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HomeMy WebLinkAboutFIR2015-00031 - FIR Permit / Conditions - 6/25/2015 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inspection Line(360)427-7262 erg°N c"U^r� Phone: (360)427-9670, ext. 352 Mason County Bldg. III 426 W. Cedar St Shelton, WA 98584 FIRE PROTECTION PERMIT FIR2015-00031 APPLICANT: WOLVERINE WEST, LLC RECEIVED: 6/17/2015 CONTRACTOR: LICENSE: EXP: ISSUED: 6/25/2015 SITEADDRESS: 10 EALDERBROOK DR UNION EXPIRES: 12/25/2015 PARCEL NUMBER: 322335000014 LEGAL DESCRIPTION: SUNNY BEACH PCL 1 OF BLA#04-58 PROJECT DESCRIPTION: FIREWORKS DISPLAY FOR ALDERBROOK RESORT ON 7/2/15 @ 10:15 PM 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?: Pressure Switches:: Smoke Detectors: Duct Detectors: Dry Chemical?: 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;: P Y Total: $250.00 $250.00 FIR2015-00031 Please refer to the following pages for conditions of this permit. Page 1 of 7 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 ---U—igitally signed by Rodney Hash Date: 2015.06.25 10:11:01 -07'00' J FIR2015-00031 Please refer to the following pages for conditions of this permit. Page 3 of 7 2.) Sales: WAC 212-17-21505 Retailers of fireworks-General provisions. Fireworks may be sold from 12:00 noon to 11:00 PM on June 28 through 9:00 PM on July 5. Fireworks may not be sold between the hours of 11:00 PM and 9:00 AM from June 28 through July 3. Fireworks may not be sold from 12:00 midnight to July 4 through 9:00 AM on July 5. X Fireworks may be sold from 12:00 noon to 11.00 PM on each day from the 27th of December through the 31 st of December of each year. X Only Division 1 AG consumer fireworks, obtained from state-licensed wholesalers, not otherwise prohibited by chapter 70.77 RCW or local ordinance, and holiday related products incidental but related to these products, may be sold in retail fireworks stands. X Fireworks stand locations: WAC 212-17-21509 Retailers of fireworks-location. (1)Activities or uses subject to this rule shall not be limited in location except where such activities or uses are prohibited or controlled by local development regulation, traffic safety or road construction standards. (2)Temporary retail fireworks stands shall not be located more than 150 feet from a private way, fire department access road, public road, street or highway as measured by an approved route around the exterior of the stand. The minimum requirements for private way shall be determined by the local authority having jurisdiction, but shall not exceed the requirements of locally adopted street, road and access standards. (3)Any two retail fireworks stands shall be at least 100 feet apart or shall be separated by a road, street or highway not less than 30 feet in width. (4) Retail fireworks stands shall be located as required by table 212-17-21509 in this section and attached to the permit. The minimum required area surrounding the stand shall be marked or flagged, except that flagging and marking shall not block a sidewalk or pedestrian pathway. Flagging need not exceed twenty feet in any direction. (5) Retail fireworks stands shall not be located closer than 100 feet from any motor fuel dispensing station, retail propane dispensing station,flammable liquid storage, or combnustible liquid storage. Retail fireworks stands shall not be located closer than 300 feet from any bulk storage of flammable or combustible liquid or gas, including bulk plant dispensing areas. X Surrounding area arond fireworks stands: WAC212-17-21511 Retailers of fireworks-areas around the retail fireworks stand. (1)The minimum areas around the retail fireworks stand specified in WAC212-17-21509 shall be kept free of accumulation of dry grass, dry brush and combustible debris. No parking shall be permitted within this minimum area. (2) No motor vehicle or trailer my be parked within twenty feet of a retail fireworks stand except when delivering , loading or unloading fireworks. (3) Fireworks shall not be discharged within 100 feet of a retail fireworks stand. Signs reading"NO FIREWORKS DISCHARGE WITHIN 100 FEET' in letters at least 2 inches high, with the principal stroke of not less than one half inch, on contrasting background„ shall be conspicuously posted on all four sides of the stand. (4) No smoking shall be allowed within the retail fireworks stand or within the minimum flagged off area. Signs reading "NO SMOKING WITHIN 20 FEET' in letters at least 2 inches high,with the principal stroke of not less than one half inch, on a contrasting background, shall be conspicuously posted on all four sides of the stand. X Electrical supply and usage: WAC 212-17-21513 Retailers of fireworks stand use and construction. (1) Fireworks may be sold from: (a)A permanent structure which meets provisions of WAC 212-17-21505(3). (b)Temporary, stable structures made of wood, metal, fiberglass or other material. Any temporary fireworks retail stand greater than 400 square feet shall meet the requirments of a permanent structure, except tents or canopies as defined in the International Fire code retail stand greater than 400 FIR2015-00031 Please refer to the following pages for conditions of this permit. Page 4 of 7 square feet shall meet the requirements of a permanent structure. (c)Tents , canopies, or structures utilizing temporary membrane material. All tents, canopies or temporary membrane materials structures shall be made from fire retardant material or treated with fire retardant as identified in the International Fire code. Any tent, canopy or temporary membrane material structure falling within the scope of the International Fire code shall comply with those requirements. When those requirements are in conflict with other provisions of these rules, the more restrictive provisions shall apply. (2) Battery powered equipment, electrical equipment cords which are used in conjunction with a retail fireworks stand or a temporary storage structure or location must be listed by a recognized laboratory and used in accordance with that listing. If electrical power is supplied by an extension cord, the size of the cord, the length of the cord and the amperage and the voltage supplied shall be in compliance with the requirements of the National Electrical code, current edition.The cord shall be protected as necessary from drive-over and other physical damage. No additional permits from a city or county or state official having jurisdiction shall be required for these temporary uses except as specified in subsection(5)of this section. (3)All heating units shall be listed by a recognized testing laboratory and shall be used in accordance with the listing Heating sources shall have"tip over' and temperature overheat protection. All heating devices shall have sealed type elements(i,e, oil filled or water filled radiator type). Open flame heating - devices are prohibited. (4)Generators which use combustible fuel and which are at least twenty feet from the retail fireworks stand or the temporary fireworks storage structure shall be allowed. Generator fuel shall be limited to not more than five gallons and stored at least twenty feet from all stands. (5)Compliance with the National Electrical code, current edition, shall be required for all new, permanent electrical installations, including temporary power drops, subject to possible fees. (6) Retail sales of fireworks and other products which are holiday related shall be from buildings used for no other purpose. X Storage associated with retail fireworks: WAC212-17-21517 Retailers of fireworks-Temporary fireworks storage associated with the retail fireworks stand operation. (1)Temporary fireworks storage is not permanent fireworks storage. Temporary fireworks is defined as storage associated with retail fireworks sales and may only be from June 13 through July 13 and from December 12 through January 10 of the following year. Permanent fireworks storage is associated with retail or wholesale fireworks activites when the period of time of storage is other than, or longer than that specified for temporary storage. Temporary fireworks storage shall be in accordance with this section. Permanent fireworks storage is subject to the lntemaitonal Fire Code and the local ordinances. (2) Delivery of fireworks to a location, or storage of fireworks in a facility, not authorized by the license and permit is prohibited. If the approved storage location is outside the jurisdiction issuing the permit, the authority issuing the permit shall notify the appropriate authorities of the jurisdiction in which the _ storage is to be(coated. (3)A temporary fireworks storage facitlity or a temporary fireworks storage location shall be authorized as a part of a license and permit if it meets the requirements specified herein. (4) No open flames nor any type of open flame equipment shall be allowed in any temporary fireworks storage structure. (5) Storage of fireworks authorized by a retail license and permit is legel only during the periods specified in this section. (6) Fireworks may be stored: (a) In a locked or secured retail fireworks stand;or (b) In a locked or secured truck, container, trailer, other vehicle or anything similar which is not less than 20 feet from the retail fireworks stand during hours of retail sales;or (c) In a locked or secured truck, container, trailer, other vehicle or anything similar which is not less than 20 feet from an inhabited building where the term"inhabited building" is defined as in the Intemational Fire Code; or (d) In a magazine which meets the minimum standards of a type 4 as prescribed by the Intemational Fire code, and which is not less than 10 feet from an inhabited building where inhabited building"is defined as in the International Fire code: or (e)In a locked or secured metal or wooden garage, shed, bam or other accessory building, or anything similar which is not less than: 20 feet from an inhabited building for storage of fireworks for one or two retail stands; or 30 feet from an inhabited building for storage of fireworks for three or more stands. The term"inhabited building is defined as in the International Fire code. (7)The local authority having juisdiction may reduce the minimum separation required of this section provided that safety of life and property is not diminished. FIR2015-00031 Please refer to the following pages for conditions of this permit. Page 5 of 7 (8) No Cooking is permitted in a retail fireworks stand or in a temporary fireworks storage structure. (9)Temporary fireworks storage structures may be inspected prior to use and other inspections may occur on other days as warranted. There shall be no additional charge for all such inspections. X 3.) Valid Permit Must be on-site. X OWNER/BUILDER acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below. I declare that I am the owner, owners legal representative, or contractor. I further declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary parties, including any easement holder or parties of interest regarding this project. The owner or authorized agent represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for review and inspection.This permit/application becomes null &void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. Digitally signed by Signature—V Ij O ney as Date �}--- Date: 2015.06.25 _ OWNER - REPRESENTATIVE - CONTRACTOR Print Name (Circle one to indicate) FIR2015-00031 Please refer to the following pages for conditions of this permit. Page 6 of 7 T N CONCRETE MECHANICAL MANUFACTURED HOME .p o - Date by Footings J Setbacks Gas Piping Ribbons n'I 6 Interior Date By Interior•Date By Date B X y — o Extem Date By Exterior-Date By Z o Set-up rn Point Load IIsolated Footings INSULATION Date By C BIG!SLAB INSULATION — m Date By oat. By FIRE DEPARTMENT Cn Foundation Wails Floors Date By Date By Data By DECKS r FRAMING Walls Date By n Date _ By Date By PROPANE TANKS PLUMBING 'Vault Cate By Date By OTHER Groundwork Attic Date By Date By Types. Dates By D.W.v DRYWALL. Type. Int.Brace Wall Date By Date By Date B X y FINAL INSPECTION N y o Water Line Fire Seperation Bate By Dated By Date By 01 CD O Pass or Request Inspect. o Type of Insp. Fail Date ©ate tone By Comments cs 7 L /S, i ��' l ! �,s�sr !4,4 - g'l�tt 3 (O D) <D 0 O n O a o' N O a N � F r► In v O v RECEIVED �A5ow `�`"ram MASON COUNTY 'Ilk! 1 7 ')n,' (360)427-9670 Shelton ext.352 DEPARTMENT OF COMMUNITY DEVELOPMENT (360)275-4467 Belfair ext. 352 BUILDING• PLANNING• FIRE MARSHAL GLDAR S 1 (360)482-5269 Elma ext. 352 Mason County Bldg. III, 426 West Cedar Street *185.1 PO Box 279, Shelton, WA 98584 www.co.mason.wa.us FIR20J_6 _- 066121 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: AIderbrook 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 OVENte Directions to Site: see attached NAIN Or �$—SO — 1 1E� edParcel Number: (twelve digit number) - - �� !t rwt apence. Legal Property Owner n/a p,U ap �con pans orre&Onocontr beo Odo ,,sped 5p,???' R1G%A Please see reverse side to complete y r ap °d't�orr 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.,�* Digitally signed by Rodney Hash Signed ,E�ate:2015.06.1314:05:29 Date 6/13/15 -07'00' PART I � ' APPLICATION DATE OF APPLICATION FOR PUBLIC FIREWORKS DISPLAY PERMIT 6113115 TO: Governing body of city,town, or county in which display is to be conducted. -APPLICANT. NAME ADDRESS PHONE Wolverine West Fireworks PO Box 99095 - Seattle, WA 98139 206.459.0917 SPONSOR ADDRESS PHONE Alderbrook Resort & S a 7101 E Hwy 106, Union, WA 98592 360.898.5529 PYROTECHNIC OPERATOR NAME ADDRESS LICENSE# Aaron Webb 800 Yauger Way SW E-208, Olympia WA 985021 P-04311 NAME OF ASSISTANTS: at least one required) NAME ADDRESS AGE Herb Harris 210 'Y' St SW, Tumwater, WA 98501 P-04312 NAME ADDRESS AGE EXACT LOCATION OF PROPOSED DISPLAY LOCATION Alderbrook Resort & Spa - 7101 E Hwy 106, Union, WA 98592 DATE TIME 7/2/15 10:15pm NUMBER AND KINOS OF FIREWORKS TO BE DISPLAYED Not to exceed: (6) Multi-Shot Cakes, (250) 3" Shells, (200) 4" Shells, (87) 5" Shells, (36) 6" Shells MANNER&PLACE OF STORAGE PRIOR TO DISPLAY(Subject to approval of Local Fire Authority) In our approved magazines V40 V_� — SIGNATU E OF APPLICANT `��.fftNAI+tCIAL RESPONSIBILITY 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 II 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 Official granting permit) 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 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/MMNY) DATE(DD/MMNY) 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 PRObl1CTS-CbMP/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 106 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS g Y AGENTS OR REPRESENTATIVES. Union,WA 98592 '� AUTHORIZED REPRESENTATIVE Alderbrook Resort July 2nd, 2015 Jh a� Fireworks Display tow 0 k,q ` x R OL 2014 FIRE WORKS td p� It WEST Ir`nagery'Date; ;`Sr'Z013 (at7.3516c Ian 123.072526" elev 13t eye aft 31 i Washington State Patrol Fire Protection Bureau Office of the State Fire Marshal General Display Fireworks License 15-1167 Licensee Data Operational Data Wolverine West, L. L. C. In State Agent: Rodney F. Hash P.O. Box 628 Phone Number: (206) 459-0917 Chehalis, WA 98532 Email Address: rod@wolverinewest.com License Number: C-04138 Date of Issue:January 30, 2015 Date of Expiration:January 31, 2016 State Fire MarkAvLicen Signature *0-0. Washington State Patrol Fire Protection Bureau Office of the State Fire Marshal Pyrotechnic Operator License 15-1210 Licensee Data Rodney F. hash Phone Number: (206) 459-0917 --- P.O. Box 628 Email Address: rod@wolverinewest.com Chehalis, WA 98532 Date of Issue: January 30, 2015 License Number. P-04255 Date of Expiration: January 31, 2016 State Fire Margy V Licensee Signature Licensee Wall Mount Carta �+s Washington State Patrol Fire Protection Bureau Office of the State Fire Marshal Importer Fireworks License 15-1152 Licensee Data Operational Data Wolverine West, L. L. C. In State Agent: Rodney F. Hash P.O. Box 628 Phone Number: (206) 459-0917 Chehalis, WA 98532 Email Address: rod@wolverinewest.com License Number: C-04138 Date of Issue:January 30, 2015 Date of Expiration:January 31, 2016 L—.-I�v - Tom State Fire Ma Licensee Signature •�'� Washington State Patrol Fire Protection Bureau Office of the State Fire Marshal Wholesaler Fireworks License 15-1119 Licensee Data Operational Data Wolverine West, L. L. C. In State Agent: Rodney F. Hash P.O. Box 628 Phone Number: (206) 459-0917 Chehalis, WA 98532 Email Address: rod@wolverinewest.com License Number: C-04138 Date of Issue:January 30, 2015 Date of Expiration:January 31, 2016 State Fire MarjAA V Licensee Signature --------------------------------------------------