The URL can be used to link to this page

Home My WebLink AboutFIR2015-00059 - FIR Permit / Conditions - 11/30/2015 '3 4 s coU�rA 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 FIRE PO Box 279, Shelton, WA 98584 nnv�v�v moo.=Wy.wa.us ��r Y p►/� 0)A I/,-qo I FIR20 I - 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: Alderbrook Resort & Spa Mailing Address: 7101 E WA-106 City: Union State: WA Zip: 98592 Phone#: 360.898.2252 Email: cindy.sund@alderbrookresort.com Sponsor Information: Name: Alderbrook Resort & Spa Address: 7101 E WA-106 City: Union State: WA Zip: 98592 Phone#: 360.898.2252 Email: cindy.sund@alderbrookresort.com Washington State Fireworks License Information (Copy Required): General Display License License Number: C-04138 Date of Issuance 1/30/15 Pyrotechnic Operator License ❑Fireworks Stand License Bond or Certificate of Insurance (Copy of Certificate/Bond Required): Provider: Professional Program Insurance Brokerage Insured: Wolverine Fireworks Display, Inc. Certified Holder: Adam & Anne Farrens Location of Stand/Display: Site Address: 7101 E WA-106, Union, WA 98592 Directions to Site: see attached Parcel Number: (twelve digit number) - Legal Property Owner n/a -- A **Please see reverse side to completeA9 pECT�ION JE T CDES AllA °LCAs NL AP�LYSOLE�RE S ON PLANS ORRgESC- IS6I gCA ONTRACT • C SHl+II. S�NSIBILITYt1OOROM FIELD MSPEC.TI TIONS 14ECu S OPFSSE• y At1Y PE4014�g 6E AT OW14EES tjoT GRANaT0 A STATE pgOVAL O VIOL A14Y CITY AIGHT ,s 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 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. Aaron R Digitally signed by Aaron R.Webb L Aaron R.Webb,o=Wolverine Signed We Date 11/30/15 West,t,LLC,ou=Display Manager, —emai I=aaron wo vennewe .com, cm a e: Alderbrook Resort 0 o° 'flu Ail 77!7,} ° i, s +m s. c FIE4F WORKS 1990 «,. a �� Irr�ager�y pate. 5,5/20013 fat 47.3502,7 Darr,., 123a070401c elegy.= Ott e ' ME _ M APPLICATION DATE OF APPLICATION PART I FOR PUBLIC FIREWORKS DISPLAY PERMIT 10/30/15 TO: Governing body of city,town, or county in which display is to be conducted. NAME ADDRESS PHONE Wolverine West Fireworks PO Box 99095 - Seattle, WA 98139 206.459.0917 SPONSOR ADDRESS PHONE Alderbrook Resort & Spa 7101 E Hwy 106, Union, WA 98592 360.898.5529 PYROTECHNIC OPERATOR NAME ADDRESS LICENSE# Aaron Webb 11417 Evergreen PK Dr#301, Olympia WA 9850 P-04311 NAME OF ASSISTANTS: at least onerequired) } NAME ADDRESS AGE Chad Beebe 11210 Saskatoon Ln Olympia WA, 98506 P-04312 NAME ADDRESS AGE EXACT LOCATION OF PROPOSED`DISPLAY . LOCATION Alderbrook Resort S Spa - 7101 E Hwy 106, Union, WA 98592 DATE 11/27/15 TIME 5pm INARBER AND KINDS OF FIREWORKS TO BE DISPLAYED Not to exceed: 15 Display Cakes up to 2.5" shells 20 3" Shells 20 4" Shells MANNER&PLACE OF STORAGE PRIOR TO DISPLAY Subject to approval of Local Fire Authority) In our approved magazines vz�nv_4, SIGNAT E OF APPLICANT -.+VMC1AL RES,P(MSIffiL1TY Y F - BONDING OR INSURANCE COMPANY (Mark One) Professional Program Insurance Brokerage ® Bond or certificate of insurance attached ADDRESS ❑ Bond or certificate of insurance on file with State Fire Marshal 371 Bel Marin Keys Blvd. Ste. 220 Bond or certificate of insurance shall provide minimum coverage of Novato, CA 94949 $50,000/$1,000,000 bodily injury liability for each person and event, respectively,and$25,000 property damage PART 11 PERMIT PERMIT# DATE: In accordance with the provisions of RCW 70.77 and applicable local ordinances, this permilliwwiteTfo conduct a fireworks display as per th bove application. � NAME: 0`' D A (Full name of person,firm,or corporation grant rmit) f�R RESTRICTIONS: N M Sp C JEC� .►4wpf SO`f RRE� APE Permit not valid without verification of the appropriate State Fireworks License } I �►�I oMVWo+►.f.JCV ,, r h tM } tw"�jai H0yedA^ � Aoft 16T^ l Es 01114 LICENSE NUMBER: gEP1c:S 10 vW+-�'tE (Instructions on reverse side) 3000-420-050(R 02/05) Distribution: WHITE (A): Local Fire Authority; YELLOW(B): Permitee Certificate of Insurance 6883 Issue Date: 5/25/2015 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF Professional Program Insurance Brokerage INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE 371 Bel Marin Keys Blvd., Suite#220 CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT Novato, California 94949 AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED INSURER A: Underwriter's at Lloyd's, London Wolverine Fireworks Display, Inc. INSURER B: 205 W. Seidlers Road Kawkawlin, MI 48631 INSURER C: INSURER D: COVERAGES: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE NAMED INSURED ABOVE FOR THE 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(DD/MM/YY) DATE(DD/MM/YY) A GENERAL LIABILITY PY/15-0010 2/1/2015 2/1/2016 EACH ACCIDENT $5,000,000 CLAIMS MADE MEDICAL EXP(any one person) FIRE LEGAL LIABILITY $50,000 GENERAL AGGREGATE $5,000,000 PRODUCTS-COMP/OPS AGG DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate holder is additional insured as respects the following: Date(s)of Display: 7/2/2015, 11/27/2015, 12/31/2015 Location: 7101 E State Highway 106 Union,WA 98592 Additional Insured: Alderbrook Resort&Spa,Mason County&its employees ATIMA Rain Date(s): 7/2/2015, 11/27/2015, 12/31/2015 Type of Display: Aerial Fireworks Display CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXIPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS Alderbrook Resort&Spa WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 7101 E State Highway 1 O6 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS g Y AGENTS OR REPRESENTATIVES. Union,WA 98592 '� AUTHORIZED REPRESENTATIVE � FI LE �VkROUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT SHAL Mason County Bldg. III, 426 West Cedar Street, Shelton, WA 98584 www.co.inason.waus Shelton (360)427-9670 Belfair(360)275-44err EIma (360)482-5269 November 16,2015 uN. FSi ARE Fire Marshal Notes: x dA1 6 TO�� ERRoftS . Permit:FIR2015-0059 cppas AKA�LY E so�pR rc Name:Alderbrook Resort/Wolverine West Fireworks ^t��°L�%9" 009 OH �c< -� Phone:206459-0917 � r""�o�p' I P se. -10%FFt r�i� 1 Y FtELU SPONS��E�OutR£NO pR'7O ANY Tv. eE,s pWNE Y aTY OR $ The Washington State Fireworks Law (RCW 70.77) an I Lo?#I DOES Te State Are, Marshall relating to fireworks (WAC 212-17) set forth regulati ing the handling and use of special fireworks intended solely for public display. A licensee must comply with those regulations. The following is a list of items that have been highlighted by Mason County Fire Marshals Office to protect the safety and security of areas and patrons surrounding firework presentations. These items are in no way exhaustive of all the requirements necessary to comply with the specified safety standards, but have been provided by this department to provide the licensee with a general background on these issues Storage/Transportation of Shells • All shells shall be inspected upon delivery to the display site by the display operators. Please refer to WAC 212-17-310 regarding return of defective materials. • All shells shall be separated according to diameter and stored in tightly covered containers of metal,wood, or plastic or in fiber drums or corrugated cartons meeting US Department of Transportation specifications for transportation of fireworks.WAC 212-17-310(3) • Shells shall be carried from the storage area to the discharge site by their bodies,never by their fuses.WAC 212-17-335 • Mortars shall be inspected for damage. Mortars found to be defective in any way shall not be used. WAC 212-17-315(1) • The shell storage area shall be located at a minimum distance of not less than 25 feet from the discharge site.WAC 212-17-310(4) • As soon as the fireworks have been delivered to the display site,they shall not be left unattended nor shall they be allowed to become wet.WAC 212-17-310 • During the display, shells shall be stored upwind from the discharge site. If the wind should shift during the display,the shell storage area should be relocated so as to again be upwind.WAC 212-17-310(5) Display Area • Spectators, vehicles, or any readily combustible materials shall not be located within the potential landing area during the display.WAC 212-17-325(g) • Mortars shall be buried securely into the ground to a depth of 2/3 to 3/4 of their length or fastened securely in mortar boxes or drums. • Mortars shall be positioned so that the shells are carried away from the spectators and.into a clear area acceptable to the authority having jurisdiction. Please refer to WAC 212-17-315 for safety requirements, and placement. • Monitors shall be located around the discharge site to prevent spectators or any other unauthorized person from entering the discharge site. The discharge site shall be so restricted throughout the display and until it the discharge site has been inspected after the display. Where practical, fences and rope barriers shall be used to aid in crowd control.WAC 212-17-330(4) • The area selected for the discharge of aerial shells shall be so located that the trajectory of the shells will not come within 25 feet of any overhead object.WAC 12-17-17325(1) • Ground display pieces shall be located at a minimum distance of 75 feet from spectator viewing area and parking areas.WAC 212-17-325(2) • Mortars shall be separated from spectator viewing areas,parking areas and occupied residences by at least 70 feet per inch of internal mortar diameter. WAC 212-17-325[3] Additional spacing requirements and exceptions are specified in detail in this section as well. • Distances from bulk storage areas of materials that have a flammability, explosive, or toxic hazard shall be twice that required in the table specifying minimum radius of display site for outdoor display of fireworks as defined in WAC 212-17-325[4]. • The potential landing area shall be a large, clear, open area which has been approved by the local fire official. WAC 212-17-325(7) • If in the opinion of local fire and/or police officials or the pyrotechnic operator, lack of crowd control should pose a danger, the display shall be immediately discontinued until such time as the situation is corrected.WAC 212-17-330(5) • No smoking or open flames shall be allowed in the shell storage area as long as shells are present. Signs to this effect shall be conspicuously posted.WAC 212-17-330(12) Pyrotechnic Operator • No public display permit shall be granted unless at least two experienced pyrotechnic operators are provided,one of whom shall be a licensed pyrotechnic operator. WAC 212-17-290 • The pyrotechnic operator is responsible for the display with respect to preparation for transporting, unloading, storing, preparing special effects, set and mechanical pieces, setting mortars and rocket launchers,loading,arming,firing and disposing of all unfired or defective devices. WAC 212-17-290(1) • Be responsible for setting all fireworks including mortars,finale batteries(hedgehogs)and rocket launchers at locations designated by the authority having jurisdiction and take into account wind direction and velocity predicted for the firing time in setting the firing angles. Shells,rockets and/or missiles shall not be permitted to cross or burst above areas occupied by persons. WAC 212-17-290(2) • The pyrotechnic operator has the primary responsibility for safety. While the operator is allowed to actively participate in the firing of the fireworks display,the operator shall not become so busy as to allow interference with attention to safety.WAC 212-17-330(6) • The pyrotechnic operator is responsible to ensure that a sufficient number of assistants are on hand for the safe conduct of the fireworks display. Only the operator and necessary assistants shall be permitted in the discharge area while the display is in progress.WAC 212-17-330(7) • The pyrotechnic operator is responsible to ensure that all assistants are fully trained in the proper performance of their assigned tasks, and that they are knowledgeable of safety hazards. The pyrotechnic operator is responsible for acts of his assistants in connection with the display, from delivery to final firing who, through smoking, drinking, carelessness or negligence or any other act, endangers the safety of himself,any other person,or any property. WAC 212-17-330(3) • At no point shall an electrical contact be allowed to occur between any wiring associated with the electrical firing unit and any metal object in contact with the ground.WAC 212-17-317 • If at any time the weather conditions present a danger to the safety of the observers or technicians, the display shall be postponed until weather conditions improve to an acceptable level.WAC 212-17-330 • In the event of a shell failing to ignite in the mortar,the mortar shall be left alone for a minimum of fifteen minutes,then carefully flooded with water. Immediately following the display,the mortar shall be emptied into a bucket of water. The supplier shall be contacted as soon as possible for proper disposal instructions. It