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FIR2017-00041 Final Fireworks Stand - FIR Permit / Conditions - 12/12/2017
-n CONCRETE MECHANICAL MANUFACTURED HOME F Date By Footings I Setbacks _j Gas Piping Ribbons m 6 Interior Date By Interior-Dale By Date BY Oo Exterior Date By Exterior-[date By Set-up 0 Point Load I Isolated Footings _TN_SULA'nON Date By BG I SLAB INSULAT.I,ON Date By z Foundation Walls Date By FIRE DEPARTMENT Floors Date By Date By Data By DECKS FRAMING WAHS Date By Date By Date By PROPANE TANKS PLUMBING Vault Date By Date any Groundwork Attic OTHER Date By Data By Type., Date By D.W.V DRYWALL Type.- Date B Int By Brace Wall Date -n y -4 Q'atO By m FINAL I SPECTION, Water Line Fire Seperation Data By Date By Data tl VJC� Pass or Request Inspect. 6 TV0 of Insp. Fail Date Date Do e Ry Comments Q o 7— k7L) 0 M cc (D O 0 0 0 =r 3 (D 0) IV XO . o m m V nn " \. O o o rD - DXLnO O _ rn m m m 0 Do o � p cnr- ZD c 5. M. u=. -n -0 Cn � � °o 1. 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G '� � ^.� b`�"ti' M o. � `e` m�.� � q .� �, �. � • �. � '�;.t a �� ��Y � �� �,� - ��, � � � �� �h; .. :� �, ���� �a.�� c,� � �,, d �� �. �N �,���'" v � s� �� �� �y y . w� ���� � � m � � � .�� �� �"'"';� �u � fit.. .��� � . i I � < I� ����w �3. � � � fit' � ya 11� � �P,_ 1 �g RO �ti'' �` s \,.. ` �,.. �� , E(MM/DD/YYYY) + CERTIFICATE tFIC3AT OF LIABILITY INSURANCE DAT03no/2017 THIS CERTIFICATE45 ISSUED.ASAMATTER OF INFORMATION ONLYAWD CoNfIERS NO R*HTS UPOkTHE CERTIFICATE HOLDER.THISCEMICAT£DOES hiDtA€f;RM471VFLYOR NEGATIVELY AME+ "XTENDORAtTERTMECOVetAGEAFF EDRYT"EPOUCtUSE.Osx.TtusCWWICATEOFMSJJRA14CEDOESUMOOttsTMTEACONMCr$EThT"TttEtssulT .INSURER(SL AUTNORMRFPRESENTATWEORPRODUCER,ANOTH€.CER MCATEHOLDER. tdAPrMt7'AN7:NthetettiHcateho3der"sanAbDtT#O#A'tfiNS'URSD,thePWftYC%Jf4wAsthaveADD1TiONALINSU Provisions orbee d.IISUBROGATION4SWANEb,subjecttothetermsand �.conditlonsofthe policy,certain policies may require an endorsement.Astatement on this certificate does not confer rights to the certificate holder in lieu of such eadorsemeaKs). PRODUCER CONTACT (3AVlD CONNOLLY INSURANCE AGENCY INC. FAX - -- --------- 9393 BAYSHORE DRIVE (A/C,NO,EXTk 3W-M-6339 (A/C,NO).- E-MAIL SILVERDAL€ WA 98383 ADDRESS: INSURER(S)AFFOADVIGCOVIEUGE NAICS.. ...� INSURED INSURERA NATIONAL FIRE&MARINE COMPANY HALO FIREWORKS LLC t fNSUR47tI? — i 15156 NW HITE CENTER RD ! URERC tF�iJ#ERt4: SEABECK WA 98380RtSURERE: INSURER F. COVERAGES CERTiFiCATENUMBER: _�..._—.. REWSiONNUMBER: �_.. THISiSTOCERTIFYTHATTHEPOLICIESOrINSURANCELISTEDBELOOWHAVESEENISSUEDTOTHEWSUREDNAMEABOVEFORTHEPOLICYPERIODINDC.ATED.t4OMITHSTANCtNGANY REQUfREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER COCUMENT WITH RESPECTTO WHICH TKSCERTtPICATE MAY BE ISSUED OR MAY PERTAIN,THE iNSJRANCE AFFOROEDli POLICIES DESCRIBED HEREIN IS SUB}ECTTO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN DRAY HAVE BEEN REDUCED BY WDClAIM& NfSR ; TYPEOFUISURANCE ADDTt SUf1R t POLICY FOLICYf.Fi POtiCYE7W + i�fAiTS LTR 4NS0 WVD 1 f It1DDf/9P#h) XieM# YYYY); COMMERCIAL GENERAL LIABILITY _� — --�� ( EACH OCCURRENCE $ 1,00t),000 } _. CLAIMS-MADE X''OCCUR DAMAGETOTciN"TED { _ PREMISE..-S(Eaoccurrerice) 3 100,000 P MED£xPfAnYanzpersnrr3 s 5'000 A r34r'01t2017 04JOSA2018 tPERSONAL&ADVINIURY S 1,000,GQO- _ i X 721.P8028234 _ .._, GEN'L AGGREGATE LIMIrAPRLiE5PER: ;GENERAL AGGREGATE 2.. : 0 1 - _ POL,C1' C nRO ECT LOc PRODUCTS-COMfYOP AEG4 2.000,000 T i OTHER: 3 , 3 AUTOMOBILE LIABILITY COMBINED SfNGLE LIMIT --� `(Eaacckdem) i$ F 1'tNY 0 j BODILY INJURY(Per person) 5 OWNFOAUTOS �,SCHEDULED - "-"- t , i ONLY AUTOS 5OD3LX Rd#UURY(Pet acefdert)-S I -- HIREOAUTOS NON-OWNED ? 'PROPERTY DAMAGE .........' ONLY AUTOS ONLY : j (Pcrarr lctt) �S UfABIdEL3A:LUf$ OCCUR - . -------.— I ',EACH OCCURRENCE EXCESS UAB } CLAIMS MADE ; "AGGREGATE -....__..._.1.-_._..—.— DED rETEKncNS WORIt£RS COMPENSATION z PER ALSO EMPLOVERS'LIABlt.ITY ST.%naE z... OTHER !s ANY PROPRIEYOR tPA111N£R/ Y/a ( E L,EA D i ACCIL7Et3T -- EXECUTIVE OFFtC:ER/MENSBER N/A EXCLUDED?(Marrdaroryin NH) E-1n DISEASE-FAENI sOYFE Ifyes,describe under DESCRIPTION OF OPERATIONS below i EX DISEASE-POUCYLMT I - -- __ --- +DESCRIPTION OFQPERATIONS/LOCATIONS/VXMCLES(ACORD101.AddikowRernarks5thedula.rnaybeanachedBmcrespaceisrequired) 'Soomtown Productions I.I.C.Mason County,Property Owner Jae Solis are listed as additional insured for the Fire work stand a122950 State Route 3 Seifair,WA, 98628 i I CERTIFICATE HOLDER CANCELLATION ...... SHOULOANYOFTHE POLICIES CELLEDBEFORE•TF EXPfRATJON ` BOOMTOWN PRODUCTIONS LLC �DATE THEREOF, BEOEUVEREDI CONDANCEWITH,34 al5ff'sI ioNS. 15156 NW HITE CENTER RD s, AUTHOR RESENTA71VE I _ RPARECK WA QRIAQ ACORD 25(2016/03) dDl 988-2015#CORD CORPORATION,All Rights Reserved 31-1769 11-15 The ACORD name and logo are registered marks of ACORD 1 Aso coU 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 17 - Mason County Fireworks Permit Application RECEIVED Incomplete applications will not be accepted DEC 12 2017 A permit for retail sales or public display of fireworks is required. A co&j§eygdAlder Street 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: Mailing Address: i 5' 1,5� n�A) 14L City: ez_b cck_ State: A Zip: Phone #:1�,�, (,�,�°,_ 1 2 Email: Sponsor Information: Name: Address: — City: State: Zip: Phone #: Email: Washington State Fireworks License Information (Copy Required): License Number: 5 n - 1 1-4 1 �z Date of Issuance :h is 2-6 14- o Pyrotechnic Operator License XFireworks Stand License Bond or Certificate of Insurance (Copy of Certificate/Bond Required): Provider: Insured: ( [; r "1 k)(1, Certified Holder: Location of Stand/Display: Site Address: 11 L n C_ fe �i (`D' t toSite:i C'/ Parcel Number: (twelve digit n er) 03.2 Legal Property Owner "Please see reverse side to complete your application" (:\Community DevelopmentTIRE MARSHAUFireworks Permit application.doc r 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 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 IACommunity DevelopmentTIRE MARSHAL\Fireworks Permit application.doc 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 `ks$ PO Box 279, Shelton, WA 98584 www.co.mason.wa.us STANDARDS FOR THE OPERATION OF RETAIL FIREWORKS STANDS SALES: WAC 212-17-21505 Retailers of fireworks—General provisions. • Fireworks may be sold from 12:00 noon to 11:00 p.m. on June 28 through 9:00 p.m. on July 5. Fireworks may not be sold between the hours of 11:00 p.m. and 9:00 a.m. from June 28 through July 3. Fireworks may not be sold from 12:00 midnight on July 4 through 9:00 a.m. on July 5. • Fireworks may be sold from 12:00 noon to 11:00 p.m. on each day from the 27th of December through the 31 st of December of each year. • Licensees shall familiarize all persons working in a retail fireworks stand with the provisions of these rules. • 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. APPROVED FIREWORKS: • Only Division 1.4G consumer fireworks, obtained from state-licensed wholesalers, not otherwise prohibited by chapter 70.77 RCW or local ordinance, and holiday related products incidental but related to these products, may be sold in retail fireworks stands. FIREWORKS STAND LOCATIONS: WAC 212-17-21509 Retailers of fireworks-Location. (1) Activities or uses subject to this rule shall not be limited in location except where such activities or uses are prohibited or controlled by local development regulation, traffic safety or road construction standards. (2) Temporary retail fireworks stands shall not be located more than one hundred fifty feet from a private way, fire department access road,public road, street or highway as measured by an approved route around the exterior of the stand. The minimum requirements for a private way IACommunity DevelopmentTIRE MARSHALTireworks Permit application.doc shall be determined by the local authority having jurisdiction, but shall not exceed the requirements of locally adopted street, road and access standards. (3) Any two retail fireworks stands shall be at least