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Home My WebLink AboutFIR2011-00043 Final - FIR Permit / Conditions - 8/20/2011 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 1� FIRE PROTECTION PERMIT FIR2011-00043 APPLICANT: ALDERBROOK RESORT RECEIVED: 8/5/2011 CONTRACTOR: LICENSE: EXP: ISSUED: 8/18/2011 SITE ADDRESS: 10 E ALDERBROOK DR UNION EXPIRES: 2/18/2012 PARCEL NUMBER: 322335000014 LEGAL DESCRIPTION: SUNNY BEACH PCL 1 OF BLA#04-58 PROJECT DESCRIPTION: FIREWORKS DISPLAY AUG. 20TH GENERAL INFORMATION System Information Type of Use: DIS Fire District: 6 Sprinkler Heads: Audible Switches: Pull Stations: Hood& Duct t: N Flow Switches: Visual Devices: Door Releases: Dry Chemical?: N Pressure Switches:: Smoke Detectors: Duct Detectors: 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;: Total: $250.00 $250.00 FIR2011-00043 Please refer to the following pages for conditions of this permit. Page 1 of 4 CASE NOTES FIR2011-00043 CONDITIONS FOR FI R2011-00043 1.) OwnN 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 id ermit Must be on-site. X 3.) Th 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 regy�elQ�ents. X '�,J 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 9 International Fire code. X Fire xt�guishers must be provided on site per Chapter 9 of the 2009 International Fire code and NFPA 10. X 4.) Per fhe 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 jus d wn the road. Loaded on to 2 barges an moved out to the location in hood canal 700 feet away from shore. X 5.) Pet the 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 jus��e�yn 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 aqd inspeApT �7 OWNER OR AGENT. �J �— DATE: FIR2011-00043 Please refer to the following pages for conditions of this permit. Page 2 of 4 55 N CONCRETE MECHANICAL MANUFACTURED HOME o Footings 1 Setbacks Gas Piping B1 Ribbons X C interior Date By Interior-Date By Date By 00 Z1 CC Extenor Date By Exterior-Date BSety Q W Point Load J Isolated Footings INSULATION Date By X BG I SLAB INSULATION Date By Data By FIRE DEPARTMENT X Foundation Walls Floors Date By N Date By Date By DECKS X FRAMING Wails Date By Date By Dato By PROPANE TANKS PLUMBING Vault hate By Date By OTHER Groundwork Attic Date By Date By Type. Date By o.w,v DRYWALL Type_ Int.Brace Wall Rate By Date ey Dal, By FINAL INSPECTION N y O Water Line Fire Seperation Dale By Dario By Date By o Pass or Request Inspect. o Type of insp. Fail Date Date Done By Comments w 54 J f 3 fQ d fa CD N O A O 7 a 0 3 N O S N a 3 i v cu w 0 Mason County HE man= Fireworks Permit Application PO BOX 186 426 W Cedar St Permit# FIR Shelton WA 98584 Receipt # (360) 427-9670 ext 273 CK # Date Received—q 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: Mailing Address: r City: tA-nj(20 State: Vb Zip: Contact Number Sponsor Information Name: Mailing Address: S City: State: W)s, Zip: Contact Number Washington State Fireworks License Information (Copy Required) License No.: Date of YIssue: Pyrotechnic Operator License ❑ Fireworks Stand License Bond or Certificate of Insurance (Copy of Certificate/Bond.Required Provider: ' 4S Oh Insured: 6 Certified Holder: Location of stand/dis Address: �6 �i ILa�'L-rb'✓ - �►/ � � (� � pI -�' lab Directions to Site: Parcel Number: - - Legal Description: Legal Property Owner: * * Please see the reverse side to complete your application [[ The followin pertinent information MUST be provided on the site diagram below ations and Setback distances from the back, sides and front of retail sales stands or d��s axed display areas to: • Fire Hydrants . Property Lines • Buildings . pkg • Combustibles Public Roads and Right of Ways • Fire Lanes Private Roads and Right of Ways 0 Trees/Brush • Landmarks • Utilities and Gas • Mortar separation distance • Desi axed landing 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 discharge of fireworks shall be mai tained. Signed i� Date FOR OFFICIAL USE ONLY BELOW THIS LINE Accepted By: Date: MASON COUNTY FIRE MARSHAL Mason County Bldg.III 426 W Cedar St PO BOX 186 Shelton,WA 98584 (360)427-9670 Ext.273 CODE ENFORCEMENT FIRE INSPECTIONS FIRE INVESTIGATION PUBLIC EDUCATION STANDARDS FOR THE OPERATION OF RETAIL FIREWORKS STANDS Sales Consumer fire works may be sold only on the following days and times. • June 28th from 12 noon to 11PM • June 29th—July 5th from 9AM to 11PM • July 61h from 9AM to 12 noon • December 27th—31" from 12 noon to 11PM Approved Fireworks Only Washington State Fire Marshal approved Class C common fireworks may be sold. Fireworks Stand Location • A fireworks stand shall not be located more than 150' from an approved access road, • Shall be at least 100' from another fireworks stand or separated by a road, street or highway at least 30' in width, • Shall not be located any closer than allowed by the table below to other structures or exposures, • Or be located closer than 100' from any flammable liquid or gas dispensing device, or 300' from any flammable liquid or gas bulk storage or dispensing facility. Retail Fireworks Stands—Minimum Clearances Buildings Combustibles Property Line Parking Motor Vehicle Motor Vehicle Traffic, Traffic, Public Road Private Way Back of Stand 20' 20' 5' 20' 20' 5' Side of Stand 20' 20' 5' 20' 20' 5' Front of Stand 20' 20' 20' 20' 20' 20' Surrounding Area around Fireworks Stands • The minimum areas around fireworks stands, as specified above, shall be kept free from dry grass, brush or combustible debris. This area shall be marked and flagged. • Motor vehicles or trailers may not be parked within 20' of the fireworks stand except when delivering, loading or unloading fireworks. • Fireworks shall not be discharged within 300' of any fireworks stand. A sign stating No Fireworks Discharge Within 300' in letters at least 2"high and in contrasting color shall be posted conspicuously on all sides of the structure. • No smoking shall be allowed within the fireworks stand or flagged off area. Signs stating No Smoking Within 100' in letters at least 2"high and in contrasting color shall be posted conspicuously on all sides of the structure. Electrical Supply & Usage • All battery powered equipment, electrical equipment and cords shall be UL listed and used in accordance with that listing. Extension cords shall be of an industrial grade type and shall be protected from physical damage. • All heating devices shall be UL listed. Only heating devices with sealed-type elements shall be used, i.e. oil filled or water-filled radiator type. Open flame or open element heating devices are prohibited. • Generators shall be located a minimum of 20' from any fireworks stand. Fuel storage is limited to 5 gallons. Fireworks Stand Operations • A minimum 24"wide isle shall be maintained inside the full length of the stand. • Customers are not allowed inside the fireworks stand. • There shall be a minimum of 2 exits at least 28" in width located at opposite ends of the stand. These exits shall remain unlocked and unobstructed during hours of operation or when stand is occupied. • Sleeping inside a fireworks stand is prohibited. • The location of the nearest phone shall be posted in the fireworks stand. All occupants of the stand shall be informed as to the location of this phone. • The local emergency phone number, 911, and the address of the fireworks stand shall be conspicuously posted inside the stand. ' • There shall be a minimum of 2 (two) approved 2 1/2 gallon pressurized water fire extinguishers located adjacent to each exit door. • Cooking, open flame or any type of open flame equipment is prohibited in a fireworks stand. • Fireworks stands shall be locked when unoccupied and not open for business if fireworks are stored in the stand during these times. Fireworks stands shall not be locked when occupied. Fireworks may be removed or transferred to a temporary storage structure or location approved as part of the license and permit. • Fireworks may be stored in a locked and secured retail fireworks stand, truck, container, or trailer that is at least 20' from the fireworks stand during business hours, or in a locked or secured metal or wooden garage, shed, barn or other accessory building that is a least 20' from the fireworks stand. • At least one person 18yrs of age or older shall be on duty in the fireworks stand when fireworks are being sold to the public. Such person shall be responsible for the supervision of the fireworks stand and its operation. No person under the age of 16 shall be allowed to occupy the fireworks stand when it is open to the public. • It is illegal to knowingly sell fireworks to persons under the age of 16. A sign stating"No Sale Of Fireworks to Persons Under the Age Of 16" in letters at least 2"high and in contrasting color shall be posted on the front of the stand. A photo ID is required and it is the responsibility of the seller to require proof of age. Driver's License or Photo ID showing a date of birth issued by a public or private school, state, federal or foreign government is acceptable. Certificate of Insurance 104094 Issue Date: 8/4/2011 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 INSURER C: Olympia, WA 98513 INSURER D: COVERAGES THIS ISSUED IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSD 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:t)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 INSUREDS SHOOTER(S)ASSISTANT(S)OR ANY OTHER PERSONS)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/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 (Each aocident) 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 AC STATUTORY OTHER LIMITS AND EMPLOYERS'LIABILITY E.L.EACH ACCIDENT E.L.DISEASE-EA EMPOYER E.L.DISEASE-POLICY LIMIT OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Alderbrook REsort and sponsors Mike 8L Stephanie Parsons are Additional Insured as respects the August 20, 2010 Fireworks Display at Alderbrook Resort, 7101 E. State Highway 106, Union, WA ON CERTIFICATE HOLDER CNIOULD ANY OF THE ABOVE DESCR®BD POLICIES BE CANCELED BEFORE'DIB MIJUATION DATE THBWOF,THE ISSUR40 COMPANY WILL ENDEAVOR TO LIAR.10 DAYS WRI=NOTICE TO TIM CERTIFICATE HOtINM NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL DROSE NO OBLIGATION OR LIABBSTY OF ANY XMD UPON ' Alderbrook Resort THE COWAW.IT'S AGENT'S OR REPPYAEMATTYES 7101 E. Highway 106 -Seattle WA 98592 AUTHORIZED REPRESENTATIVE PART I �° APPLICATION yIr Vt.,�,Ln„spy FOR PUBLIC FIREWORKS DISPLAY PERMIT TO: Governing body of cityLtown,oLcauqtLin which display is to be conducted. AgffLICANT rlon Pyrotechnics *Imaskatoon Ln SE,Olympia,WA 98513 � 0-3409 Z'rbrook Spa and Resort 17101 WA-106,Union Wa 98592 OT HNIC OPERATOR _r Webb 11210 Saskatoon Ln SE,Olympia,WA 98513 04311 tv ftc00 VC -- Chad Beebe 111210 Saskatoon Ln SE,Olympia,WA 98513 40 NAME wntJJ V ffw C POSED f10'(Wl06,Union Wa 98592 Aug 20th,2011 10:00 PM MBER ANUMDS OF FIRIEWOMWO BE MSPA&YED 11 99x 3"rholts 86x 4"shells 2x multi shot cakes ]6x-2�� G PRIOR tt to ap al Fire ) SI NATURE OF APPLICANT FI NCI RESPONSIBILIT BONDING-OR i W;E COMPANY (Mario One) Combined Specalties,Inc x❑ Bond or certificate of insurance attached ❑ Bond or certificate of insurance on file with State Fire Marshal 205 San Marin Dr,Suite 5 Bond or certificate of insurance shall provide minimum coverage of Novato,California 94945 $50,000/$1,000,000 bodily injury liability for each person and event, respectively,and$25,000 property damage r II PERMITERMIT# DATE: accordance with the provisions of RCW 70.77 and applicable local ordinances,this peLmit is granted to conduct a firework _.ems NAME: RESTRICTIONS Permit not valid without verification of (Signature of Official arantina nermitl the appropriate State Fireworks License itle) LICENSE NUMBER: (Instructions on reverse side) 3000-420-050(R 02/05) Distribution: WHITE(A): Local Fire Authority; YELLOW(B): Permitee 8/4/11 Orion Pyrotechnics 11210 Saskatoon Ln,Oympia WA,98513 Please accept this as our application for a fireworks display at the Alderbrook Resort on August 20"', 2011.The display will be in the same spot we use for the July show there.This is for a wedding. We will shoot between 9:45-10:30pm. Please contact Aaron Webb at 360-790-3409 or aaronw@orionpyro.com for any further questions. Alderbrook Fireworks Display • July 51h, 2010 y 700' Diameter Secured Permiter FV"l ` 4� Barge Location Ir 40.'r`•s �'+�► � ''`,�"• .� 1� ��• - ` >r n ,F f •try r y. �.�`� MASON COUNTY PERMIT NO. BUILDING PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 • Belfair (360) 275-4467• Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Alderbrook Resort Company Name Orion Pyrotechnics/Aaron Webb Mailing Address 10 East Alderbrook Dr. Mailing AddreSS11210 Saskatoon Ln City Union State WA Zip Code 98592 City0lmpia State WA Zip Code 98513 Phone360-898-4610 Other Ph. Phone360-790-3409 Other Ph. Lien/Title Holder Contractor Reg. # Exp. E mail address aaronw@orionpyro.com E Mail Address aaronw@odonpyro.com Drivers Lic.# DOB Drivers Lic.# _ DOB SEPTIC/WATER SYSTEM INFORMATION -Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No Fire District Legal Description Site Address(Please include street name, street number and city)7101 E State Highway 106 Union WA,98592 Directions to site Will timber be cut and sold in parcel preparation?Yes/No Is property within 200' of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New Add Alt Repair OtherFIREWORKS PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building Describe Work Fireworks display on August loth No. of Bedrooms No. of Bathrooms Square Footage- 1 st Floor 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price$ Replacement Unit? Yes/No Installer Name Certification No. 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 the contractor.I further declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on 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. PROOF OF CONTINU TION OF 7RK IS BY IIVIIEIANS OF A PROGRESS INSPECTION. X Date: Owner driers Represefitative/Contractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing& Base Fee Planning Review Fee Mechanical & Base fee Other Wood/Gas/ Pellet Stove Fee IState Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES