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Home My WebLink AboutFIR2011-00047 - FIR Permit / Conditions - 11/15/2011 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 FIRE PROTECTION PERMIT FIR2011-00047 APPLICANT: ALDERBROOK RESORT RECEIVED: 10/31/2011 CONTRACTOR: ORION PYROTECHNICS 1.3960.790.3409 LICENSE: EXP: ISSUED: 11/15/2011 SITE ADDRESS: 10 E ALDERBROOK DR UNION EXPIRES: 5/15/2012 PARCEL NUMBER: 322335000014 LEGAL DESCRIPTION: SUNNY BEACH PCL 1 OF BLA#04-58 PROJECT DESCRIPTION: FIREWORKS DISPLAY FOR WINTER WONDERLAND NOV 25TH, 2011 Display at 7:00pm 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 Zones: Heat Detectors: Wet Chemical?: N 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;: p y Total: $250.00 $250.00 FIR2011-00047 Please refer to the following pages for conditions of this permit. Page 1 of 4 CASE NOTES F I R2011-00047 CONDITIONS FOR FI R2011-00047 1.) Ow q 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.) Va ermit Must be on-site. X 3.) The access to the site must be in full compliance with ordinance 31-04 title 14 chapter 14.17 of the Mason County code fire apparatus access re i gents. X V Storage and use of fire works must be in full compliance with RCW70.77, WAC 212-17, NFPA 1123-06, NFPA 1124-06, NFPA 160-06 and chapter 33 of the International Fire code. X ,r Fir guishers must be provided on site per Chapter 9 of the 2009 International Fire code and NFPA 10. X 4.) Pe"t e application: There will be no on site storage or fire works or explosives of any kind. The fireworks will arrive on site the morning of the display by truck at the marina ju d n the road. Loaded on to 2 barges an moved out to the location in hood canal 700 feet away from shore. X 5.) Per he application: Ther will be no on site storage or fire works or explosives of any kind. The fireworks will arrive on site the morning of the display by truck at the marina just the road. Loaded on to 2 barges an moved out to the location in hood canal 700 feet away from shore. 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 access to the above described property and structure for review an I insp tion. 11"- -- OWNER OR AGEN DATE / FIR2011-00047 Please refer to the following pages for conditions of this permit. Page 2 of 4 T �D CONCRETE MECHANICAL MANUFACTURED HOMEDate Footings !SetbacksVv__ _._. Gas Piping By Gas M n intenor Date By Interior-Date By Date By � �. O Exterior Date By Exterior-Date B Stu-tip 0 V Point Load!Isolated Footings INSULATION Date By BG!SLAB INSULATION -�- Date By Data By FIRE DEPARTMENT _ m Foundation Walls Floors Date By CA 0 Date By Data By DECKS X FRAMING walls Date By Date By Data By PROPANETANKS PLUMBING vault Date By Data By OTHER Groundwork Attic Type. Gate By oats By Date By D.W.v DRYWALL Type_ Date B Int.Brace Wail Date BY Y 56 w DAte By FINAL INSPECTION N Water Line Fire Seperation Date By Date By Date By O o Pass or Request Inspect. o Type of Insp. Fail Date Date Done By Comments y R ca d cc CD 0 -w O n O 3 a o' N O S N fD K N cc CD W O A Mason County HE Nam= Fireworks Permit Application PO BOX 186 Permit# FIR 2011- L17 426 W Cedar St .� Shelton WA 98584 Receipt # 427-9670 ext 273 1�S CK # Date Received 1013 / Q 7 -3401 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 Ip [mltion . Name: !—- X"l�' dCj Mailing Address: t/ City: State: A Zip: Contact Number ( ) Sponsor Information Name: I.IJ Mailing Address: �n City: 46 State: �,/V,4 Zip: Contact Number Washington State Fireworks License.Information (Copy Required) License No.: Date of P -0q3! j Issue: Pyrotechnic Operator License ❑ Fireworks Stand License Bond or Certificate of Insurance (Copy of Certificate/§ond Required) r .► Provider: 0,iia �`� Q Y Insured: • Certified Holder: L Location of stand!