Loading...
HomeMy WebLinkAboutFIR2023-00017 Final Firework Stand - FIR Inspections - 6/28/2023 • o Inspection Card Mason County 615 W. Alder St. Bldg. 8, Shelton, WA 98584 (360) 427-9670 ext 352 www.co.mason.wa.us°} s ge X PERMIT# FIR2023-00017 PROJECT ADDRESS 5962 E State Route 3 Shelton, WA 98584 PARCEL# 321363800010 PROJECT DESCRIPTION FIREWORK STAND/TENT OWNER MOUNT MORIAH LODGE#11 ADDRESS PHONE INSPECTION INSP DATE COMMENT FIREWORKS INSPECTION L' CONDITIONS * (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)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. (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)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. (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. * (4)No open flames nor any type of open flame equipment shall be allowed in any temporary fireworks storage structure. (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. * (8)No cooking is permitted in a retail fireworks stand or in a temporary fireworks storage structure. 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. * Fireworks may be sold from 12:00 noon to 11:00 p.m.on each day from the 27th of December through the 31st of December of each year. Inspection Card 1712 :W Mason County 615 W. Alder St. Bldg. 8, Shelton, WA 98584 �m (360) 427-9670 ext 352 = www.co.mason.wa.us 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. 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. Mason County B Mason County - Division of Community Development 615 W.Alder St. Building 8 Shelton, WA 98584 360-427-9670 ext 352 www.masoncountywa.gov FPROJECT -00017 FIREWORKS STAND APPLICATION & STANDARDS ESCRIPTION: FIREWORK STAND/TENT ISSUED: 06/27/2023 ESS: 5962 E STATE ROUTE 3 SHELTON EXPIRES: 12/24/2023 PARCEL: 321363800010 APPLICANT: MOUNT MORIAH LODGE#11 OWNER: MOUNT MORIAH LODGE#11 1342 SE ARCADIA RD 1342 SE ARCADIA RD SHELTON,WA 98584 SHELTON,WA 98584 360-951-2281 FEES: Paid Due Retail Fireworks Stand Permit $100.00 $0.00 Fee Totals : $100.00 $0.00 REQUIRED INSPECTIONS Fireworks Inspection CONDITIONS (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. * (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. * 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. * 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. Printed by:Annie Wilson on:06/27/2023 01:45 PM Page 1 of 2 DATE(MMIDD/YYYY) ACOR�� CERTIFICATE OF LIABILITY INSURANCE `1110� 11/1/2023 6/14/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Lockto 1 Companies NAME, 3280 Peachtree Road NE,Suite#250 PHONE — FAX Atlanta GA 30305 E-MAIL No). (404)460-3600 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Everest Indemnity Insurance Company 10 K INSURED American Promotional Events,Inc. INSURER B: 1359629 DBA TNT Fireworks,Inc. INSURER C: P.O.Box 1318 INSURER D: 4511 Helton Drive INSURER R REER R E: Florence AL 35630 INSU F COVERA CERTIFICATE NUMBER: 12219631 REVISION NUMBER: XXXXXXX THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS MM/DD MMIDD A X COMMERCIAL GENERAL LIABILITY Y N SI8GL00242221 I1/l/2022 11/1/2023 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DA GE PREMISES EaENTE,ence $ 500.000 _ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY NOT APPLICABLE COMBINED SINGLE LIMIT $ Ea accident XXXXXXX ANY AUTO BODILY INJURY(Per person) $ XXXXXXX OWNED SCHEDULED BODILY INJURY(Per accident $ AUTOS ONLY AUTOS ) XXXXXXX HIRED NON-OWNED PROPERTY DAMAGE $ XXXXXXX AUTOS ONLY AUTOS ONLY Per accident $ XXXXXXX UMBRELLA LIAB OCCUR NOTAPPLICABLE EACH OCCURRENCE $ XXXXXXX EXCESS LIAR HCLAJMS-MADE AGGREGATE $ XXXXXXX OED I I RETENTION$ $ }(XXXXXX WORKERS COMPENSATION NOTAPPLICABLE PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ XXXXXXX OFFICER/MEMBER EXCLUDEI ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ XXXXXXX If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT I$ XXXXXXX DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER,APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERMS)REFERENCED. Property located at Deer Creek Garden&Landscape Supply-5962 East State Route Hwy 3,Shelton,WA 98584(WAS5016) Certificate holder is an additional insured on the General Liability as required by written contract