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Fireworks Stand Location • A fireworks stand shall not be located more than 150' from an approved access road, • Shall be at least 100' from another fireworks stand or separated by a road, street or highway at least 30' in width, • Shall not be located any closer than allowed by the table below to other structures or exposures, • Or be located closer than 100' from any flammable liquid or gas dispensing device, or 300' from any flammable liquid or gas bulk storage or dispensing facility. Retail Fireworks Stands—Minimum Clearances Buildings Combustibles Property Line Parking Motor Vehicle Motor Vehicle Traffic, Traffic, Public Road Private Way Back of Stand 20' 20' 5' 20' 20' 5' Side of Stand 20' 20' 5' 20' 20' 5' Front of Stand 20' 20' 20' 20' 20' 20' Surrounding Area around Fireworks Stands • The minimum areas around fireworks stands, as specified above, shall be kept free from dry grass, brush or combustible debris. This area shall be marked and flagged. • Motor vehicles or trailers may not be parked within 20' of the fireworks stand except when delivering, loading or unloading fireworks. • Fireworks shall not be discharged within 300' of any fireworks stand. A sign stating No Fireworks Discharge Within 300' in letters at least 2"high and in contrasting color shall be posted conspicuously on all sides of the structure. • No smoking shall be allowed within the fireworks stand or flagged off area. Signs stating No Smoking Within 100' in letters at least 2"high and in contrasting color shall be posted conspicuously on all sides of the structure. Electrical Supply & Usage • All battery powered equipment, electrical equipment and cords shall be UL listed and used in accordance with that listing. Extension cords shall be of an industrial grade type and shall be j protected from physical damage. • All heating devices shall be UL listed. Only heating devices with sealed-type elements shall be used, i.e. oil filled or water-filled radiator type. Open flame or open element heating devices are prohibited. • Generators shall be located a minimum of 20' from any fireworks stand. Fuel storage is limited to 5 gallons. Fireworks Stand Operations • A minimum 24"wide isle shall be maintained inside the full length of the stand. • ECus:tom:ers:are not allowed inside the fireworks stand. • There shall be a minimum of 2 exits at least 28"in width located at opposite ends of the stand. These exits shall remain unlocked and unobstructed during hours of operation or when stand is occupied. • Sleeping inside a fireworks stand is prohibited. • The location of the nearest phone shall be posted in the fireworks stand. All occupants of the stand shall be informed as to the location of this phone. • The local emergency phone number, 911, and the address of the fireworks stand shall be conspicuously posted inside the stand. • There shall be a minimum of 2(two) approved 2 1/2 gallon pressurized water fire extinguishers located adjacent to each exit door. • Cooking, open flame or any type of open flame equipment is prohibited in a fireworks stand. • Fireworks stands shall be locked when unoccupied and not open for business if fireworks are stored in the stand during these times. Fireworks stands shall not be locked when occupied. Fireworks may be removed or transferred to a temporary storage structure or location approved as part of the license and permit. • Fireworks may be stored in a locked and secured retail fireworks stand, truck, container, or trailer that is at least 20' from the fireworks stand during business hours, or in a locked or secured metal or wooden garage, shed,barn or other accessory building that is a least 20' from the fireworks stand. • At least one person 18yrs of age or older shall be on duty in the fireworks stand when fireworks are being sold to the public. Such person shall be responsible for the supervision of the fireworks stand and its operation. No person under the age of 16 shall be allowed to occupy the fireworks stand when it is open to the public. • It is illegal to knowingly sell fireworks to persons under the age of 16. A sign stating"No Sale Of Fireworks to Persons Under the Age Of 16"in letters at least 2"high and in contrasting color shall be posted on the front of the stand. A photo ID is required and it is the responsibility of the seller to require proof of age. Driver's