Loading...
HomeMy WebLinkAboutFIR2011-00014 Fireworks - FIR Permit / Conditions - 4/18/2011 T , m o m c) D b o o p v ;a � n LCo > cc m mmmZ S. M. 3. = n n Z C D n = 90 m �_ o � � 0 32) 3 a J a a ca r Z C' +> > O Z Z Z Z Z N1 O 17 r = Z v X m CA) r m D= C) -n n OD a C Z a m `�, Z m NI o CA m ° ccX m m z w Q rn 4 CO -vm Cl) m -n O n D —I y CO) 00 = o 0 3 ar W -n'o m m x -' � "a , 3 8 8 8 cn � � D rnC � " _. _ X 0 Z m o � -♦ D N N CD N c `I o rn m 0 m Z < o w -p m CZL -, 4 O 7 0 S. o N 3 cn D m ui x 3 c a off — Z 79 3 -� o. v y ' .� o o � m y < 3 m o cn c c < c o Cnvv N vv � � � cc co to i3 0 0 to iv ° N °�, o $ O-P O c� c-& 9 c 21, O .vi 0, w rn 0) N N TI v 70 O � X --l0D x0 X0 � X5 ?-> X5 Z XZ21 X � Xd -i xno cS D X0 x C- C- 0 6 0 O N cr j O 3 0 N'I� N C AL M 406 M. v, dN a, a 8d 3 �' � C (D N p aa_ Fi �p N o o f (p N 01 N N a .. N d N � 7 2 (�D �_ co � Q�. M !31 �p a � p C �MS1 � N Al$ 3 3 CD 90. CL w CL roi* 0 CL 3 3 080chi �i 9 cn o° Q 00 O 7 IQ3Z (� a WO lD .�. ` u O .. 01 g .. 3 (/� m N O to CD 0 aka 3 < N. � � ° o c� � �_ cl o 0 (o CL O O (omo �8 � o * -% a 3 &9 3 N ocn (� Q. 3N o(a do ? ' cr, O O ter w N s � �- rn (D0 CD O 0 9(0 7Z ° N c?D o N 01 �� (D N fA (Dj 'e3 p 0 N (D .. (D O G. O 01 N a 0 c Er01 N N (p o m O f! S X (A N O (D N O� �" a 0)=' '� ° 7 N 01 (p 3 N co(G_ p^ a N (�D N N Z .. n C* G1 pl _ O ¢ p 3 a S: N cr OZ 17 CD (D 4 Cl) q - - (D � O fl -% 0) O to (D Cl) 5 = ,r CL (D �j p 0 � co O - 0) O. p W - - m ° u' o FLcfl a 0 (o ? - r. ? o CL s� N Cl (o a co ,�c CD 3 w - _ Acr O D M 't W N O 01 (� O N im p CL N "" O N Q rt N N m M C,4 O (D =r (D N (D O 7'1l O (D N n 01 CL coM to (D = 1 (SD =b cr N (p N ? AK: O M 01 ? �• p Q = Q (D (D W 2. In o pp W-4 N Z O m H v CDA,I b Opr HXN X 'n Xg S a X cD� i ? c M ° m X IA R- 3 3 N R A 7 N (p tC ? O S N ! (g N O N � C ON p_ O O ' m O 7 N S N n* a O }+ Ot _,ems. �D=r N (D 0 O (CD N 3 A n m �p— o �S. j1 cic� � 001CL -A0 � Q ° m � a ND 8 N 7C 0 p 'C m p 7 p O� O .+ O m C 7C N m S "O (p 'p O N A� @ R (D 01 N N 7 21 CO M N 0(a !� IDO N �1 (D O O �3 _ Q 8 =� 'C < 01 &y ' y U, Q G (A Cc N p 7 N K) a(p O _ a c . N = V1 N �p 03 1 f C N N gyp aam0 Q. to — � N � aG am) (D co Q. p'p 0 CL p C aCL � O N 0) .� N � ° o cDN � wa Q� � 0 3 .o N � mHy N p' � �'S aC Q �1 3 = j N °w 'N+f .« a y p N Qao N O O ,.. S � O A '.. 0) O M N 3 N O N N ma� g CL (D o m ° as v 3 a v; � O m @ o <D G CL m ?O 0 D O @ � SOD rt O Q O N �p p empg C G O C 03c' N x ' N a C� cr .�► D ? o N p, Q a (p N M m m m = `� oN Z m" 3 �, Nn N D) ~`�' 'pO N a fl1 pD O m p O C M N N �1 � a (NA N a A O am O 0 a ncr ' = 0 7 N ='f 01 c <y 'N �. D Z paw =r o N = a 1 N O O ° <D =t (D - N CD O ? MO. Cl) N O n Cl) ? D) 01 N f�A .�► S G A •O" N O (p D) n "r N Q p -p S W d O N N D) �1 m n MO ���+ O p _� O t� N NN � � N O03 N O C a � N -n O N . Q@ a C� CA (p j m •� pSj (DD N tll y y O U3 O cr a Q � , C (g C N O (A _fD p =r a D) C .+ CD � f' S 9 (D C N (C -r rt S ^� C. S C y O fir p M N O N p N -7 a A OL 3, y C1 N O0. � = (aO S p C (DN N a C (D -w O .. N N m .� O ° G > > > ° g wa =, O O p � -„ S O N a (0 0 N 3 N S O � .-. M a p a Cj O 5 IR N S C-O m O O O (D aQ'a n cD SO N N O D) N O d N T�.p o Mm 0 =f � 30 N :3a" 3 CnN �' O N N ,(� S M N (DO C N N Q pcSDN E12N N'ON Oa (DN O a- cr C 4t 7 GNO f�! a N C' CD 7 tD (Aa =r cC m 3 m CD fD a A O O) CONCRETE MECHANICAL MANUFACTU D HOME Footings 1 satbooke Gas Piping ay Rlbbona a bInterior Date By Interior-Data By Dabs By O Exbarior Date By Exterior-Date By Sot-Lip y A Point Load laolated Footings INSULATION lam, By (A BG 1 BLAB N OULATION m Date By Data By FIRE DEPARTM ENT a 001 Foundation Walla Floors Data By r Date By Data By DECKS 0 FRAMING W Data By II Date By Data By PROPANE TANKS DO PLUMBING vault Data By p Date By OTHER C Groundwork Attic Type: C Date BY Date By--- -- Date BY DRYWALL Type:. Q«W.11 Int Braes Wail Dfft By Date By Date By FINAL INSPECTION o Weeder Una, Fin Separation Date By Date By Data By o Pass or Request Inspect. Type of Insp. Fall Date Date Done By Comments A m t c- e- 0 0 a a 0 2 0 co m 0 0 0) Mason County . Fire w tt Pomit Appff"Won PO Box I'm 428 W Ceder 8t Permit#FiR — n =.iL4 Sin WA19 4 Receipt pit { }427-9970 ezt 273 qi 2A- 2.011 3 � 0VXk_,, Date Received -j-4 A Permitforlhe Retail Sales or Public display of*ewo*s is required. A ownpleted Application wiffy nxpkVd:docunwft0on and few shall be submifted for Flm Marshall review. A permit will be wed upon eeti Cory site fiction by the Fire Marshal. Appkltnut Watawin Name. TYSON DEVRIES MBlling Addf0 23001 NE STATE RT 3 y BELFAIR State: WA Zia., 98528 ott ctNumber (360) 277-3778 Sponsor Information Nam: BELFAIR ASSEMBLY OF GOD Mailing Address: 23001 NE STATE RT 3 City: BELFAIR State: WA Zip 98528 Contact Number (3 6 0 ) 2 7 7-3 7 7 8 Washington Staft Fireworits Ucense Info► uMon (Copy ReWked) License No.: Date of WSPFL-00848 Issue: 02/18/2011 El Pyrotechnic operator Lit nse Fireworks SUnd License Smul or Certficitt+s ©f insurance (Copy of CerWk*e!Bond Requited) Provider: SEE ATTACHED INSURANCE Insured; Certified Holder: Locaftn of ztwWdisplay Andress: SAFEWAY #1571 23961 NE ST RT 3 BELFAIR, WA Directions to Site: Parch Number; - 1 - 1 Legal Description:: Legal Property owner: SAFEWAY * * Please,see the reverse side to complete your application ! i l � a Locations a !gtiWk( i"dsma from the back,sib and ftnt of reWl s or dealweas to. Fire"Hydrants ' Pmpaty Lines • Buikli Parking • Combustibles • Public R-o*b=4 R4ft of Waw Fire Lanes • Private Roads and Right of Ways Trees/Brush • J.atict no&s: Utilities and Gas • Mortar separadon distance Pm—goated,loading area "PLEASE SEE ATTACHED DIAGRAM AWW l teNy t *farr+rletf+n provided herein is a=rate and that oMpliatm with all Cmmty,. State WW Federal iiim pertaining to the awes or dim"of f eworks shall to Mourned. Slgtied FOR TYSON DEVRIES Date 04/14/2011 1001i .$EI.m Tms Li�TE Accepted By: Bate: z WID Iiniimited N 78M M w*pt of one We OW 17 509-Mile-ISM Fax J9vM6M?-IJM To Whom It May concern: TNT Fireworks,Inc.has been granted the exclusive rights to license,eruct,and maintain fireworks stands/tents on Safeway,Inc. store parking areas for the 2011 fireworks season. i L. i4� 'than Phillips December 23,2010 To whom it may concern: Please be advised that W.Van Phillips/WID Unlimited,has a license to conduct .fireworks sales at the Safeway store locations listed on the attached exhibit. - Safeway ' c. B : Y Its A istant Vice-presi By; 12 23 2010 Its Assist a etary Ev�M L(�pr\)u 7 - 1 _ _ � o, N � r . ng , masm -nitarl, �kslk at Z � �► i .► i V cci io z n C/) m 0 � m 70 N CD O W � � 0i W Si� � ..� IV l�'�pJNd Nii w, V C? � Qd ii Vd otri � c� � u, Jf mz �o ii im:Z 0j8 m0 '�: (� nv� = rQSm2y� zm � ' O �j ' v � 0 m WE Kz � om � � � �r � C7 � N -� a = z �Da � 'z $ mr n � vcn --i -CZ " M DO -' -i � px m --11 'v RE zm (O� Ua �oOR p -iSZ — c� < Z DI'O S SrMrO OcrN mcn c� Zm �, z � mi cn �rD � r m z Dnm -i : Z � m -� � < -+ � DA C � D Cj) X m0 amw m -< m v v z rn z m 70v z m A � v mO � n -� ZzrZ m mm C Mirn Cr = D KSDOD -1 ZZS -1 .3 � C < "qZ om OzmDr D � p0 * mn0zzq * 0 mmc cc m -iO mDDS S ,r- -I � ZCM '� m < 00 � 00 z � v p mm Dz zv m z m Z3) r � Z zz n CO) cmmn Z 2 m m » » > > » D > > » » » » » » » '♦ O O O O N N ma . . . . N N N N 80000 N N N N N N . . . . N N N N N N O O O O O O O O d 0 0 0 0 0 0 0 0 0 0 O O O O O d O O 0 0 i �i i i i i i i i i i i i i i i i i i i i i ..i i .► i i i i i i i i i i i i i i i i i i i i i i i vvvvv3vvvvvvvvvc� vvvvvvvvvvvvvvvsv ccccccccccccccccccccccccccc c c c ZZZZZEZZZZZZZZZZZZZZzzzzzzzz� z� z z rrrrr � rrrrrrrr- rrrrrrr- rr � rrr r,_ r; rn mmmmmmmmmmmmmmmmmmmmmmmmmmmmm mvct vvvvvvvvvvvvvvvvvvvvvvvvvvvvv v � Li 3 m APPLICATION FOR RETAIL FIREWORKS STAND PERMIT 6551 TO: Governing body of city,town, or county in which DATE OF JAN.02, 2011 fireworks stand will be located. I APPLICATION: Applicant Name: Address,City,State: BELFAIR ASSEMBLY OF GOD 2120 MILWAUKEE WAY, TACOMA WA 98421 Sponsor(If other than applicant): Address. City,State: TYSON DEVRIES 2120 MILWAUKEE WAY, TACOMA,,WA 98421 Location of Proposed fireworks stand: [Enclose drawing of stand location] 23961 NE STATE RT#3 BELFAIR,WA SAFEWAY#1571 Manner+ and D-lace of storage prior,during,and after sales dates: ON SITE WIT14 SECURITY State Licensed Fireworks Supplier: American Promotional Events NW 2120 Milwaukee Way, Tacoma,WA 98421 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - FIREWORKS STAND PERMIT For The Fireworks Sales Year Of: 2011 (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 IAG Consumer fireworks at the location designated herein between the following date and times: Sales For July 4th Sales For December 313t From: From: To: To: Sponsor: BELFAIR ASSEMBLY OF GOD Location: SAFEWAY#1571 23961 NE STATE RT#3 BELFAIR.WA /s/ /s/ FOR TYSON DEVRIES Signature of Official Granting Permit Signature of Applicant Title: Agency: Date: Permit Number: Licensee Name: BELFAIR ASSEMBLY OF GOD License Number: 00848 3000-420-013(Rev.7A5) CD o � CD Q r 0-4 CD CD N r'7 f�D .