one hundred feet apart or shall be separated by a road, street or highway not less than thirty feet in width. (4) Retail fireworks stands shall be located as required by Table 212-17-21509 in this section. The minimum required area surrounding the stand shall be marked or flagged, except that flagging and marking shall not block a sidewalk or pedestrian pathway. Flagging need not exceed twenty feet in any direction. Retail Fireworks Stands - Minimum Clearances MOTOR MOTOR VEHICLE VEHICLE TRAFFIC TRAFFIC Combustibl Property Parki PUBLIC PRIVATE Buildings es Line ng ROAD* ROAD* BACK OF STAND 20 FT. 20 FT. 5 FT. 20 20 FT. 5 FT. FT. SIDE OF STAND 20 FT. 20 FT. 5 FT. 20 20 FT. 5 FT. FT. FRONT OF STAND 40 FT. 40 FT. 20 FT. 20 20 FT. 20 FT. FT. 20 FT.** 20 FT.** NOTE: Clearance distances are not cumulative *Measured from the outer edge of the nearest traffic lane. **If stand is equipped with 135 fusible links which will automatically close all sales doors in case of fire,or is equipped with a wire-mesh screen with openings of not more than one inch which covers not less than 90%of all sales openings. (5) Retail fireworks stands shall not be located closer than one hundred feet from any motor vehicle dispensing station, retail propane dispensing station, flammable liquid storage, or combustible liquid storage. Retail fireworks stands shall not be located closer than three hundred feet from any bulk storage of flammable or combustible liquid or gas, including bulk plant dispensing areas. EXCEPTION: 1.Fuel for generators as allowed by WAC 212-17-21513(4). 2.Fuel within the tanks of motor vehicles. SURROUNDING AREA AROUND FIREWORKS STANDS: WAC 212-17-21511 Retailers of fireworks-Area around the retail firework stand. (1) The minimum areas around the retail fireworks stand specified in WAC 212-17-21509 shall be kept free of accumulation of dry grass, dry brush and combustible debris. No parking shall be permitted within this minimum area. I:\Community Development\FIRE MARSHAL\Fireworks Permit application.doc (2)No motor vehicle or trailer may be parked within twenty feet of a retail fireworks stand except when delivering, loading or unloading fireworks. (3) Fireworks shall not be discharged within one hundred feet of a retail fireworks stand. Signs reading "NO FIREWORKS DISCHARGE WITHIN 100 FEET" in letters at least two inches high, with a principal stroke of not less than one-half inch, on contrasting background, shall be conspicuously posted on all four sides of the stand. (4)No smoking shall be allowed within the retail fireworks stand or within the minimum flagged off area. Signs reading "NO SMOKING WITHIN 20 FEET" in letters at least two inches high, with principal stroke of not less than one-half inch, on a contrasting background, shall be conspicuously posted on all four sides of the stand. ELECTRICAL SUPPLY & USAGE: WAC 212-17-21513 Retailers of fireworks-Stand use and construction. (1) Fireworks may be sold from: (a)A permanent structure which meets provisions of WAC 212-17-21505(3). (b) Temporary, stable structures made from wood, metal, fiberglass or other material. Any temporary fireworks retail stand greater than four hundred square feet shall meet the requirements of a permanent structure, except tents or canopies as defined in the International Fire Code retail stand greater than four hundred square feet shall meet the requirements of a permanent structure, (c) Tents, canopies, or structures utilizing temporary membrane material. All tents, canopies or Temporary membrane materials structures shall be made from fire retardant material or treated with a fire retardant as identified in the International Fire Code. Any tent, canopy or temporary membrane material structure falling within the scope of the International Fire Code shall comply with those requirements. When those requirements are in conflict with other provisions of these rules,the more restrictive provisions shall apply. (2) Battery powered equipment, electrical equipment