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HomeMy WebLinkAboutFIR2012-00039 - FIR Permit / Conditions - 12/27/2012 (2) MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inspection Line(360)427-7262 Mason County Bldg. 3 426 W. Cedar P.O. Box 279 Phone: (360)427-9670, ext. 352 Shelton, WA 98584 P14 FIRE PROTECTION PERMIT FIR2012-00039 APPLICANT: ORION PYROTECHNICS RECEIVED: 12/11/2012 CONTRACTOR: LICENSE: EXP: ISSUED: 12/27/2012 SITE ADDRESS: 10 E ALDERBROOK DR UNION EXPIRES: 6/27/2013 PARCEL NUMBER: 322335000014 LEGAL DESCRIPTION: SUNNY BEACH PCL 1 OF BLA#04-58 PROJECT DESCRIPTION: FIRE WORKS DISPLAY NEW YEARS EVE GENERAL INFORMATION System Information •, Type of Use: DIS Sprinkler Heads: Audible Switches: Pull Stations: Fire District: 6 Flow Switches: Visual Devices: Door Releases: Hood&Duct?: N Pressure Switches:: Smoke Detectors: Duct Detectors: Dry Chemical?: N Wet Chemical?: N Zones: Heat Detectors: Sprinkler?: N Standpipe?: N SQUARE FOOTAGE FEES Monitoring Company: First Floor: Type Amount Due Amount Paid Monitoring Phone No.:() - Second Floor: Fireworks Display Permit $250.00 $250.00 Auto Fire Alarm?:N Third Floor;: Total: $250.00 $250.00 FIR2012-00039 Please refer to the following pages for conditions of this permit. Page 1 of 4 CASE NOTES FIR2012-00039 CONDITIONS FOR FIR2012-00039 1.) Owner/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. X 2.) Vali,q P� #Must be on-site. Xr � �/� 3.) Sto g"f fireworks at a display site shall comply with the requirements of section 3308 of the 2009 International Fire code and NFPA 1123 and 1126. X C� V Shells shall be inspected by the operator or assistant after delivery to the display site. Shells having tears, leaks, broken fuses or signs of having been wet shall be set aside and shall not be fired. Aerial shells shall be cheched for proper fit in mortars prior to discharge, shells that do not fit properly shall not be firedX Mortars for firing fireworks shells shall be installed in accordance with NFPA 1123 and shall be positioned so that shells are propelled away from • spectators and over the fallout area. Under no circumstances shall mortars be angled toward the spectator viewing area. X After the fireworks display, the firing crew shall conduct an inspection of the fallout area for the purpose of locating unexploded aerial shells or live components. This inspection shall be conducted before public access to the site shall be allowed. Where fireworks are displayed at night and it is not possible to inspect the site thoroughly, the operator or designated assistant shall inspect the entire site at first light. A report identifying any shells fail to Xnitt ' or disc ✓ J� harge from, a mortar or fail to function over the fallout area or otherwise malfunction, shall be filed with the fire code offical. IFC section 3308.4 Clearance. Spectators, spectator parking areas, and dwellings, buildings or structures shall not be located within the display site. A 70 foot clearance per 1 inch of mortar tub diameter is required. Exception: 2. This provision shall not apply to unoccpied dwellings, buildings and structures with the approval of the building owner and the fire code offical. ote: this also applies to the dock and boats moored at the doc. X This permit b comes 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 owner or the 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: FIR2012-00039 Please refer to the following pages for conditions of this permit. Page 2 of 4 f f 2 VW Mason County Fireworks Permit Application 4M HAM@= PO BOX 186 426 W Cedar St Permit# FIR z 2_M 39 Shelton WA 98584 Receipt # (360) 427-9670 ext 273 CK # Date Received 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: Orion Pyrotechnics Mailing Address: 11210 Saskatoon LN SE City: Olymipa State: WA Zip: 98513 Contact Number (253 ) 224-0997 Sponsor Information Name: Alderbrook Spa and Resort Mailing Address: to E �1b� I�c��_.p C City: union State: Wa Zip: 98592 Contact Number _(3_6_0 )898-5 2�_....._._. Washington State Fireworks License Information (Copy Required) License NO.: Date of P-04311 Issue: 01/01/2012 ❑✓ Pyrotechnic Operator License ❑ Fireworks Stand License Bond or Certificate of Insurance (Copy of Certificate/Bond Required) Provider: Combined Specialties International,inc. Insured: Orion Pyrotechnics Certified Holder: Orion Pyrotechnics �� Q Location of stand/display Address: _ �u E A tl.�r b�� ��. .� �►y�vN, W �$_ Directions to Site: See Attachment Parcel Number: Legal Description: Legal Property Owner: * * Please see the reverse side to complete your application Certificate of Insurance 120213 Issue Date: 12/7/2012 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON Deborah M. Merlino THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT Combined Specialties International, Inc. AMEND,EXTEND OR LATER THE COVERAGE AFFORDED 205 San Marin Drive, Suite 5 BY THE POLICIES BELOW. Novato, California 94945 INSURERS AFFORDING COVERAGE INSURED Pyrotecture, LLC INSURER A: Underwriters, Lloyd's London DBA: Orion Pyrotechnics INSURER B: 11210 Saskatoon Lane SE INSURER C: Olympia, WA 98513 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 HERIN 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES INCLUDING,BUT NOT LIMITED TO THOSE FOLLOWING:LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,ADDITIONAL CONDITIONS AND EXCLUSIONS:1)THE INSURANCE EVIDENCED BY THIS CERTIFICATE IS LIABILITY INSURANCE ONLY,IT IS NOT A BOND OR ANY FORM OF SURETY AGAINST WHICH SOMEONE OTHER THAN"INSURED"MAY ASSERT A CLAIM OR BRING ANY ACTION. SUBJECT TO POLICY TERMS,CONDITIONS,DEFINITIONS AND EXCLUSIONS THE INSURANCE ONLY INDEMNIFIES AN INSURED AGAINST CERTAIN LEGAL LIABILITY.2)THE INSURANCE DOES NOT COVER CLAIMS FOR BODILY INJURY OR PROPERTY DAMAGE OF THE NAMED INSURED's SHOOTER(S)ASSISTANT(S)OR ANY OTHER PERSON(S)INCLUDING ANY VOLUNTEER(S)PARTICIPATING IN ANY WAY IN ANY DISPLAY OR SPECIAL EFFECT PERFORMED OR EXECUTED BY THE NAMED INSURED.3)COVERAGE DOES NOT APPLY TO CLAIMS FOR BODILY INJURY OR PROPERTY DAMAGE ARISING OUT OF THE INSURED's FAILURE TO FOLLOW NFPA OR OTHER APPLICABLE REQUIREMENTS,LAWS OR RECOMMENDATIONS,INCLUDING THOSE RELATING TO POST DISPLAY OR SPECIAL EFFECT SEARCHES OR CLEAN UP. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(DD/MMNY) DATE(DD/MM/YY) A GENERAL LIABILITY CSI-844650-12 5/15/2012 5/15/2013 EACH ACCIDENT $1,000,000 CLAIMS MADE MEDICAL EXP(any one person) $5,000 FIRE LEGAL LIABILITY $50,000 GENERAL AGGREGATE $2,000,000 PRODUCTS-COMP/OPS AGG AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Each accident) ANY AUTO ANY OWNED AUTO SCHEDULED AUTOS BODILY INJURY(Per Person) HIRED AUTOS NON-OWNED AUTOS BODILY INJURY(Per Accident) PROPERTY DAMAGE (Per person) EXCESS LIABILITY EACH ACCIDENT FOLLOWING FORM AGGREGATE WORKERS COMPENSATION WC STATUTORY OTHER LIMITS AND EMPLOYERS'LIABILITY E.L.EACH ACCIDENT E.L.DISEASE-EA EMPOYER E.L.DISEASE-POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Alderbrook Spa & Resort and Mason County are Additional Insured as respects the December 12/31/2012-January 1, 2013 1.3G Fireworks Display at Alderbrook Spa & Resort, 7101 WA-106, Union, WA CERTIFICATE HOLDER SHOULD ANYOOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.THE ISSUING COMPANY VILL ENDEAVOR TO MAIL 10 DAYS WRrTFN NOTICE TO THE CERTffICATE HOLDER NAMED TO THE LEFT.BUT Alderbrook Spa & Resort THECOWANYITSAA SUCH NOTICE AG TO MAIL ENTS RFFRESENTATWEEg SHALL IMPOSENO OBLIGATION ORWABBIfYOF ANY KINDuroN 7101 WA-106 Union, WA 98592 Alderbrook Spa & Resort 12/3/hpit Fireworks Display Site Map Traf�c shot pOsiiiot{ t e=1 iiE:! Back main shot site of& 1-4 100' apart 5" biggest shell 5" biggest shell 300' radius kir -•, �� .� � s � �r �as Y e w � Imagery IPe612" 0.58 in ©2012 Orion Pyrotechnics PART I APPLICATION lznoizol2 FOR PUBLIC FIREWORKS DISPLAY PERMIT TO: GoverniqR body of city,town, or county in which display is to be conducted. -AII-PLICAi4)T non Pyrotecnics y oskatoon LN SE Olympia,WA 98513 - 0-3409 d bOK er rook Spa and Resort f0 IG Plocr 6 cook,Dr !o>u W R Its 0360-998-5529 aco B.Johnson s r a PYROTEtr1HNtC OPERATG)R 11740 Morris RD SE Yelm,WA 98597 P-04313 _( OFATg011T5 t ane r, uGr RPM- Jackie Ringquist 18740 119th Ave.SE Yelm,WA 98597 25 v Doug McClure 1703 N.Oakes Tacoma,WA 98406 40 `C- iACTL ATIQN O ;REPOSED DISPLAY Ider rook Spa and Resort Union WA 98592 12-31-2012 11:59 pm �=l�Uf41BER AND, fNDS OF FIREWWO TO BE DtS%AYED 3"(244)°wial She"s "(150)Aerial Shells (3)multiple shot cake rt3r2 roman candies - - M "POSCE OF`SMRAC'Gll �PRICIR TO©l t, 1f.(Subjt3ctto apgfdv C►f ogal F#re Auttia ;.. r SI (CANT FINANCIAL RESPONSIBILITY- BONDING OR iNSU AN'c COMPANY (Mark One) [Combined Specalties Inc. 0 Bond or certificate of insurance attached Q Bond or certificate of insurance on file with State Fire Marshal 205 San Marin Drive,Suite 5 Bond or certificate of insurance shall provide minimum coverage of Ndvdto,California 94945 $50,000/$1,000,000 bodily injury liability for each person and event, respectively,and$25,000 property damage PART II PERMIT r PERMIT# DATE: In accordance with the provisions of RCW 70.77 and applicable local ordinances, this pe,�lit is granted to conduct a firework — NAME: RESTRICTIONS Permit not valid without verification of (Sinnattira of Official orantina oermitl the appropriate State Fireworks License (Title) LICENSE NUMBER: (Instructions on reverse side) 3000-420-050(R 02/05) Distribution: WHITE(A): Local Fire Authority; YELLOW(B): Permitee