License or Photo ID showing a date of birth issued by a public or private school, state, federal or foreign government is acceptable. i Mason County Fireworks Permit Applipt jo o P.O. BOX 186 Permit# FIR -6O i a:-, 426 W Cedar St Shelton WA 98584 Receipt# (360) 427-9670 ext 273 �G r :-j y RDate Received A Permit for the`'letail S (,Public display of fireworks is required. A completed application wit r�gy{ e�Q mentation and fees shall be submitted for Fire Marshal review. A pewill be issued upon satisfactory site Inspection by the Fire Marshal. Applicant Information Name: \ V y(\ 0_1 A 0V� Mailing Address: Li -� City:-1-o cor la State: Zip: Contact Number 613S),L149 -D-3SCU Sponsor Information Name: phar1 nYY1 \`CCwcI l s *s� R611(d "gal Mailing Address: o�(64 L rnMjn &yP City: :a.COrnq Sta e: LA-)A zip: q$4c--' Contact Number (aS3)alRO Washington State Fireworks License Information (Copy Required) License No.: Date of WSPFt_-Q 16L t 3 Issue: Li ( 1 b I os, ❑ Pyrotechnic Operator License Fireworks Stand License Bond or Certificate of Insurance (Copy of Certificate/Bond R quired) Provider: - 41 eA-- Insured: C Certified Holder: L Location of standidisplay Address: 3 l- Direction to Site: Parcel Number: Legal Description: —e2 Q - 9 Legal Property Owner: * * Please see the reverse side to complete your application M CO) N CO) CO) CO) o Ina a fl. c. o ° N n a o N n O • � fl' Of TI W N O ep' 021, x� to0 NO m Z � m _ tp C D n ♦ w � O a c�.♦ co � m o •% �o c) a •, Z .O+ m :' ag =r a 0 � o � � � a �• 0 T r D 0 0 O n T� o m o z 3 0 � 11 • � Z 1 K W w 1 o m o 3 Z 3 •RR• c m' N d m N w 7 O 3 1 ID D 1 � W co 0 to c.n 0 wW 4 O cc O c CD M � C X lb co Q> co _� . 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FIRE PROTECTION BUREAU FIREWORKS LICENSING PROGRAM PO Box 42600 Olympia WA 98504-2600 WMHiMMM am m7R% •++slIALS (360)596-3914 FAX: (360)596-3934 APPLICATION FOR RETAIL FIREWORKS STAND PERMIT TO DATE OF F. &V&V I APPLICATION Applicant Name Address,City, State TgXpn1C� 23C� Lon) Ayg__.� 4�_l Sponsor(If other than applicant) Address,City,State hcrm fi�x<�-3cie Tom' 1 Location of p1roposed fireworks stand [Enclose drawing of stand location]se ciny-c4- Qpmd k ai��n I kN -;w K Manner and place of storag prior,during,and after sales dates D Sf&ae_) - State-Licensed FirkFwdrks Supplier f Q, C-0 N Lc - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - FIREWO_D.KS STAND PERMIT For the Fireworks Sales Year of: 2_b0 q (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 aSOyl rrILAI as the local governing authority,the named person, firm or organization is hereby Authorized to sell U.N. 0336 1 AG Consumer fireworks at the location designated herein between the following date and times: Sales for July 41h Sales for December 315r From:7T, I O From: To: U� To: Sponsor Phan iM 1�1 �r�S �., ACMU XkM I Location fClr�� �" ( 'oi (-1 l /s/ 11 /s/ Signature of Official Granting Permit ignature of Appliddit Title Agency Date Permit Number Licensee Name License Number 3000420-013 (R 3/09) The f6flowing pertinent information MUST be provided on site diagram below Locations and Setback distances from the back, sides and front of retail sales or designated display areas to: • Fire Hydrants • 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 • Designated 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 maintai d Signed Date S-/Z 7/09 FOR OFFICIAL USE BELOW THIS LINE Accepted By: Date B.J. ALAN COMPANY NORTHWEST (Distributor of Phantom® Brand Fireworks) Home Office: 555 Martin Luther King Jr. Blvd.,Youngstown,OH 44502 Phone(800)777-1691,Fax(330)746-4410 Western Region Offices: 2367A Lincoln Ave.,Tacoma,WA 98421 Phone(253)396-0966,Fax(253) 396-0771 ' 8139 Elder Creek Rd,Sacramento,CA 95824 Phone(916)388-1479,Fax(916)388-1476 3729-13,San Gabriel River Pkwy. Pico Rivera,CA 90660 Phone(562)669-0505 Fax(562)699-0504 700 Kiernan Ave., Unit A,Modesto,CA 95356 Phone(209)491-5180 Fax(209)491-5188 124 West Burton Ave.Salt Lake City,UT 84115 Phone(801)486-1516 Fax(801)486-4021 FIREWORKS LICENSE AGREEMENT This Agreement is made between Belfair Center LLC as Licensor, and B.J. Alan Company NW, LLC as Licensee, for the sale of 1.4g consumer fireworks at the following Location: NAME: Belfair Center ADDRESS: SE Corner Highway 3 and NE Clifton Lane ORDINANCE: CITY/STATE/ZIP: Belfair WA. 98528 The Location as listed above, is owned and/or controlled by the Licensor, and the Licensor grants to Licensee, and the group selected by the Licensee, the exclusive right to operate a temporary Fireworks Structure on these premises for the period: TUNE 15, 2006, THROUGH JULY 15, 2006 The exclusive right to operate a fireworks structure during the period stated above, with the same terms stated herein shall be automatically renewed through the years 2007, 2008, and 2009. The Licensee agrees to the following terms and conditions: (1) Licensee will provide liability insurance coverage and provide to the Licensor, before occupancy, a certificate of insurance evidencing the insurance in force covering the set-up, maintenance, and operation of the fireworks structure. The insurance shall name the Licensor as an additional insured, and Licensee will hold the Licensor harmless from any claims arising from the maintenance or operation of the structure. (2) Licensee shall pay all costs involved in set-up, maintenance, and operation of the structure, and, on departure, the hall return the remises to its original condition. Licensee s Lice p (3) Licensee shall obtain and pay for all necessary permits and licenses required by law; shall post with local authority any debris or performance bonds, which might be required; and shall adhere to all laws and regulations. (4) If the sale of 1.4g consumer fireworks is prohibited by public authority, or if Licensee is unable to secure a retail permit to operate on the property and the property is not utilized, the license amount prepaid will be refunded in a timely manner, and this license agreement shall automatically become null and void. If the local municipality 9 D7 having jurisdiction over this location limits the sale of 1.4g consumer fireworks or makes any local rules modifying r the state statutes,the hi license agreement is subject to revision. (5) If the property is sold, f1 1 ss/egress changed, a building permit issued for construction or the like,than this license is subject to cancellation or revision. Should cancellation or revision occur, Licensee will be given first right of refusal to conduct the sale fireworks at the location listed above during the term of this agreement. �(6) Licensee shall pay in hill to Licensor within 30 days after receipt of a signer+ rnnv ^f}tiffs agreement the minimum License Fee of $_ ind a _ % fee on sales exceeding the $_ . breakpoint. Licensee shall deliver a sales statement to Licensor including any additional percentage fee due by August 5th of each year. � -Fh AGREED AND DATED THIS 2» DAY OF -2eeS Licensor: Licensee: B.J. Alan Company NW LLC i Signature: aY1 Signature: Title: Ma nct,C3 for Title: Director of Northwest Operations Address: 10 Ave_ a 2P-6 City/St/Zip: (?)ClI ie,Vo-e _(A-)A � D� Phone/Fax: �.�-�� 1 SS •2g`�8 ` 2,S/45_b'Zcg7 2— Corp. ( LLC ❑ Individual or Partnership Tax ID#/SSA#: *THIS AGREEMENT IS CONTINGENT UPON LICENSEE SECURING ALL LOCAL AND STATE LICENSES.* ACORD. CERTIFICATE OF LIABILITY INSURANCE 7 DATE(MMIDONYYY) 11 25 2008 PRODUCER Phone: 440-248-4711 Fax: 440-248-5406 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Britton-Gallagher and Associates, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6240 SOM Center Rd. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Cleveland OH 44139 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:Lexin ton Insurance Co B.J. ALAN COMPANY INSURERB:Arch Speciality Ins Co 21199 BIG BEAR FIREWORKS, INC. ; PHANTOM FIREWORKS 555 MARTIN LUTHER KING JR BLVD INSURERC: YOUNGSTOWN OH 44502-1102 INSURERD: INSURER E: COVERAGES THIS CERTIFICATE SUpEgSEpES PREVIOUSLY ISSUED CERTIFICATE 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D'NSR POLICY NUMBER POLICYEFFECTIVE POLICYEXPIRATIONLTR TYPE OF INSURANCE DATE(MMIDDFM DATE(MMIDDrfYI LIMBS A GENERALLIABILITY 43925182 10/30/2008 10/30/2009 EACHOCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $5 0 0 0 0 CLAIMS MADE Fx__1 OCCUR MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $1 0 0 0 0 0 0 GENERAL AGGREGATE $2 0 0 0 0 0 0 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2 00Q 000 POLICY PRO- jEcT X LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTYDAMAGE $ (Peraccident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHERTHAN EAACC $ AUTO ONLY: AGG $ B EXCESSIUM13RELLA LIABILITY OF P 0 0 3 0 3 6 0 10/3 0/2 008 10/3 0/2 009 EACH OCCURRENCE $9,000,000 X OCCUR CLAIMS MADE AGGREGATE $9 00O 000 $ DEDUCTIBLE $ RETENTION $ $ WC WORKERS COMPENSATION AND ORSTATY lbdi O R EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTNE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ Iyes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS STAND LOCATION: SE CORNER ROY BOAD ROAD AND CLIFTON LANE, PAD #3, BELFAIR, WA 98528. DATES OF OPERATION: JUNE 20TH, 2009 TO JULY LOTH, 2009. DITIONAL INSUREDS: MASON COUNTY, ITS AGENTS, EMPLOYEES, OFFICIALS AND VOLUNTEERS WHEN ACTING IN THEIR OFFICIAL APACITY. roup Code: TACOMA WA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BELFAIR CENTER, LLC BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE BELFAIR CENTER PARKING LOT CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO 16650 NE - 79th STREET, SUITE 103 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON REDMOND WA 98052 USA THE INSURER, ITS AGENTS OR REPRESENTATIVES. 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L.:.-,.-:.i`.•t..•l.: �.,V 'tr li.".-.�.'�_L:. - (veil!o:•e:3' ,{ i..'�.:11:1 _"`.:'i_.J;� �� Tom iSi IG.J,.1il�J - ��1.a.Cuid�if IL ,'lame of Ap?licaior or?roduction Suparintsndent iitic ((i• f:•; '�i'.1i .)i i� 'f e:l�� -:.:..tJ.'_t I{"-,•�il• li'1• :i t�"[•• - �_ - - - -13., '•i ..J,�l...i.t.�� .:s�{..tili t..:l,tt !:tlr.l�i1)'3 t:a�.,,,��ff t'i { ) Olt {`� Ali;. i � ��{� �. 1p {:• i:., i 1'1 �i:i.{ !'•i♦;11'.<17iit' i(t�;' ii `r '.�L'::.. ,:I,-..J:, ZF:t,`-,:•..11:.. :. .:iSi.'i?l`�• J:j`�•t`1,�'.k3:-', .-`I 1- 5:�3. •t ;�4,:1i lt,�t f•� Ai,i,t..i;1:; ' t:t ^.t:4.t�1' .1..p.';'kt�.Et[i:- .(.i�.n'��' ir.�.:ii.; THIS T'ASRTC WAS USED IN THE AiANWACTURI NG O3 T SE FOLLOWING 10RA IOX10 21PC WEMN CANDY TOPS LACE STYLE W/LOGO 3EA 10X10 Vb'HTT T:CANOPY MM TOPS LACE STYLE WILOGO '-jO+'•:'i�':��n3C20 WHITE C,A,�O.pY j�TOP�c'>F S'PYf.F.wRnrn 2iE•A SX20 SEDE-W.41L CILw4R 1F A 20X20 23PC VVBITE CANOPY TOPS 55023 LAKE STYLE W/IAGO 1c r-, :+�0. --A 20X10 WHITE CANOPY IVIED TOP .. PJ-�-�: :_�; ;:e`;- :--,; 53361 LACE S'if'fY�LvE WILOGO . !Z . ,.1- ' :i 7JRA 20X220 iR�+ii�+yt�iAi'i/�.CANOPYMID -.i•�i LACE STYLE 1<7.'3I�)GO —4 30X36 21PC WEM CAOPY TOP `I'L.-2EA f0 20 WBIT'E CANOPY 11+I M TOP LACE STYLE WAA)GO SEA EA 30X10 WHITE CANOPY MID TOP r f"Pjk19d- E.EEWALIL NV13M LACE STYLE l 4A)GO 2EA SX30 SID ALL WHITE LEA 30X2b WHTIE CANOPY MID TOP 6EA SX20 SIDEWALL PANORAMA LAGS STYLE WILOGO ALL MATEWAIS ARE CERTRIED BY THE CALIMRNIA STATE FIRE �RSH A 1-I 4YW MEET THE REQUIREIdMIS OF TSE PWA 701 AND U*..�2M- Z'd LZUCMZt, slelueU luen3 leioedS 08d 8V0:0L 60 66 AeW B.J. ALAN COMPANY NW PHANTOM FIREWORKS 2367 Lincoln Ave.,Tacoma, Washington 98421 February 23, 2009 PHANTOM NIGHT SECURITY Tents are equipped with sidewalls and lighting. The tent will be attended 24 hours a day and will be lit and look attended at night when the tent is not open for sales. Nighttime, off-hours attendant(s) will be providing security during hours the tent is not open for sales. Nighttime attendant(s) will have telephone(s) in case of emergency. Nighttime attendants will be instructed to call 911 for emergencies and they will be given emergency numbers to contact B.J. Alan Company NW/Phantom Fireworks management. There will be a trailer, camper, or other vehicle on site during closed hours to confirm someone is on site at the tent. Trailer, camper, or other vehicle will be in close proximity to the tent, per local codes and rule's allowable setbacks. Nighttime attendants will carry whistles, horns, or other noisemaking devices to alert any intruders to their discovery. All information regarding the sale of fireworks and nighttime watch over the fireworks will be covered at Fireworks Retail Orientation Workshops, mandatory attendance with every group associated with the sale of Phantom Fireworks. Phone: 253.396.0966 Fax: 253.396.0771 n .' All by k t iv s ? # t 115 yin 4Y. t'FY jtt ,fix w 6-70 MASON COUNTY Department of Community Development FIRE PROTECTION SYSTEMS INSPECTION CARD* PO BOX 186, 426 W Cedar ST, Shelton WA 98584 IrP14 General Questions: (360) 427-9670 ext 352 Inspection Requests: (360) 427-7262 Permit Number FIR2009-00032 Date 06/19/2009 Issued By Project Stand Site Address 141 NE CLIFTON LN BELFAIR Applicant KEVIN TAYLOR 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 Dud 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 UNITL ALL APPLI CABLE 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 MAIGNG 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.