� o r to CD .''' �1• 00 z UJ ~moo O O 0 O 10 —1C oo � bu o fD r PO � � n eb o 00 �• N y O CD h m t"t7 t"nt" I O C.Z w o. eyo �. > Y V pME ��" z � ; [ ta, -� o {✓r' l �y R�5OT 1-3 tz CLGO o. a co n 5r 1 A w IV N t4 v Cil I cn I CERTIFICATE OF INSURANCE ISSUEDATE ACORD�, 10129/2010- PRODUCER This certificate is issued as a matter of information only and confers no nights MCGRIFF,SEIBELS S 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 PHONE:800-476-2211 COMPANIES AFFORDING COVERAGE Company Liberty Surplus 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 DGLB00810581 11/01/2010 EACH OCCURRENCE $ 1,000,000 ®Commercial General UaNiny 11/01/2011 FIRE DAMAGE $ 200,000 ❑Claims Made M Occurrence MEDICAL EXPENSE $ EXCLUDED ❑Owners'and Contractors'Protection ❑ PERS.AND ADVERTISING INJURY $ 1,000,000 ❑ GENERAL AGGREGATE $ 2,000,000 General Aggregate Umit applies per: PRODUCTS AND COMP.OPER.AGG. $ 2,000,000 ❑Policy ❑Project ®Location AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ❑Any automobile BODILY INJURY r rson $ ❑All Owned Automobiles . El Scheduled Automobiles BODILY NJ Per accident) $ ❑Hired Automobiles PROPERTY DAMAGE(Per accident) $ ❑Non-owned Automobiles COMPREHENSIVE ❑ COLLISION WORKERS'COMPENSATION WC Statuto Limit T76th r AND EMPLOYERS'LIABILITY EL EACH ACCIDENT $ EL DISEASE Ea em I ee $ EL DISEASE(Policy Limit $ EXCESS LIABILITY EACH OCCURRENCE $ ❑Occurrence ❑Claims Made AGGREGATE $ $ $ Re:Safeway located at 23961-NE St Rt 3 in Belfair,WA(WWH6551) The Certificate Holders are named as Additional Insureds 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 Ili LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF Safeway ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Belfair Assembly of God Mason County Authorized Representative PO Box 186 426 W Cedar ,�y Shelton,WA 98584 Page 1 of 1 Certificate to# 42HYFCT0 SITE DIAGRAM Date Updated: L y 1010 Location #: w w co Location Name: Ordinance Of: M.O,W) GOL-t.h tm Site Address: 2."J V ( N E S}- 1Z- �J Structure Size: 2!,P+, CITY 5,6�Pa,l ir- STATE/ZIP WA- °1 ructure Faces: Parcel: Shots.al setback from structures, gas, fire lanes, public and private roads, property lines trees and landmarks Kad CIA N E ( SUBMIT CHANGES FS PRIOR TO PERFOR INGAP WORKPROVAL S oy no Park• C or Air: 4,- Notes MASON COUNTY FIRE MARSHAL 4WMason County BIft 111426 W Cedar St PO BOX 186 Shelton,WA 98584 (360)427-9670 Ext.273 CODE ENFORCEMENT FIRE INSPECTIONS FIRE INVESTIGATION PUBLIC EDUCATION STANDARDS FOR THE OPERATION OF RETAIL FIREWORKS STANDS Sales Consumer fire works may be sold only on the following days and times. • June 28 h from 12 noon to 11PM • June 29th—July 5th from 9AM to 11PM • July 6th from 9AM to 12 noon • December 27th—31"from 12 noon to 11PM Auuroved Fireworks Only Washington State Fire Marshal approved Class C common fireworks may be sold. 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' 201. 20' 20' 20' 20' w Surroundine 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 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. • Customers 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 equipnjenvis,prohfted,iift'a firl Wo*s mod: ., a • Fireworks stands shall.be locked when unoccupied and not open fgr b ass if f ewer �stored in the stand during these times. Fireworks stands shall Inot be lockrd,�whe� 66-6 ipied Flfewohiks may be removed or transferred to a temporary storage structure or loeation of thi 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.