and electrical cords which are used in conjunction with a retail fireworks stand or a temporary storage structure or location must be listed by a recognized laboratory and used in accordance with that listing. If electrical power is supplied by an extension cord, the size of the cord, the length of the cord and the amperage and the voltage supplied shall be in compliance with the requirements of the National Electrical Code, current edition. The cord shall be protected as necessary from "drive-over" and other physical damage.No additional permits from a city or county or state official having jurisdiction shall be required for these temporary uses except as specified in subsection (5) of this section. (3) All heating units shall be listed by a recognized testing laboratory and shall be used in accordance with the listing. Heating sources shall have "tip-over" and temperature overheat protection. All heating devices shall have sealed type elements (i.e., oil filled or water filled radiator type). Open flame heating devices are prohibited. (4) Generators which use combustible fuel and which are at least twenty feet from the retail fireworks stand or the temporary fireworks storage structure shall be allowed. Generator fuel shall be limited to not more than five gallons and stored at least twenty feet from all stands. (5) Compliance with the National Electrical Code,current edition, shall be required for all new, permanent electrical installations, including temporary power drops, subject to possible permit fees. (6) Retail sales of fireworks and other products which are holiday related shall be from buildings used for no other purpose. I:\Community Development\FIRE MARSHAL\Fireworks Permit application.doc 'TORAGE 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. (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. (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. (4)No open flames nor any type of open flame equipment shall be allowed in any temporary fireworks storage structure. (5) Storage of fireworks authorized by a retail license and permit is legal only during the periods specified in this section. (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. (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. (8)No cooking is permitted in a retail fireworks stand or in a 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. IACommunity DevelopmentTIRE MARSHAUFireworks Permit application.doc r WAC 212-17-21519 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. (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. (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. (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. IACommunity DevelopmentTIRE MARSHAL\Fireworks Permit application.doc APPLICATION FOR RETAIL FIREWORKS STAND PERMIT TO: Governing body of city, town, or county in which DATE OF fireworks stand will be located. I APPLICATION: Applicant Name: Address,City,State: Johnathan Miller 15156 NW Hite Center Rd, Seabeck, WA 98380 Sponsor(If other than applicant): Address, City, State: Location of proposed fireworks stand: [Enclose drawing of stand location] 22950 NE State Route 3, Belfair, WA Manner and place of storaize prior,during,and after sales dates: ATF and L & I approved storage. Fireworks to be delivered on site State Licensed Fireworks Supplier: Jakes Fireworks - -- - - -- - - - - -- - -- - -- - - - -- - --- -- - - - - -- - - - -- - --- - - - - - - -- - - -- - - --- - -- - - FIREWORKS STAND PERMIT For The Fireworks Sales Year Of: (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 as the local governing authority,the named person, firm or organization is hereby authorized to sell U.N. 0336 1.4G Consumer fireworks at the location designated herein between the following date and times: Sales For July 41n Sales For December 31s' From: From: To: To: Sponsor: Location: /s/ /s/ Signature of Official Granting Permit Signature of Applicant Title: Agency: Date: Permit Number: Licensee Name: License Number: