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Home My WebLink AboutFIR2011-00042 Final - FIR Permit / Conditions - 9/10/2011 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 P10 FIRE PROTECTION PERMIT FIR2011-00042 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 ALDERBROOK RESORT 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: 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;: Total: $250.00 $250.00 FIR2011-00042 Please refer to the following pages for conditions of this permit. Page 1 of 4 CASE NOTES FIR2011-00042 CONDITIONS FOR FIR2011-00042 1.) O Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. 2.) V li JPermit Must be on-site. X � 3.) Th.e 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 it ents. X 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 Fire > guishers must be provided on site per Chapter 9 of the 2009 International Fire code and NFPA 10. X 4.) Per 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 jusKNwn the road. Loaded on to 2 barges an moved out to the location in hood canal 700 feet away from shore. X V 5.) Per 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 just down 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 ifn�sp ctlion. OWNER OR AGENT: DATE v I FIR2011-00042 Please refer to the following pages for conditions of this permit. Page 2 of 4 Mason County • Fireworks Permit Application PO BOX 186 Permit # FIR 426 W Cedar St �- Shelton WA 98584 Receipt # (360) 427-9670 ext 273 p 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: V* Mailing Address: ld City: rl, State: WA, Zip: Contact Number _ (� Sponsor Information Name: t Mailing Address: City: 01Y-,D � _ State: Fa Zip: Contact Number ( ) Washington State Fireworks License.Information (copy Required) License No.: Date of P -0 Issue: U Pyrotechnic operator License ❑ Fireworks Stand License Bond or Certificate of Insurance (Copy of Certificate/Bo d Requir�edj Provider: �,� S Insured: Certified Holder: Location of stand/display Address: Q Directions to Site: Parcel Number: Legal Description: Legal Property Owner: * * Please see the reverse side to complete your application The following pertinent information MUST be provided on the site diagram below Locations and Setback distances from the back, sides and front of retail sales stands or deli at display areas to: • Fire Hydrants • Property Lines • Buildings . Parking • Combustibles • Public Roads and Right of Ways • Fire Lanes 0 Private Roads and Right of Ways Trees/Brush • Landmarks • Utilities and Gas • Mortar separation distance • Designated 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 m 'ntained. Signed Date FOR OFFICIAL USE ONLY BELOW THIS LINE Accepted By: Date: MASON COUNTY FIRE MARSHAL I?!IDB 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 51h from 9AM to 11PM • July 6`h from 9AM to 12 noon • December 27`h—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 104091 Issue Date: 8/4/2011 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF Deborah Medino 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 INSURER A: Underwriters, Lloyd's London Pyrotecture, LLC 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 HENIN 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:1)THE INSURANCE EVIDENCED BY THIS CERTIFICATE 15 LIABILITY INSURANCE ONLY,IT IS NOT A BOND OR ANY FORM OF SURETY AGAINST VMICH 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 PERSON(S)INCLUDING ANY VOLUNTEER($)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 INSUREDS FAILURE TO FOLLOW WPA 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 $1000 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 accident) ANY AUTO ANY OWNED AUTO SCHEDULED AUTOS BODILY INJURY(Per Person) HIRED AUTOS A BODILY INJURY(Per Accident) NON-OWNED AUTOS ) 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/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Brad Green as sponsor and Alderbrook Resort&Spa are Additional Insured as respects the September 10, 2010 Fireworks Display at Alderbrook Resort&Spa, 7101 E. State Highway 106, Union, WA CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEJJD BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WH.L ENDEAVOR TO MAD.10 DAYS VM TFN NOTICE TO THE CERTIFICATE HOLDER NAM®TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL SSE NO OBLIGATION OR LIABB.ITY OF ANY KIND UPON Brad Green THE COMPANY,1175 AGENTS OR RFPIMSENTATWES. 2574 27th Avenue West Seattle, WA 98199 APPLICATION 9 r Vr qeM,VA I1UN PART I How FOR PUBLIC FIREWORKS DISPLAY PERMIT TO: Governin _body of city,town,or county in which display is to be conducted. LICANT A on Pyrotechnics IR��askatoon Ln SE,Olympia,WA 98513 3� '1 0-3409 erbrook Spa and Resort 7101 WA Id -106,Union Wa 98592 r tv OT HNIC PERATOR Y _ Aaron Webb 11210 Saskatoon Ln SE,Olympia,WA 98513 ��04311 a t or* Chad Beebe 11210 Saskatoon Ln SE,Olympia,WA 98513 1 40 ILL J C OSE 10 - 66,Union Wa 98592 - - IM September 10th 2011 10: 0 PM i&MBER AN DS OF FIREWO OBE YEQ - - 19Qx 3"rhalls 86x 4"shells 2x multi shot cakes GI[FiRI eGt to a al Fir+'Delivered day ) _ ' SI 'NATURE OF APPLICANT FI NCI RESPONSIBILITY,_ BONQtNGN" COMPANY (Mark One) Combined Specalties,Inc 0 Bond or certificate of insurance attached ❑ Bond or certificate of insurance on fife with State Fire Marshal 205 San Marin Dr,Suite 5 Bond or certificate of insurance shall provide minimum coverage of $50,000/$1,000,000 bodily injury liability for each person and event, Novato,California 94945 respectively,and$25,000 property r damage P� 9 PART IE PERMIT PERMIT# DATE: In accordance with the provisions of RCW 70.77 and applicable local ordinances, this pglmit is granted to conduct a firework NAME: RESTRICTIONS: Permit not valid without verification of (Sionature of Official arantina hermit) 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 I 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 September 10th, 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. I L Alderbrook Fireworks Display WA• July 5th, 2010 a Traffic, Llvie... Satellite Earth • 700' Diameter . �# P Secured Permiter � , . A t rM O' e, • Barge Location 'u r ; �! ))) t,�-�Ialv s r Y T _ ✓ I ` r, L� jv + ,1r r 'Jr° � • �. . .C.•� �i._� •.� �,� � �,. � geoortaorct;e- R Washington Hotel i0 Hyatt Hotels in Washir_ Alaranteej j Dori 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 Cityunion State WA Zip Code 98592 CltyOlmpia State WA Zip Code98513 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@ohonpyro.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 nu and 'ty) 1 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 ver/Creek Pond Wetland Seasonal Runoff Stream lopes or Bluffs 1 15% Is this permit submittal the result of a Stop Work Notice,CorrectIlIftbtice or other enforcement action?Yes/No TYPE OF JOB - New Add Alt Repair OtherFl WORKS PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building Describe Ork rks display September 10th 2011 No. of Bedrooms No. of Bathrooms re tage-'Tst Floor 2nd Floor 3rd Floor Basement Deck vered Deck Other Sq. ft. Garage Attached Detached port Attached Detached MANUFACTURED HOME INFORMATION - Make -' Model Year Length Width Serial No. o. 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 i 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 entifled 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 NTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X Date: caner/Own sentative/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 State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES