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FIREWORKS STAND SITE PLAN
SITE DIAGRAM
DATE UPDATED: June 1, 2017 LOCATION NAME: Belfair Stand
12ti3
PARCEL NUMBER: 12332 00044 ORDINANCE OF: Boomtown Productions
SITE ADDRESS: 22950 NE State Route 3 STRUCTURE TYPE: Wood
CITY&STATE: Belfair,WA STUCTURE SIZE: 32 x 8
CROSS STREETS: State Route 3 & NE Roessal Rd STRUCTURE FACES: West
NT
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CERTI
FICATE CIF LIABILITY INSURANC DATF(�#MfDD/YYYY)
OWO/2R17
THIS GERTIRICATEis ISSUED ASAMATTER OF#NFORMAT#ONIONLYAfitD CONFERS NO RWISUFON THE CERTIFICATEHOWER.THtSCOrTiFiCATE DOES N0TAFF401MATIVELYOR NEGATIVELY
AMEM.:DXTfiNDORALTEPTHECOVERAGEAFFOR DED 8t'TtiE:POUCIES EELOWW.T#it'SiCERMEATEOF IttSURANCE40ES ItOT CONS'MT£ACONTRACT SETW£EN THELSSUI NG LNSURER(S).
AUTHOR#ZEDR€PRESENTATIVEORPRODUCER,ANDTHECERTIRCATEHOLDER,
i IMPORTANT.tfitheveri3ficaY,e'ho#der is an ADDITIONA13NSURED the Aoilcy(tcs):nust hBve.A0oMONAL'WSURED#rw4istonswbeendotsed.irsuBROGitmoN is w^H7ED,subject to thirterm5 and'.
1_conditions of the policy,certain policies may require an endorsement.Astatement on INS certi#'icate does not confer rights to the certificate Holder in lieu of suchendorsernent#sj.
PRODUCER .-. ..__. __ .�.._...�._
CONTACT
DAVID CONNOLLY INSURANCE AGENCY INC. FAX
9393 BAYSHORE DRIVE (a/C,NO,£Irrk 3&0-6V-6439 (A/C,NO)-
E-MAIL
SILVERDALE WA 98383 ADDRESS:
iNSURER(S)AFFORDINGCOVERAGE NAIC9
INSURED ......A INSURER* NATIONAL FIRE$Y(S+IAWINE COMPANY -
INSURER& _...—
HALO FIREWORKS LLC ; —
15156 raw HITE CENTER RD —
}-'WSURERD:
!INSURER.E:
SEABECK WA 98M }..__ __ — _. _ — —
INSURER F
COVERAGES CERT#FiCATENUMBER:.... REWS#ONNUMBER;
THIS IS TO CERTiFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABOVE FOR THE POLICY FERtOO INO;CATED.NOTWITHSIAND
REQUIRE*+LENT,TERM Or,COND;TION0F ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTOWHiCHTHtS CERTIFICATE MAY$£ISSUED 09 MAY PERTAIN,THE INSURANCE ORDEDBY1'HE
POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.FXCLUSIOMS AND CON(ATIONSOF SUCH POLICIES LIMITS SHOWN MAY"AVE BEEN REDUCED BYPAfDCLAILKL
INSR I ADOTL SUER POLICY EFF PoLICYEitP
TYPE OF INSURANCE {
LTR 'R�iSD W q, ? POLILYNU6'E#M i(MIDDly" ommot'YYYY)
— 1COMMERCIAL GENERAWABILttY ( -�--_ EACH OCCURRENCE s 1,000,000
CLAIMS-MADE X OCCUR t +DAMAGETORENTED
— I PREMl56(EaOccursence) 100,000
MDD£xP(Arryrxrrn) 5 S —_
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A �^ X ?2L1'8t128234 ry430T12(}17 (34101x2ft1(I `PDRSJNAL&ADVIt1JURY 5 1, tj[)t1-
GENT AGGREGATE Lih+ff APPLIES PER 1 )GENERALAGGREGATE 5 _2 000,OOQ
POLICY C PROJECT LOC, ? PRODUCTS COW.RiOPAGG i$ 21000,000
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AUTOMOWLE LIABILITY C MBdrra:_DSIN LE LMIT
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ANY AUTO BODILY INJURY(Per pemn) Is
OWNEDAUTOS _� SCHEDULED
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r DESCRIPTION OFOPERATIONS;LOCATIONS/VEHICLES(ACORU 101,Additional RemWksSchedule army bearntched4morespace is regained) !