subject to policy terms,conditions,and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 12219631 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Mason County ACCORDANCE WITH THE POLICY PROVISIONS. Mount Moriah Lodge#11 AUTHORIZED REPRESENTATIVE Deer Creek Garden&Landscape Supply } PO BOX 186 Shelton WA 98584 IL�� ;VO4 _ _ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD S914rI Mason County Mason County - Division of Community Development 615 W. Alder St. }! Building 8 Shelton, WA 98584 360-427-9670 ext 352 www.masoncountywa.gov FIREWORKS STAND APPLICATION & STANDARDS FIR2023-00017 * 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. * 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. * (4) No open flames nor any type of open flame equipment shall be allowed in any temporary fireworks storage structure. * (2) No motor vehicle or trailer may be parked within twenty feet of a retail fireworks stand except when delivering, loading or unloading fireworks. * (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. * (8) No cooking is permitted in a retail fireworks stand or in a temporary fireworks storage structure. * (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. * (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. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of Laws and Ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions ofNil any other state/local law regulating construction or the performance of construction. Issued By: i L 011=1 Contractor or Authorized Agent: Date: Printed by:Annie Wilson on:06/27/2023 01:45 PM Page 2 of 2 ��QON co o Tp 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.wams FIR20 2.3 - Ooo 1-1 Mason County Fireworks Permit Application 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: MOUNT MORIAH LODGE NO. 11 Mailing Address: 1342 SE ARCADIA RD City: SHELTON State: WA Zip: 98584 Phone #:360-951-2281 Email: JACKHUGGINS58@MSN.COM Sponsor Information: Name:JACK HUGGINS Address: 1342 SE ARCADIA RD City: SHELTON State: _VA Zip: 98584 Phone #: 360-951-2281 Email: JACKHUGGINS58(5�MSN.COM Washington State Fireworks License Information (Copy Required): License Number:G23470 Date of Issuance 03/23/2023 ❑ Pyrotechnic Operator License v Fireworks Stand License Bond or Certificate of Insurance (Copy of Certificate/Bond Required): Provider:SEE ATTACHED INSURANCE Insured: Certified Holder: Location of Stand/Display: Site Address: DEER CREEK GARDEN&LANDSCAPE SUPPLY:5692 E STATE ROUTE HWY 3,SHELTON WA 98584 Directions to Site: Parcel Number: (twelve digit number)31.13(e Legal Property Owner SEE ATTACHED LEASE "Please see reverse side to complete your application" �-) � O 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 DIAGRAM 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. 1 Signed Date 06/14/2023 MASON COUNTY (360) 427-9670 Shelton ext.352 DEPARTMENT OF COMMUNITY DEVELOPMENT (360) 2754467 Belfair ext. 352 BUILDING• PLANNING • FIRE MARSHAL (360) 482-5269 Elma ext. 352 Mason County Bldg. III, 426 West Cedar Street " 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 I AG 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 Fireworks Stands-Minimum Clearances MOTOR MOTOR VEHICLE VEHICLE TRAFFIC TRAFFIC Combustibl Property Parkin PUBLIC PRIVATE Buildings es Line g ROAD* ROAD* 13ACKOFSTAND 20 1: 1'. 20 FT. 5 FT. 20 20 FT. 5 FT. FT. SIDE OF STAND 20 F"I'. 20 FF. 5 FT. 20 20 FT. 5 FT. FT. IRONTOFSTAND 40FT. 40 FF. 20 FT. 20 20 FT. 20 FT. I I . 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 2 12-1 7-2 1 5 13(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 tk0Rfi& WW 0fef4 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. City of Shelton WAS 5016 THIS FORM IS INTENDED FOR USE BY LOCAL AUTHORITIES HAVING JURISDICTION(AHJ)IN THE EVENT THEY DO NOT HAVE A PERMIT FORM SPECIFIC FOR RETAIL FIREWORKS SALES AT A CONSUMER FIREWORKS RETAIL SALES(CFRS)FACILITY. IT IS NOT MEANT TO BE REQUIRED IN ADDITION TO OR IN LIEU OF ANY LOCAL PERMITTING FORM AND/OR PROCESS THAT MAY EXIST WITH THE LOCAL AHJ. Directions: Provided the local jurisdiction has no permit form of their own,complete this permit application and submit it with the local AIIJ portion of your Retail