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HomeMy WebLinkAboutFIR2005-00043 - FIR Permit / Conditions - 11/3/2005 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inspection Line(360)427-7262 Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Phone: (360)427-9670,ext.352 Shelton, WA 98584 P14 FIRE PROTECTION PERMIT FIR2005-00043 APPLICANT: NORTH FORTY LODGING LLC RECEIVED: 11/4/2005 CONTRACTOR: LICENSE: EXP: ISSUED: 11/4/2005 SITE ADDRESS: 7101 E STATE ROUTE 106 UNION EXPIRES: 5/4/2006 PARCEL NUMBER: 322335000014 LEGAL DESCRIPTION: SUNNY BEACH LOTS: 10-11 &8-9 EX ALL N OF HWY PROJECT DESCRIPTION: Fire Works Display GENERAIL INFORMATION System Information Type of Use: DIS Sprinkler Heads: Audible Switches: Pull Stations: Fire District: 6 Flow Switches: Visual Devices: Door Releases: Hood&Duct?: Pressure Switches:: Smoke Detectors: Duct Detectors: Dry Chemical?: Zones: Heat Detectors: Wet Chemical?: Sprinkler?: Standpipe?: SQUARE FOOTAGE FEES Monitoring Company. First Floor: Type Amount Due Amount Paid Monitoring Phone No.: _ Second Floor: Auto Fire Alarm?: Third Floor;: Fireworks Display Permit $100.00 $0.00 Total: $100.00 $0.00 FIR2005-00043 Please refer to the following pages for conditions of this permit. 1 of 3 CASE NOTES FIR2005-00043 CONDITIONS FOR FIR2005-00043 1.) Site inspection by the Fire Marshal is required prior to discharge of the display. Contact the Fire Marshal @ 360-427-9670 ext 273 on 11-04-05 to schedule an inspection time. X JLlJ Due to current and forecasted weather conditions the dock dry standpipe is not required to be charged. X JDf.I This permit becomes null and void if work or construction authorized is not commenced within 180 days,or if construction or work is suspended for a period of 180 days at any time after work is commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied.Proof of continuation of work is by means of a progress inspection.The ownerorthe agent on the owners behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. OWNER OR AGENT: DATE: FIR2005-00043 Please refer to the following pages for conditions of this permit. 2 of 3 NOV-3-2005 12:41 FROM:EFI OLYMPIA WA 360-352-0205 TO:4277798 P.2 ` W I Mason County Fireworks Permit Application PO BOX 186 426 W Cedar St Permit# FIR tX© -- o��c Shelton WA 98584 ( xt Receipt # ,Z�xL" /&L) 22 ��5i�c4 CK # _, I to Received 4� A Permit for the 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 Name: _ Entertainment Fireworks, Inc. Mailing Address: Po Box 7160 City: Olympia State: WA Zip: 98507-7160 Contact Number (360 ) 352-8911 Sponsor Information Name: Jerry Elrod Mailing Address: 2120 Milwaukee WAy City: Tacoma State: WA Zip: 98421 Contact Number ( 253-�38-1099 Washington State Fireworks License Information (Copy Required) License No.: C-04085 Date of 1/20/05 Issue: ® Pyrotechnic Operator License ❑ Fireworks Stand License P-OQ4241 Aaron Kul Bond or Certificate of Insurance (Copy of Certificate/ Bond Required) Provider: _ See Attached Insured: Certified Holder: Location of stand/display Address: 7101 E. State Route 106, Union Wa - Alderbrook Inn Directions to Site: Take Hwy. 16 west to Gorst, then go south on Hwy. 3 to Belfair. South of Belfair turn right on Hwy 106 and go 15 miles to Alderbr Ink Parcel Number: - - 2� v 8 14 Legal Description: Sunny Beach Tr 8-11 EX and895 See SP #1664 Legal Property Owner: * * Please see the reverse side to complete your application NOV-3-2005 12:42 FROM:EFI OLYMPIA WA 360-352-0205 TO:4277798 P.3 The following pertinent information MUST be provided on the site diagram below Locations and Setback distances from the back, sides and front of retail sales stands or designated display areas to: • Fire Hydrants Property Lines • Buildings Parking • Combustibles Public Roads and Right of Ways • Fire Lanes Private Roads and Right of Ways • Trees/Brush Landmarks • Utilities and Gas Mortar separation distance • Designated landing area Applicants Affidavit I certify that the information provided herein is accurate and that compl iance with all County, State and Federal laws pertaining to the sales or discharge of fireworks shall be maintained. Signed ,,,4 /f Date FOR OFFICIAL USE ONLY BELOW THIS LINE Accepted By: Date: _ NOV-3-2005 12:41 FROM:EFI OLYMPIA WA 360-352-0205 T0:4277798 P.1 PART I ®® c APPLICATION DATEOFAPPLICATION FOR PUBLIC FIREWORKS DISPLAY PERMIT 1- - S TO: Governing body of city, town or county in which display is to be conducted. APPLICANT NAME ADDRESS PHONE Entertainment Fireworks, Inc. PO Box 7160 Olympia WA 98507-7160 360-352-8911 SPONSOR ADDRESS PHONE Elrod Wedding 2120 Milwaukee Way, Tacoma NZ WA 98421 253-838-1099 PYROTECHNIC OPERATOR NAME ADDRESS LICENSE# Aaron Kulp 1556 Sunflower_ Ln. #34203, Tumwater WA 98512 P-004241 NAMES OF ASSISTANTS: at least one required) NAME ADDRESS AGE rX 3Gd -�ja- oME ADDRESS AGE ACT LOCATION.OF PROPOSED DISPLAY LOCATION From stationary dock at Alderbrook Inn 7101 E. St Rt 106, Union im Mason Cty #3223350000 DATE TIME November 5 2005 1 Early Evening NIIMIBE13 AND KINDS OF FIRIEWORKS TO BE DISPLAYED 3.0" Salutes - 10, 2.0" & 3.0" Comets - 21, Roman Candles up to 2.0" - 16 Multi-shot Cake Devices up to 2.5" - 3, 2.0" Aerial - 20 2.5" Aerial - 20 3.0" Aerial - 90, 4.0" Aerial - 50, Set Piece of Lancework - 2 MANNER 8 PLACE OF STORAGE PRIOR TO DISPLAY Sub ect to ap proval of Local Fire Authority) Deliverpd to site day of display. SIGNATURE PLIC NT FINANCIAL RESPONSIBILITY BONDING OR INSURANCE CO. (Mark One) Britton Gallagher & Associates X El Bond or certificate of insurance attached ED Bond or certificate of insurance on file with State Fire Marsha ADDRESS Bond or certificate of insurance shall provide minimum 6240 SOM Center Rd. Cleveland OH 44139 coverage of$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 permit is granted to conduct a fireworks display as per the above application. NAME (Full name of person,firm or corporation granted permit) RESTRICTIONS: Permit not valid without verification of Signature of Offical granting permit) State General Display License . (Title) LICENSE NUMBER_C—p4085 (Instructions on reverse side) Distribtuion: WHITE(A): Local Fire Authority; YELLOW(B): State Fire Marshal's Office; PINK(C): Permitee 3000-420-050(R 01/01)