/lisp ay Address: Directions to Site: .,�Jb V) 4- - Parcel Number: 32233 - r--4 -appiq Legal Description: Legal Property Owner: * * Please see the reverse side to complete your application The f0J10Win2 Dertinent 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 • Desi ated landimg area 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 disch rge of fireworks shall be maint inad Signed Date FOR OFFICIAL USE ONLY BELOW THIS LINE Accepted By: Date: Certificate of Insurance 106164 Issue Date: 10/25/2011 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 Olympia, WA 98513 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 HERIN IS 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:11 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-852908-11 5/15/2011 5/15/2012 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/LOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Alderbrook Resort and Mason County are Additional Insured as respects the November 25, 2011 (RD.- TBD) Fireworks Display at Alderbrook Resort, 7101 E. State Highway 106, Union, WA C ER 111'1 C A TE HOLDER SHOULDLATION ANY F THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY V LL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY F ANY KIND UPON Alderbrook Resort THE COMPANY,ITS AGENTS OR REPRESENTATIVES. 7101 E. State Highway 106 Union, WA 98592 lyG�r-vur-� Ala -AUTHORIZED REPRESENTATIVE_ APPLICATION PART I FOR PUBLIC FIREWORKS DISPLAY PERMIT 1oi25i11 TO: Governing body of cqy,town, or county in which display is to be conducted. PLICANT AME non Pyrotecnics askatoon Ln SE,Olympia,WA 98513 JYW 0-3409 rPH to, er rook Spa and Resort 7101 WA-106,Union Wa 98592 360-898-5529 pYROt e:HNlC OPERATOR - --- _ — Raron Webb 712 36i Ave Olympia WA P-04311 #� A1TSc a ° t ott - ., ..__. ancey Wilkins 3805 College st#65 Lacey WA 30 h 0 a�CACf"! • Of- .,QPOSED PIAY�= - ..�`° j101-kwl06,Union Wa 98592 November 25th,2011 aprox 7pm MBER Ahlb 1 OF FIREWORWT-0 BE DISPLAYED 120x 2.5"shells 20x 3"she Is - -- - - -- 100x 4"shells 34x 5"shells sproximategerbs�cr--ossettes.-comets - -- — ired electricaly MA.MEWIOit: RA(3_,PRIOR tW� " .-9t1 4'�to aPP ro o `t Fire A ! _ eyed on day of shuM SI NA' —_ NT Chad E.Bee e 2010.05.14 15:07:11-07'00' Fill Av WSPOWUM"- BONDING OR INSURANCE COMPANY (Mari(One) Combined Specialties,Inc x❑ Bond or certificate of insurance attached ❑ 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 Navato,California 94945 $50,000/$1,000,000 bodily"ury liability for each person and event, respectively,and$25,000 property damage PART II PERMIT PERMIT# DATE: In accordance with the provisions of RCW 70.77 and applicable local ordinances,this petit is granted to conduct a firework _•� NAME: RESTRICTIONS' Permit not valid without verification of (Sionaturs of Official oranlino permit) the appropriate State Fireworks License (Title) LICENSE NUMBER: I (Instructions on reverse side) 3000-420-050(R 02/05) Distribution: WHITE(A): Local Fire Authority; YELLOW(B): Permitee Alderbrook Inn & Resort Winter Wonderland Fireworks and Proximate Effects November 364b 2-5 General Notes Phase 1: 2.5"and 3"shells shot from Lady Dock to be closed during all Alderbrook following path indicated. phases. All mortars angled 5 deg.Off back of All devices to be shot vessel during movement.Shooting to be electronically. complete during docking of vessel. Approx show duration=5 minutes J' M Setback required =210' Setback Provided=600' i Phase 2: a t 3 4"and 5"aerial shells and finale shot from floating platform moored to dock. } - All shells angled 10 deg.north. Approx show duration=3 minutes t Setback required =350' Setback Provided=500' Phase 3: Proximate effects shot from dock and � y ) from balcony of rm 204. Gerbs to be shot as Santa walks by, , r r Crossette,comets to be shot at tree ` # �* , *' r • e_- - lighting. Approx show duration=2 minutes Setback required =None t 1T_ Setback Provided=50' Y M