Fireworks Stand License to the jurisdiction in which you wish to run your CFRS facility. WASHINGTON STATE FIREWORKS RETAIL SALES PERMIT APPLICATION Applicant Information ❑ New/First Time Applicant ® Previous Permit Holder Mount Moriah Lodge No. 11 Name of Group,Organization,or Person(Last,First,Middle Initial,and Date of Birth)Issued the Fireworks Retailer License Jack Huggins Name of Permit Applicant(Last,First,Middle Initial,and Date of Birth) 2120 Milwaukee Way Tacoma, WA 98421 Permit Applicant Mailing Address(Complete Including Street,City,State,and ZIP Code) ( 360 )951-2281 coppolav@tntfireworks.com ( 253) 922-0800 Phone Number E-Mail Address Local Business Number(if required) CFRS Facility Information ❑ Stand ❑ Tent Other: Size: Specify Square FeeUDimensions Deer Creek Garden & Landscape Supply, 5692 E State Route HWY 3 Shelton WA 98584 CFRS Facility Address(Complete Including Street,City,State,and ZIP Code) ( ) Name of Property Owner Phone Number Parcel Number for Stand Location Fireworks Supplier Information List all of the licensed fireworks wholesalers who will be supplying this stand product TNT FIREWORKS Storage Information 0 On Site ❑Off Site: Storage Address(Complete Including Street,City,State,and ZIP Code) X❑ Sales Structure ❑ Detached Building ❑ Truck/Trailer ❑ Other: Specify CHECKLIST FOR SUBMISSION Check with the local AHJ for all applicable submission dates and deadlines: ❑X Application/Permit Fee X❑ Insurance Certificate($1,000,000) ❑ Clean-Up Bond Fee(if applicable) Q Valid Washington State Fireworks Retailer License ❑ Property Owners Written Permission Q Detailed Site Plan ❑ Interior Plan (required for tents and "other"facilities) I hereby certify the information in this application is true and correct. I am aware of and agree to comply with all relevant provisions of law, rule, and any ordinance of the state of Washington and the city/county permitting this CFRS Facility. 1 LLigA LQ'mi For Jack Huggins I (-/` For Jack Huagins G 5 Signature of Permit Applicant Printed Name of Permit Applicant Date of Signature OMZINJG.0.• ✓..f. ! ( - ` \ F /' a" r f /:'/ L ,�G ��.#; ✓ f. 'UTH 14A FIREWT,.'COD COQ .,,...1`..OFr..H..i.;,✓7 e.�aa_NI,G e`JYVf.. M' f L /C 1 y s-�..ymF7'sm +,,.r /i"..�V✓`mow..f4 .r C rr .�..L _y! .:..-r,-^' :r.�> f"y'r r �s.: ^'L C,y.v".r"r'li sk" l'"� ,c -.°!�k:--'s k` u� u'ac ,��, ri2" `�-r, `�'���� �� C`�'e�f' .".',',✓,'�s"'��. ����� r` �� fir"w v � '� ..ems �`c.�,.. �x*�`2 "a- '�� �- �''�*',.s^€' 4<�"'%� �c; 1, x ,`' r SE BAGfCQFTIS FORM FOR ANY RESTRICTIONS, CONDITIONS;OR NOTATIONS O(V TF(1S PI<ftMlTf ��.q, -!'` rc \..��-\E ��'cG`c f I K � l..c�e j�'� rF �, r .,<� � 7..` l �f F � a.✓- .e -_1.c2 �i - yR. `w��✓," �' �r�3igpatut'e of Pennitting Official ,; � � �� � ,� :Printed Name attd Title f � y r av✓�`��Date of Signtiture,�r f- THE FIREWORKS RETAILER LICENSE HOLDER(LICENSEE)SHALL RETAIN THIS PERMIT WITH THE ASSOCIATED FIREWORKS RETAILER LICENSE AND MAKE THEM BOTH A VAILABLE FOR INSPECTION AT ANY TIME THE STAND IS IN OPERATION 3000-420-013(R 11/16) WAS5016: A Shot in the Dark 5692 WA -3 STAND Shelton WA, 98584 LOCATION TYPE: STAND 24' CONTAINER g * SO' OF a , N!k r 4 NrO r.7,, ... �,. «a �pSN%xGTON gT+TF Washington State Patrol Fire Protection Bureau Office of the State Fire Marshal G23470 ;w CONSUMER FIREWORKS RETAIL SALES (CFRS) FACILITY LICENSE Stand Number: SN-15300 9f'MARSNAI.'S���` Licensee Data Operational Data American Promotional Events, Inc. - West Wholesaler: American Promotional Events, Inc. - WE 2120 Milwaukee Way County of Operation: Mason Tacoma, WA 98421 Operates For: MOUNT MARIAH LODGE NO. 11 License Number: WSPFL-02766 Stand Operated By: JACK HUGGINS Phone Number: (253) 922-0800 Date of Issue.-March 23, 2023 Date of Expiration:January 31, 2024 Consumer Fireworks Retailer Licenses issued after May are ONLY valid for New Years Sales This license is NOT valid without a permit from a local fire code official/authority having jurisdiction. This license allows for operation of a single location/stand for retail sales to the public of state legal consumer fireworks purchased only from a licensed fireworks wholesaler. THIS LICENSE PORTION ACCOMPANIES YOUR LOCAL PERMIT APPLICATION we sni �