Loading...
HomeMy WebLinkAboutIncident Report - FIR Letters / Memos - 6/25/2012 Mason County Fire District 2 INCIDENT REPORT Official Law Enforcement Report-Unauthorized Dissemination is Prohibited Incident Type: Fire/Accidental Result Type: Actual Agency Incident ID: 12-FM0013 BATS ID: i-260461 q4t, Incident Date/Time/Location Status Jurisdiction Investigation Inactive Primary Start Date/Time 6/25/2012 1:34 AM Monday Address - Street Address 25603 NE State Route 3 City/State/Zip County Belfair, WA 98528 Mason Investigator Information Name Phone Email Jeromy N Hicks 360-275-6711 jhicks@mcfd2.com Title Deputy Fire Marshal Property Use or Target Information Type Subtype Outside/Special Properties Vehicle Parking Area Page: 1 For Official Use Only If Mason County Fire District 2 INCIDENT REPORT Official Law Enforcement Report-Unauthorized Dissemination is Prohibited Incident Type: Fire/Accidental Result Type: Actual Agency Incident ID: 12-FM0013 BATS ID: i-260461 Scene Details Area of Origin/Device Placement Area of Origin Area of Origin Subtype Storage Areas Storage area, other Fire Descriptors Fireworks/Pyrotechnics Damage and Casualties Est. Damage $50000.00 Pre Incident Value Primary Gov't Association $50000.00 No Government Association Related Incidents BATS Agency Agency ID Agency Name Incident ID Incident ID 261449 K 12-006533 WAWSP0010 Washington State Patrol Bomb Squad Miscellaneous Information Latitude Longitude Investigator Right of Entry 47.468717 -122.803618 Consent Exigent Circumstances Page: 2 For Official Use Only Mason County Fire District 2 INCIDENT REPORT Official Law Enforcement Report-Unauthorized Dissemination is Prohibited Incident Type:Fire/Accidental Result Type: Actual Agency Incident ID: 12-FM0013 BATS ID: i-260461 OWlk Insurance Insurance Information Insurance Company Name Insurance Type National Fire and Marine DBA State Farm Other Insurance Holder Insured's Name Robert A Nitz Telephone Office 360-620-1077 Insurance Coverage Insurance Company Point of Contact David Connely Telephone Office 360-692-6439 Insurance Agent Point of Contact Same as Above Page: 3 For Official Use Only Mason County Fire District 2 INCIDENT REPORT Official Law Enforcement Report-Unauthorized Dissemination is Prohibited Incident Type:Fire/Accidental Result Type: Actual Agency Incident ID: 12-FM0013 BATS ID: i-260461 Subjects/Business Information Name SHEPARD, PARIS C DOB Race Ethnicity 6/6/1969 White Age at time of Incident 43 Juvenile No Relationship(s) Reporting Party Address Information Street Address 25603 NE State Route 3 City/State/Zip County Belfair, 98528 Mason Contact Information Primary Phone 360-286-3430 Street Address 25603 NE State Route 3 City/State/Zip County Belfair, 98528 Mason Contact Information Primary Phone 360-286-3430 Page: 4 For Official Use Only Mason County Fire District 2 INCIDENT REPORT Official Law Enforcement Report-Unauthorized Dissemination is Prohibited Incident Type:Fire/Accidental Result Type: Actual Agency Incident ID: 12-FM0013 BATS ID: i-260461 Name NITZ, ROBERT A DOB Race Ethnicity 11/28/1969 Age at time of Incident 42 Juvenile No Relationship(s) Victim Address Information Street Address 29399 Beach Drive NE City/State/Zip County Poulsbo, 98370 Kitsap Contact Information Primary Phone 360-620-1077 Street Address 29399 Beach Drive NE City/State/Zip County Poulsbo, 98370 Kitsap Contact Information Primary Phone 360-620-1077 Name Page: 5 For Official Use Only Mason County Fire District 2 IRA INCIDENT REPORT Official Law Enforcement Report-Unauthorized Dissemination is Prohibited Incident Type:Fire/Accidental Result Type: Actual Agency Incident ID: 12-FM0013 BATS ID: i-260461 i< Name NITZ-TERRILL, ANNETTE M DOB Race Ethnicity 9/21/1969 Age at time of Incident 42 Juvenile No Relationship(s) Interviewed Party Address Information Contact Information Primary Phone 360-620-1077 Contact Information Primary Phone 360-620-1077 Page: 6 For Official Use Only Mason County Fire District 2 INCIDENT REPORT Official Law