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HomeMy WebLinkAboutFIR2012-00021 - FIR Permit / Conditions - 8/3/2012 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inspection Line(360)427-7262 Phone: (360)427-9670, ext. 352 Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Shelton, WA 98584 004 FIRE PROTECTION PERMIT FIR2012-00021 APPLICANT: ALDERBROOK RESORT RECEIVED: 7/10/2012 CONTRACTOR: LICENSE: EXP: ISSUED: 8/3/2012 SITE ADDRESS: 10 E�LQERBROOK DR UNION EXPIRES: 2/3/2013 PARCEL NUMBER: 3223 0014 LEGAL DESCRIPTION: SUNNY BEACH PCL 1 OF BLA#04-58 PROJECT DESCRIPTION: FIREWORKS DISPLAY AUGUST 4, 2012 GENERAL INFORMATION System Information Type of Use: DIS Fire District: 6 Sprinkler Heads: Audible Switches: Pull Stations: Flow Switches: Visual Devices: Door Releases: Hood Duct?: Dry Chemical?: Pressure Switches:: Smoke Detectors: Duct Detectors: Wet Chemical?: Zones: Heat Detectors: Sprinkler?: Standpipe?: 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.. Third Floor;: Total: $250.00 $250.00 FIR2012-00021 Please refer to the following pages for conditions of this permit. Page 1 of 4 CASE NOTES FIR2012-00021 Ar CONDITIONS FOR FIR2012-00021 1.) Owne 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.) VaI6 Permit Must be on-site. X 3.) S ctators, spectator parking, and dwellings, buildings or structures shall not be located witin the display site, a minimum of a 70 set back per 1 inch in diameter of mortar is required. Per section 3308.4 of the 2009 International fire code Exception 2. This provision shall not apply to unoccupied dwellings, buildings and structures with the approval of the building owner and the fire code official. It is the applicants resposiblity to obtain permission from all propert owners whether personal or real property. X The s a fire at the display site shall comply with the requirements of this section and NFPA 1123 or 1126. X Shells sha I be inspected by the operator or assistants 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 checked for proper fit in mortars prior to discharge. Aerial shalls that do not fit properly shall not ge fired. After the fireworks display, damaged, deteriorated or dud shells shall either be returned to the supplier or distroyed in accordance with the sup ie ' tructtions and section 3304.10 of the 2009 International Fire code. X Mortars for firing fireworks shells shall be installed in accordance with NFPA 1123 and shall be positioned so that shalls are propelled away from spectators and over the fall out area. Under no circumstances shall mortars be angled toward the spectator viewing area. Prior to placement, mortars shall spected for defects , such as dents, bent ends, damaged interiors and damaged plugs. Defective mortars shall not be used. X Post fireworks display inspection, 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 displayeiKat night and it it not possible to inspect the site thoroughly, the operator or designated assistant shall inspect the entire site at first light. X 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 owner or the agent on the owners behalf, represents that the information provided is accurate and grants employees of Mason County a ces o the above described property and structure for review and inspection. �1) OWNER OR AGENT: DATE: OtR, 3— 2yl /„ FIR2012-00021 Please refer to the following pages for conditions of this permit. Page 2 of 4 -n N CONCRETE MECHANICAL MANUFACTURED HOME O Date gy? Footings J Setbacks Gas Piping Ribbons -- - m CInterior Date By Interior-Date By paw gy W OG Exterior Date By Exterior Date v B Sot-up O Point Load J Isolated Footings INSULATION Date By 0 BG 1 SLAB INSULATION Date By Data By FIRE DEPARTMENT ;0 rn Foundation Wails Floors Date By fn Date By Data By DECKS - 0 FRAMING walls Date By Date By Dat`' By PROPANE TANKS PLUMBING vault Date ay Date _ By OTHER Groundwork Attic Date gy Date By Type- DRYWALL Date Fay D.W.V Type- Int.Brace Wall Date By Date By T y Date By FINAL INSPECTION N Water Line Fire Separation O Date By Date By Date Fay N O o Pass or Request Inspect. c Type of insp. Fail Date Date Done By Comments ,v N O n O 7 a 0 N O -w S N fD C T I W O M Mason County Fireworks Permit Application PO BOX 186 426 W Cedar St Permit# FIR 2-.0 12- 000 Z 1 Shelton WA 98584 #t c (360) 427-9670 ext 273 Receipt 51 A6 I L4 - 10 10 CK # Date Received - LA 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 Pyrotechincs Mailing Address: 11210 Saskatoon LN SE City: Olymipa State: WA Zip: 98513 Contact Number (253 ) 224-0997 Jacob Johnson Sponsor Information Name: Alderbrook Spa and Resort Mailing Address: 1 WA-1�6 t'Q_ tJi.Qf t�'�� City: Union State: Wa Zip: 98592 Contact Number -Cam-)898-5-52g_____ Washington State Fireworks License Information (Copy Required) License No.: Date of P-04313 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 Pyrotechincs _ Location of stand/display Address: 7101 WA-106, Union, WA 98592 Directions to Site: See Attachment Parcel Number: _ - - Legal Description: Legal Property Owner: * * Please see the reverse side to complete your application 1 � " ®, APPLICATION PART I FOR PUBLIC FIREWORKS DISPLAY PERMIT 07-08-2012 TO: Governin body of city,town, or county in which display is to be conducted. iAPPLICANT y - 6non Pyrotecnics askatoon LN SE Olympia,WA 98513 136D=790-3409 AshleyYngold 10125 36 th ST NW, Gig Harbor,WA 98335 PYR01 f=IrHNIC`OPERATt)F .. E -. __ III acob B.Johnson 111547 Morris RD.SE Yelm,WA 98597 1 IP-0431'3' p C Doug McClure 1703 N.Oaks,Tacoma WA 98406 0 ANIC V EXACTIw A N t3►f p;I20Posto 0'1SPLAY _, Ider rook Spa and Resort 7101 WA-106,Union WA 98592 08-04-2012 110:00pm - NUMBER AND,; ;J0A_OF FIREW . 0 RE ?J; YED ,..,.. . , (123)2.5"Aerial shells 0 99)3"Aerial Shel s (60)4"Aerial Shells _ (2)Multiple shot cake (4)2"Roman candles MA T -8: QF�S-T-RAdi�PRitlR Ta' .l lf'1Seb3dc;k to apkoiv ,4f t,q al re Autltk� NQ 5tQrdy -required d1l piudULt delivered to diSpIdy site day fil S110W SI NT FINANCIAL RESPONSIBILITY" BONDING iNSURANCE COMPANY (Mark One) Combined Specalties Inc. El 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 mineum coverage of Navato,California 94945 $50,000/$1,000,000 bodily injury liability for each person and event, respectively,and$25,000 property damage i PART it PERMIT PERMIT# DATE In accordance with the provisions of RCW 70.77 and applicable local ordinances, this permit is granted to conduct a firework NAME: RESTRICTIONS: Permit not valid without verification of fSinnature of Official orantino cermitl the appropriate State Fireworks License777t (Title) LICENSE NUMBER: (Instructions on reverse side) 3000-420-050(R 02/05) Distribution: WHITE(A): Local Fire Authority; YELLOW(B): Permitee i Washington State Patrol Fire Protection Bureau 13679 Office Of The State Fire Marshal Washington State Fireworks License Pyrotechnic Operator License Pyrotechnic Operator: Jacob B. Johnson . Licensee Location: 11547 Morris Road Southeast Detach this wallet card and carry with you for Yelm,WA 98597 verification of certification. Washington State Patrol �, 7 9 Phone Number: (253)244-0997 Fire Protection Bureau a Office Of The State Fire Marshal Pyrotechnic Operator Jacob B.Johnson License Number: P-04313 Date of Issue Expiration Date License Number Type of License: Pyrotechnic,Operator March 15,2012 January 31,2013 P-04313 Expiration Date: January-31,2013 3000-420-012(R 9/05) State Fire arsh'aj- i nature Licensee Signature j � I Alderbrook Spa & Resort �r Fireworks Display Site Map � 5. ~ u ",1 Fallout Area 46C ` - Largest Shell 4" * Fallout Area Obi Y ' 4" K ,r` a>- e -G \777 Imo• u. 1"+"' . (� C n r t . �"..+�,. •M �. .� t 3s,- �,,a d<.- .. � .: , �_ .._.- '.��. t a.. , �eort i pro6lerti �. 4 0.60 in ©2012 Orion Pyrotechnics Certificate of Insurance 116202 Issue Date: 7/10/2012 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF Deborah Merlino INFORMATION ONLY AND CONFERS NO RIGHTS UPON 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 MATH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES INCLUDING,BUT NOT LIMITED TO THOSE FOLLOWING:LIMBS 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/MM/YY) DATE(DD/MMNY) 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 $1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Each accident) 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/LOCATIONSA/EHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Ashley Ingold as sponsor; Alderbrook Spa & Resort and Mason County are Additional Insured as respects the August 4, 2012 (RD: TBD) 1.3G Fireworks Display at Alderbrook Spa & Resort, 7101 WA-106, Union, WA CERTIFICATE HOLDER `lot R.BI.NYO Ui(XNGANYOF'TICnBOVI:DAv RIBFD An.10D BF.WRITTEN TICET n1ti FCTMTI ICA DATED 6RRFA TIC: IX M LFA-CON1T FAILURE wn.iURE I MAU.S R H NOTICE 10 DAYS WRnTEN OBLIGATION TO TNIi CFRTiflCATIi F ANY I MUP TO Ti B I.EPr,AMITNY 1IT'S G TO MAB.SUCH NOTICE XI W,I.B(POSE NO(XlLIGATiDN OR LIABILITY OF ANY KIND UPON Ashley Ingold Till:LY1MPANY,IT'S AOhMS(X(RC•.PRI SL•MATIVlS 10125 36th Street NW Gig Harbor, WA 98335 AUTHORIZED REPRESENTATIVE