is the responsibility of the person igniting the aerial shells to detect when a shell does not fire from a mortar. The person shall warn others in the area and shall immediately cause the mortar to be marked to indicate the presence of an unfired aerial shell. Operators shall never attempt to repair a damaged shell nor shall they attempt to dismantle a fry shell. In all cases, the supplier shall be contacted as soon as possible for proper disposal instructions. WAC 212-17-335 The licensee shall ensure that the firing range is inspected at the conclusion of the display or the following morning. SITE ( D COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT F RSHAL Mason County Bldg. III, 426 West Cedar Street, Shelton, WA 98584 www.co.mason.wa.us Shelton(360)427-9670 Belfair(360)275-4467 Elma(360 ti52G&- November 16,2015 � ' A 1 UNV FIRE Fire Marshal Notes:' �i�� t �� r /'Y� r*�5 CT1QN. A �P Permit:FIIt2015-0059 1' 18dF- T10 APPLY-SOLE R- � LY ERRORS Name:Alderbrook Resort/Wolverine West Fireworks , A pL�cAe, CppEs g"'^'L rLA -c Phone:206-459-0917 ALL p ��OW S ON TR'OTOA- ERlCON IN,,PEcT $PONSIBIUTY di O;RO FIELD ' TNI3 •:: FROM SXPENSE t4 TVA � TIONS OWNS `OQT GNANV TO "S-TITE AWS. ? The Washington State Fireworks Law (RCW 70.77) and the�zu��oetteT 'arsh�ll relating to fireworks (WAC 212-17) set forth regulations regardi ,G"th g and use of special fireworks intended solely for public display. A licensee must comply with those regulations. The following is a list of items that have been highlighted by Mason County Fire Marshals Office to protect the safety and security of areas and patrons surrounding firework presentations. These items are in no way exhaustive of all the requirements necessary to comply with the specified safety standards, but have been provided by this department to provide the licensee with a general background on these issues Storage/Transportation of Shells • All shells shall be inspected upon delivery to the display site by the display operators. Please refer to WAC 212-17-310 regarding return of defective materials. • All shells shall be separated according to diameter and stored in tightly covered containers of metal,wood, or plastic or in fiber drums or corrugated cartons meeting US Department of Transportation specifications for transportation of fireworks.WAC 212-17-310(3) • Shells shall be carried from the storage area to the discharge site by their bodies,never by their fuses.WAC 212-17-335 • Mortars shall be inspected for damage. Mortars found to be defective in any way shall not be used. WAC 212-17-315(1) • The shell storage area shall be located at a minimum distance of not less than 25 feet from the discharge site.WAC 212-17-310(4) • As soon as the fireworks have been delivered to the display site,they shall not be left unattended nor shall they be allowed to become wet.WAC 212-17-310 • During the display, shells shall be stored upwind from the discharge site. If the wind should shift during the display,the shell storage area should be relocated so as to again be upwind.WAC 212-17-310(5) Display Area • Spectators, vehicles, or any readily combustible materials shall not be located within the potential landing area during the display.WAC 212-17-325(8) • Mortars shall be buried securely into the ground to a depth of 2/3 to 3/4 of their length or fastened securely in mortar boxes or drums. • Mortars shall be positioned so that the shells are carried away from the spectators and into a clear area acceptable to the authority having jurisdiction. Please refer to WAC 212-17-315 for safety requirements, and placement. • Monitors shall be located around the discharge site to prevent spectators or any other unauthorized person from entering the discharge site. The discharge site shall be so restricted throughout the display and until the discharge site has been inspected after the display. Where practical, fences and rope barriers shall be used to aid in crowd control.WAC 212-17-330(4) • The area selected for the discharge of aerial shells shall be so located that the trajectory of the shells will not come within 25 feet of any overhead object.WAC 12-17-17325(1) • Ground display pieces shall be located at a minimum distance of 75 feet from spectator viewing area and parking areas.WAC 212-17-325(2) • Mortars shall be separated from spectator viewing areas, parking areas and occupied residences by at least 70 feet per inch of internal mortar diameter. WAC 212-17-325[3] Additional spacing requirements and exceptions are specified in detail in this section as well. • Distances from bulk storage areas of materials that have a flammability, explosive,or toxic hazard shall be twice that required in the table specifying minimum radius of display site for outdoor display of fireworks as defined in WAC 212-17-325[4]. • The potential landing area shall be a large, clear, open area which has been approved by the local fire official. WAC 212-17-325(7) • If in the opinion of local fire and/or police officials or the pyrotechnic operator, lack of crowd control should pose a danger, the display shall be immediately discontinued until such time as the situation is corrected.WAC 212-17-330(5) • No smoking or open flames shall be allowed in the shell storage area as long as shells are present. Signs to this effect shall be conspicuously posted.WAC 212-17-330(12) Pyrotechnic Operator • No public display permit shall be granted unless at least two experienced pyrotechnic operators are provided,one of whom shall be a licensed pyrotechnic operator. WAC 212-17-290 • The pyrotechnic operator is responsible for the display with respect to preparation for transporting, unloading, storing, preparing special effects, set and mechanical pieces, setting mortars and rocket launchers,loading,arming,firing and disposing of all unfired or defective devices.WAC 212-17-290(1) • Be responsible for setting all fireworks including mortars,finale batteries(hedgehogs)and rocket launchers at locations designated by the authority having jurisdiction and take into account wind direction and velocity predicted for the firing time in setting the firing angles. Shells,rockets and/or missiles shall not be permitted to cross or burst above areas occupied by persons. WAC 212-17-290(2) • The pyrotechnic operator has the primary responsibility for safety. While the operator is allowed to actively participate in the firing of the fireworks display,the operator shall not become so busy as to allow interference with attention to safety.WAC 212-17-330(6) • The pyrotechnic operator is responsible to ensure that a sufficient number of assistants are on hand for the safe conduct of the fireworks display. Only the operator and necessary assistants shall be permitted in the discharge area while the display is in progress.WAC 212-17-330(7) • The pyrotechnic operator is responsible to ensure that all assistants are fully trained in the proper. performance of their assigned tasks, and that they are knowledgeable of safety hazards. The pyrotechnic operator is responsible for acts of his assistants in connection with the display, from delivery to final firing who, through smoking, drinking, carelessness or negligence or any other act, endangers the safety of himself,any other person,or any property.WAC 212-17-330(3) • At no point shall an electrical contact be allowed to occur between any wiring associated with the electrical firing unit and any metal object in contact with the ground.WAC 212-17-317 • If at any time the weather conditions present a danger to the safety of the observers or technicians, the display shall be postponed until weather conditions improve to an acceptable level.WAC 212-17-330 • In the event of a shell failing to ignite in the mortar,the mortar shall be left alone for a minimum of fifteen minutes,then carefully flooded with water. Immediately following the display,the mortar shall be emptied into a bucket of water. The supplier shall be contacted as soon as possible for proper disposal instructions. It is the responsibility of the person igniting the aerial shells to detect when a shell does not fire from a mortar. The person shall warn others in the area and shall immediately cause the mortar to be marked to indicate the presence of an unfired aerial shell. Operators shall never attempt to repair a damaged shell nor shall they attempt to dismantle a fry shell. In all cases, the supplier shall be contacted as soon as possible for proper disposal instructions. WAC 212-17-335 The licensee shall ensure that the firing range is inspected at the conclusion of the display or the following morning.