;Boomtown Productions LLC.Mason County,Property Owner Joe Solis are ftled as additional insured((N the fire work Stand a122950 Slate Route 3 Belfair,WA,
98528
i
CERTIFICATE HOLDER CANCELLATION �•'''�
SHOULD ANY OF THE91116E PQUC#DS CELL£DBEFORE THE EMRATION
BOOMTOWN PRODUCTIONS LLC DATE THEREOF N $EDEINERtf. £ORDANCE wiTtiTN zQ WONs
_...
I 15156 NW HITE CENTER RD ur AUTHOR RESENTATIVE ---- t
_ SPARECK WA 911380
ACORD 25(2016/03) L19W20t5 ACORD CORPORATION.AII[Right5 Reserved
31-1769 1 1-15 The ACORD naive and logo are registered marks of ACORD
APPLICATION
FOR RETAIL FIREWORKS STAND PERMIT
TO: Governing body of city,town, or county in which DATE OF May 18, 2017
fireworks stand will be located. 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 storage 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: qnrq
(Must be conspicuously displayed at all times while th s and is open to the public)
By vi e f havi g been granted a license by the State of Washington and this permit from
as the local governing authority,the named person, firm or
organizattari hereby authorized to sell U.N. 0336 I AG Consumer fir orks at the location designated
herein between the following date and times:
Sales For July 4"' Sales F DeceZer
From: From:
To: PPR41RE RSMAL To:
MASO By �N p _r N
pA�
�Ip�6ftt `;ODES SHALt APPLY'
PLANS ARE SOL ORES o
ANpOROMiSSONw ONTRACT
SILTY OF OWN FIELD tNSPECTtON SHALL BE AT
E its APPROVAL- /s/
REC It"GNT TO Signature of Applicant
OW ANY �TATE LAWS•
0OFF���N07
,41( . S' CITY,COUNTY OR Agency:
Date: Permit Number:
Licensee Name: License Number:
pox copes MASON COUNTY (360)427-9670 Shelton ext.352
DEPARTMENT OF COMMUNITY DEVELOPMENT (360) 275-4467 Belfair ext.352
.9�
BUILDING. PLANNING• FIRE MARSHAL (360)482-5269 Elma ext.352
Mason County Bldg. III, 426 West Cedar Street
IRss PO Box 279, Shelton, WA 98584 www.co.mason.wa.us
RECEIVED FIR20 ' - o IT
JUN 0 2 2017 Mason County Fireworks Permit Application
615 W. Alder Street 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: Johnathan Miller
Mailing Address: 15156 NW Hite Center Rd City: Seabeck State: WA Zip: 98380
Phone #: 360.620.1732 Email: millerj73@hotmail.com
Sponsor Information:
Name: Boomtown Productions, LLC
Address: 15156 NW Hite Center Rd City: Seabeck State:WA Zip: 98380
Phone #: 360.620.1732 Email: millerj73@hotmail.com
Washington State Fireworks License Information (Copy Required):
License Number: WSPFL-02027 Date of Issuance March 30, 2017
❑ Pyrotechnic Operator License rt Fireworks Stand License
Bond or Certificate of Insurance (Copy of Certificate/Bond Required):
Provider: David Connolly, Connolly Insurance
Insured: Boomtown Productions, Mason County, Joe Solis
Certified Holder: Boomtown Productions LLC
Location of Stand/Display:
Site Address: 22950 State Hwy 3, Belfair
Directions to Site: Corner of NE State Route 3, Belfair NE, Roessel Rd, next to Belfair Elementary
Parcel Number: (twelve digit number) 12332: - - 00044
Legal Property Owner Joe Solis, EFM Properties
"Please see reverse side to complete your application"
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
See attached Site map
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 Qel�P� W A"L' Date 5/18/2017
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
r 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
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 Fire ands-Minimum Clearances
000010, MOTOR MOT
VEHICLE VEHICLE
TRAFFIC TRAFFIC
Combustibl Property Parkin PUBLIC PRIVATE
Buildings es Line g 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.**
NO
Cleara istances are not cumulative
*Measure the outer edge of the nearest traffic lane.
**If stand is equi 135 fusible links which will automatically close all sales doors in case of fire,or is equipped with a wire-mesh scr ith openings
of not more than one inch t less than 90%of all sales openings.
(5)Retail fireworks Stan s s cated closer than one hundred any motor vehicle
dispensing station, retail propane dispensing s (quid 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.
(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.
STORAGE 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.
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.