Enforcement Report-Unauthorized Dissemination is Prohibited Incident Type:Fire/Accidental Result Type: Actual Agency Incident ID: 12-FM0013 BATS ID: 1-260461 Attachments Filename Description Date ATF Permits.pdf ATF Permits 8/2/2012 No Image speclfled Parcel Information.pdf Parcel Information 8/2/2012 No Image speclfled Page: 7 For Official Use Only Mason County Fire District 2 INCIDENT REPORT Official Law Enforcement Report-Unauthorized Dissemination is Prohibited Incident Type:Fire/Accidental Result Type: Actual Agency Incident ID: 12-FM0013 BATS ID: i-260461 Mace-Com Call Log.pdf Dispatch Log 8/2/2012 No Image speciAed WSFM Permit Information.pdf WSFM Permits 6/26/2012 No Image speciAed Page: 8 For Official Use Only i ` r r Mason County Fire District 2 INCIDENT REPORT Official Law Enforcement Report-Unauthorized Dissemination is Prohibited Incident Type:Fire/Accidental Result Type: Actual Agency Incident ID: 12-FM0013 BATS ID: i-260461 ROP.pdf Release of Premises 6/25/2012 No image specified DSC_0025.JPG Overall Container 6/25/2012 Page: 9 For Official Use Only Mason County Fire District 2 INCIDENT REPORT M Official Law Enforcement Report-Unauthorized Dissemination is Prohibited Incident Type:Fire/Accidental Result Type: Actual Agency Incident ID: 12-FM0013 BATS ID: i-260461 DSC 0028.JPG Overall Container 6/25/2012 174 DSC_0040.JPG Container Information 6/25/2012 Page: 10 For Official Use Only Mason County Fire District 2 INCIDENT REPORT Official Law Enforcement Report-Unauthorized Dissemination is Prohibited Incident Type:Fire/Accidental Result Type: Actual Agency Incident ID: 12-FM0013 BATS ID: i-260461 DSC_0044.JPG Shooting position 6/25/2012 t` Fire Notes.pdf Fire Notes 8/2/2012 No image specified Page: 11 For Official Use Only Mason County Fire District 2 INCIDENT REPORT Official Law Enforcement Report-Unauthorized Dissemination is Prohibited Incident Type:Fire/Accidental Result Type: Actual Agency Incident ID: 12-FM0013 BATS ID: i-260461 Fire Response Report.pdf Fire Report 8/2/2012 No Image specilled Sheriffs Office Report.pdf Sheriffs Office Report 8/2/2012 No Image specifted Page: 12 For Official Use Only Mason County Fire District 2 INCIDENT REPORT y "! Official Law Enforcement Report-Unauthorized Dissemination is Prohibited Incident Type:Fire/Accidental Result Type: Actual Agency Incident ID: 12-FM0013 BATS ID: i-260461 DSC_0052.JPG Sketch of Contents 6/25/2012 r ,y t .z DSC 0054.JPG Bullet hole location 6/25/2012 Page: 13 Mason County Fire District 2 INCIDENT REPORT Official Law Enforcement Report-Unauthorized Dissemination is Prohibited Incident Type: Fire/Accidental Result Type: Actual Agency Incident ID: 12-FM0013 BATS ID: 1-260461 Narrative(s) Title Author Narrative 1 Jeromy Hicks 3602756711 jhicks@mcfd2.com Description Fire crews responded to the report of a Fireworks storage magazine which had been detonated by a person shooting a .308 riffle at the storage shed. Crews responded and extinguished the fire and adjacent vehicle that were located inclose proximity. A small tire pile was also extinguished. Pictures, interviews, and diagrams were completed and are contained in this report. Page: 14 For Official Use Only Mason County Fire District 2 INCIDENT REPORT + Official Law Enforcement Report-Unauthorized Dissemination is Prohibited Incident Type: Fire/Accidental Result Type: Actual Agency Incident ID: 12-FM0013 BATS ID: i-260461 Title Author Synopsis Jeromy Hicks 3602756711 jhicks@mcfd2.com Description On Monday June 25, 2012 Mason County Fire District 2 was dispatched to the report of a brush fire in the 26000 block of State Route 3. Upon arrival of fire units it was determined that the fire was in excess of a brush fire and contained what appeared to be one structure, several cars and a 40x40 pile of tires. During the initial phase of the fire crews were met by the owner of Belfair Auto Wrecking Yard(RP-01)who stated that the structure was a 40x8 storage facility for commercial grade fire works. The owner further stated that the explosion started after he fired his rifle in the direction of the storage container. Further assistance was requested from Alcohol,Tabacco, Firearms and Explosives(ATF)and the regional Bomb Squad(WSP). Units from Mason County Fire District 2 and South Kitsap Fire and Rescue extinguished the fire. Page: 15 For Official Use Only Mason County Fire District 2 INCIDENT REPORT Official Law Enforcement Report-Unauthorized Dissemination is Prohibited Incident Type:Fire/Accidental Result Type: Actual Agency Incident ID: 12-FM0013 BATS ID: 1-260461 Title Author Interview Property Owner Jeromy Hicks 3602756711 jhicks@mcfd2.com Description RP-01 Parris C Shepard(06-06-1969)360-286-3430 25603 NE State Route 3 Belfair, WA 98528 I made contact with Mr. Shepard at/around 0430hrs on June 25,2012. He stated that he was awake in the early morning with his daughter who had just arrived on leave from the Military. He decided to show his daughter a new riffle that he recently purchased. (DPMS LR-308 s/n 87008) They went outside at/around 0130hrs and started shooting into the"burm"area behind the junk yard. This was approximately 200 yards from the area he was shooting. Mr. Shepard stated that he shoots here often and has no specific spot he shoots "just into the cars". He was aware that the storage unit was onsite and what was contained in the storage unit. He also admits to having six beers but did not feel intoxicated. The storage unit was not insured by him. He indicated that rent was $60.00 per month and was paid ahead of time by the owner of the company(Aurora Fireworks LLC). The last contact he had with the fireworks outfit was about ten days ago when he saw them loading the storage facility. He stated that the owner came/went as he pleased and had a key to the gates. Page: 16 For Official Use Only Mason County Fire District 2 INCIDENT REPORT Official Law Enforcement Report-Unauthorized Dissemination is Prohibited Incident Type:Fire/Accidental Result Type: Actual Agency Incident ID: 12-FM0013 BATS ID: i-260461 Title Author Interview Container Owner Jeromy Hicks 3602756711 jhicks@mcfd2.com Description Robert A Nitz(11-28-1969) 360-620-1077 29399 Beach Drive NE Poulsbo,WA 98370 Mr.Nitz was contacted via cell phone shortly after 0500hrs on Monday, June 25,2012,no answer, and a message was left. At 0614 my call was returned. I informed him that a storage facility containing fireworks that he operated had been involved in a fire. I asked him to meet with me at the auto wrecking yard and to bring his appropriate ATF, and State Fire Marshals Office paperwork. Around 0700hrs his wife and him arrived at the fire scene. He stated that he had loaded the facility about 1 Odays ago and removed some items on June 23rd for a show he was conducting. He locked the storage unit up. Further questions identified that the storage unit was approximately 60% full of both Class 1.3 and 1.4 explosives. Page: 17 For Official Use Only Mason County Fire District 2 INCIDENT REPORT Official Law Enforcement Report-Unauthorized Dissemination is Prohibited Incident Type: Fire/Accidental Result Type: Actual �. Agency Incident ID: 12-FM0013 BATS ID: I-260461 Title Author W, Jeromy Hicks 3602756711 jhicks@mcfd2.com Description Origin and Cause Report Scene examination revealed a 40x8' Connex Box unit that had obvious signs of explosion. The unit had been displaced by approximately 20 feet and rotated 90 degrees on to the west side. The unit also was missing one side of the Connex Box's door. This was located 50 yards from the original site of the explosion. The door appeared to be intact with all of the original hardware. In addition,the door contained two locks in the locked position. The explosion tore a large hole, almost separating the box into two pieces and moving the box approximately 29 feet from its original location. Diagrams contained within the original report show that the container contained approximately 75%of it's over volume of fire works. Upon examination of the container a bulled hole that would be consistent with a.308 round(photos attached to original file). The hole was located on the east side of the container with no exit hole on the opposite side. The round was shot from a distance of approximately 200 yards. The container appeared to be AC-37058-p listed manufactured in the 1990's. While it appeared to have been lined with wood as required there was no vent holes or explosion shafts that were noted during the investigation. CSC safety approval rates this as follows: F/BV/4878/95. Photos are attached. It is apparent that this explosion and fire was caused by the discharge of a.308 riffle at 200 yards that then penetrated a metal structure containing both 1.4 and 1.3 class rated explosive fireworks. Page: 18 For Official Use Only Mason County Fire District 2 INCIDENT REPORT Official Law Enforcement Report-Unauthorized Dissemination is Prohibited Incident Type:Fire/Accidental Result Type: Actual Agency Incident ID: 12-FM0013 BATS ID: i-260461 This section intentionally left blank l l 7 - Deputy Fire arshal-Hicks,Jeromy Date Approving Official Date Page: 19 For Official Use Only � � _ r- r 6/27/12 Mason County FD#2:2012-871 Location: Incident Type: 25603 NE State Route 3 120-Fire in mobile prop.used as a �\ \ Belfair WA 98528 fixed struc.,other Lat/Long: FDID: 23D02 FIREDtsT. N470 28'4.21" Incident#: 2012-871 FF��dd W 1220 48'16.99" Exposure ID: 4562096 ------- ----------- --— — Exposure#: 0 Zone: Incident Date: 06/25/2012 72-Tri-Lakes Location Type: 1-Street address Mason County FD #2 Station: 21 Shifts Or Platoon: A Report Completed by: Not Completed Report Reviewed by: Not Reviewed Report Printed by: Hicks,Jeromy N ID:8381 Date:6/27/2012 Time:17:20 Structure Type: Fixed portable or mobile structure I Property Use: 000-Property Use,other Automatic Extinguishment System Present: 13 Detectors Present: El Cause of Ignition: Cause under investigation Aid Given or Received: Mutual aid received I Primary action taken: it-Extinguishment by fire service personnel Losses Pre-Incident Values Property: Property: Civilian Injuries: 0 Fire Service Injuries: 0 Contents: Contents: Civilian Fatalities: 0 Fire Service Fatalities: 0 Total: Total: Total Casualties: 0 Total Fire Service Casualties: 0 Total#of apparatus on call: 5 Total#of personnel on call: 10 NARRATIVE E21 dispatched for possible brush fire in the area of log yard road. While enroute advised by dispatch this is at the wrecking yard and fireworks may be involved. Upon approaching the scene a moderate thermal column was present in the distance. Requested M21, E27,T21. Arrived at the front gates to find young male and female trying to unlock the gate. The female approached the engine to explain they were trying to get it unlocked. My engineer(Baker)asked what happened. She states they were doing some shooting and hit a storage container of fireworks and it exploded. They were unsuccessful at unlocking the gate so we forced entry with bolt cutters. Arrival report: Multiple vehicles buring on the left and the right of the roadway in, a large pile of tires on fire with extension into an approximately 60 foot fir tree to the crown. Dismount apparatus to walk into the scene further, rnultipke explosions on either side in the vehicles.At the C side of the scene discover an approx 10x20 conex type container burning with appearance of pressurization and rupture. Order E21 to advance toward the C side. Order extinguishment of the vehicles and storage container first utilizing class A foarn M21 arrives, assigned to overhaul supply line for T21. M21 reports after task complete, order 2 1/2 to tire fire. At this point SKFR arrives and command is assumed by DCB. Defensive operations until extinguishment. An excavator from NM Fiber is ordered in and pulls apart the tire pile for extinguishment. Investigator and ATF arrive. Scene turned over to them. MCFD2 command terminated, all units available. APPARATUS Unit E21 Unit M-21 Type: Engine Type: ALS unit Use: Suppression Use: EMS Response Mode: Lights and Sirens Response Mode: Lights and Sirens #of People 3 #of People 2 Injury Or Onset -- /--/-- -- : - : - Injury Or Onset -- /--/-- - -- -- Alarm 06/25/2012 01:36:40 Alarm 06/25/2012 01:40:40 Dispatched 06/25/2012 01:36:44 Dispatched 06/25/2012 01:40:44 Enroute 06/25/2012 01:40:11 Enroute 06/25/2012 01:46:00 https://secure.emergencyreporting.com/nfirs/print.asp?printtype=2&printtype=3&printtype=4&eid=4562... 