC NE 1403 OLD BELFAIR HWY BELFAIR, WA
Directions to Site:
Parcel Number. T3
Legal Description:
Legal Property Owner: _
* * Please see the reverse side to complete your application
MASON COUNTY
Department of Community Development
FIRE PROTECTION SYSTEMS INSPECTION CARD*
PO BOX 186, 426 W Cedar ST, Shelton WA 98584
Irpto General Questions: (360) 427-9670 ext 352 Inspection Requests: (360) 427-7262
Permit Number FIR2009-00033 Date 06/26/2009 Issued By
Project Fireworks Stand-QFC/STARBUCKS
Site Address 201 NE STATE ROUTE 300 BELFAIR
Applicant NORTH MASON PEE WEE'S
Contractor License Number
Con. Phone Expiration Date
Primary Code 2006 IFC Wet Chem N Sprinkler N
Use STND Dry Chem N Standpipe N Hod and Duct N
Public Works Access/Driveway Other
_ Health Dept Septic Well
Planning Dept Site Inspection
Fire Marshal Fire Apparatus Access Fire Sprinkler
Auto Fire Alarm Hood and Duct
Other Final
Building Dept Building Official: Community Development Designee
Concrete Setbacks Slab
Footing Perimeter Ret.Wall /Bulkhead
Footing Interior Footing Decks/Porches
Foundation Stem Other
Rough-In Groundwork Plumbing Plumbing
Groundwork Mechanical Other
Groundwork Gas Pipe
Gas Piping
Framing
Mechanical
Insulation Slab Ceiling
Floor Vaulted Ceiling
Walls Vapor Barrier
Other
Wallboard Nailing Interior Wall Brace Panels Fire walls
Other
Final Building
Manuf. Home Setbacks Setup
Concrete Foot/Runners Final
Other
APPROVED PLANS MUST BE ONSITE FOR ALL INSPECTIONS
*THIS STRUCTURE MAY NOT BE USED FOR OCCUPANCY UNTTL ALL APPLICABLE FINAL INSPECTIONS ARE COMPLETED
DO NOT PROCEED BEYOND EACH STAGE OR COVER WORK UNTIL APPROVALS ARE GIVEN.
POST THIS CARD IN A CONSPICUOUS PLACE ON THE FRONT OF THE PREMISES CONVENIENT FOR MA1QNG REQUIRED
ENTRIES.
ALL PERMITS EXPIRE 180 DAYS AFTER PERMIT ISSUANCE OR 180 DAYS AFTER LAST INSPECTION ACTIVITY IS PERFORMED.
OWNER/AGENT IS RESPONSIBLE FOR CALLING FOR ALL INSPECTIONS
PRIOR TO CALLING FOR FINAL INSPECTION,ALL CONDITIONS OF THE PERMIT MUST BE MET.
m
CONCRETE MECHANICAL MANUFACTURED HOME O
-- X
p Footings I Setbacks Date By Ribbons
Gas Piping =
Cinterior Date By Interior-Date By Date By 3
O Exterior Date By Exterior Date BY Set-up N
tW Point Goad/Isolated Footings INSULATION Data By
BG/BLAB INSULATION Z
Date By Date By FIRE DEPARTMENT C)
Foundation Walls Floors Date By m
Date By Data By DECKS
FRAMING Wiwi' Date By m
Date By Data By PROPANE TANKS N
PLUMBING vauk Date By
Date By OTHER
Groundwork Attic
Date B Date By Type.
v Date By
n.w.v DRYWALL Type:
�
Int Brace Wall Cate By m
_ y
81 Date B Date By FINAL INSPECTION N
m 'Water tine Fire Separation �
Date By Data By Date By
O
o Pass or Request Inspect. o
Type of Insp. Fail Rate Date D9 By Comments w
04X o�,-j8-oq 0/0,U "ZOT
0
N!
CYI
0
h
rn