1/3 •6/27/12 Mason County FD#2:2012-871 Arrived 06/25/2012 01:46:56 Arrived 06/25/2012 01:50:13 Cancelled --�L-_-__ Cancelled — Cleared Scene _ —06/25/2012 06:08:41 Cleared Scene 06/25/Z012 03:45:20 --— In Quarters _ ._ -- —/— --: --: -- In Quarters __ -- /--/_ _•_•_ In Service 06/25/2012 06:08:41 In Service _ — —.- -- 03:45:20 -- Unit T21 _ Unit E27 Type: _ -___ Tanker or tender Type: Engine Use: —__ _ _ Suppression Use: Suppression_ Response Mode:__— No LiQhts or Sirens _— Response Mode: Lights and Sirens #of People _ 1 #of People 2 ----- -------- Injury Or Onset _ _ /_/_ _;- i Injury Or Onset -- /--/-- -- Alarm 06/25/2012 01:40:40_ Alarm 06/25/2012 01:40:40 Dispatched 06/25 2012 01:40:44 Dispatched 06/25/2012 01:40:44 Enroute 06/25/2012 01:47:45 Enroute 06 252012 01:46:00 — Arrived 06/25/20 / .12 01:53:53 Arrived 06/25/2012 02:02:33 Cancelled -- - Cancelled Cancee / -L -- - - ---- -- / -/-- -- . -- Cleared Scene 06/25/2012 06:08:41 Cleared Scene 06 - /25/201_2 06:08:41 In Quarters In _.----- Quarters In Service 06/25/2012 06:08:41 In Service 06/25/2012 06:08:41 Unit T22 --- -_ Type: Tanker or tender Use: Suppression Response Mode: No Lights or Sirens #of People 1 Injury Or Onset -- -- Alarm 06/25/2012 01:40:40 Dispatched — 06/Z5 2012 01:40 44 _ Enroute 06/25/2012 01:58:09 Arrived _ _-- 06/25/2012 02:04:21 - -- - Cancelled Cleared Scene 06/25/2012 06:08:41 — In Quarters -- /--/-- -- : -- : -- In Service 06/25/2012 06:08:41 Number Of People not on apparatus:1 FIRE Acres Burned 0 Acres Burn From False Wildland Form Material Ordnance, explosives, fireworks, other, Autos, trucks, buses, recreational vehicles , Tires Storage Use Bulk storage or warehousing Bulk storage or warehousing , Bulk storage or warehousing Area Of Fire Origin Storage area,other Heat Source Fireworks Item First Ignited Undetermined Fire Is Confined To Of Origin Type Of Material Paper, including cellulose, Cause Of Ignition a Cause under investigation waxed paper g Factor Contributing To Misuse of material or product,other Ignition Mobile Property Involved in ignition and Mobile Property Type Shipping container, Involve And Type burned rrech nically moved Mobile Property Make Other Make Mobile Property Year STRUCTURE FIRE Structure Type Fixed portable or rnobile structure Building Status In normal use #Of Stories At Above Grade 1 #Of Stories Below Grade 0 Square Feet Length __20 Width 10 Floor Of Origin 1 Fire Spread Beyond building_of origin Minor Damage 0 Significant Damage 0 Heavy Damage 0 Extreme Damage 0 ARSON https://secure.emergencyreporting.com/nfirs/print.asp?pdnttype=2&printtype=3&printtype=4&eid=4562... 2/3 6'27112 Mason County FD#2:2012-871 CUSTOM FIELDS FORM MCFD8 Call? No. HIPAA/Consent signature obtained or exception filled out properly? NO Procedures performed N/A Mileage at$1 per 1/10 mile Total Billing_ -" 0 Offered smoke detector Controlled Substance Administered or Used?(Versed,Ativan,Morphine,Etomidate or Demeroq— No _ __ -_-_._-Potential AED Program Participant NO Was this call a result of MCFD2 Auto Dialer Activation? NO Is this a Stroke or STEMI activation? NO https://secure.emergencyreporting.com/nfirs/print.asp?printtype=28printtype=3&printtype=4&eid=4562... 3/3 MASON COUNTY SHERIFF' S OFFICE Incident Report for Case 12-08216 Nature: 24F.Fires Address: 25603 NE STATE ROUTE 3 Location: L072 Belfair WA 98528 Offense Codes: Received By: Germain,Kim How Received: T Agency: MCS Responding Officers: Responsible Officers: Nault,Joel Disposition: ACT 06/25/12 When Reported: 01:34:21 06/25/12 Occurred Between: 01:33:35 06/25/12 and 01:33:35 06/25/12 Assigned To: Detail: Date Assigned: Status: Status Date: **/**/** Due Date: Complainant: Last: First: Mid: DOB: **/**/** Dr Lie: Address: Race: Sex: Phone: City: , Alert Codes: Offense Codes Reported: FIRE Fire Observed: Additional Offense: FIRE Fire Circumstances FILE Files Attached Responding Officers: Unit Nault,Joel 1P59 Baty,Byron 1 P51 Responsible Officer: Naultjoe1 Agency: MCS Received By: Germain,Kim Last Radio Log: 04:28:47 06/25/12 OS How Received: T Telephone Clearance: B Report Only When Reported: 01:34:21 06/25/12 Disposition: ACT Date: 06/25/12 Judicial Status: Occurred between: 01:33:35 06/25/12 Misc Entry: and: 01:33:35 06/25/12 Modus Operandi: Description : Method Involvements 06/25/12 Incident Report for Case 12-08216 Page 2 of 4 Date Type Description 06/25/12 Name Shepard, Pearris Complaintant 06/25/12 Name Aurora, Fireworks Mentioned 06/25/12 Cad Call 01:34:21 06/25/12 24F.Fires Initiating Call 06/25/12 I Incident Report for Case 12-08216 Page 3 of 4 Name Involvements: Mentioned : 173656 Last: Aurora First: Fireworks Mid: DOB: **/**/** Dr Lie: Address: Race: Sex: Phone:.( - City: , Complaintant : 173655 Last: Shepard First: Pearris Mid: DOB: 06/06/69 Dr Lie: Address: NE STATE ROUTE 3; #22300-22399,22400-224 Race: Sex: Phone: (360)286-3430 City:Belfair, WA 98528 06/25/12 Incident Report for Case 12-08216 Page 4 of 4 Narrative INVESTIGATION NARRATIVE Case Number: 12-08216 On Monday June 25, 2012 at approximately 01:34 hours dispatch advised of a explosion at the Belfair Auto Wrecking yard. Upon my arrival I observed Fire District 2 was on scene. I contacted C/Shepard, Pearris C DOB: 06/06/69 who advised his daughter is home on leave from the military and he wanted to shoot his new rifle (308 caliber) with her. Pearris advised he was shooting from the front of his property towards the junk cars on the backside of his property. Pearris stated "I shot a few rounds through the gun and all of a sudden I saw a huge flame in the air and heard a loud explosion. I grabbed my daughter, ran in the house and called 911. I have lived at this house for over thirty years and have shot at the junk cars on numerous occasions". Pearris advised that he rents out a portion of his property to M/Aurora Fireworks so they can store their professional grade fireworks in a forty foot metal cargo container located at the back of his property. Pearris stated "due to the grade and amount of fireworks the company has to be licensed through the ATF and I'm authorized to only store the cargo container in a specific location on the backside of my property. If I need to move the storage container I have to contact the company and provide them with GPS coordinates which have to be authorized by the ATF". I asked Pearris if he would provide me with a voluntary recorded statement and he agreed. I attached Pearris's statement to the case file. After further investigation of the shooting area I observed an approximate 6 to 8 foot tall mound of dirt located on the backside of the property where Pearris claims to have been shooting. I was unable to confirm any signs of Pearris shooting in a reckless manor. For information only. I declare under penalty of perjury under the laws of the State of Washington that the foregoing facts and attached arresting agency affidavit are true and correct to the best of my knowledge (RCW 9A.72.085) and I am entering my authorized user ID and password to authenticate it. Dated: Mon Jun 25 04:18:08 PDT 2012 Name/Per#: J.Nault #1389 Signed in Mason County, Washington by: /38 �iqnatureof Deputy //.41 Superviso 06/25/12 6/27/12 TerraScan TaxSifter-Mason County Washington MASON COUNTY �t -r WASHINGTON TAXSIFTEI SIMPLE SEARCH SALES SEARCH REEfSIFTER COUNTY HOME PAGE CONTACT DISCLAIMER Elisabeth Frazier Mason County Treasurer 411 N Sth Street, Building 1 Shelton, WA 98584 Assessor Treasurer Appraisal MapSifter Parcel Parcel#: 12321-14-00020 Owner Name: JAMES, ELVA R Land Use Code: 64 - Services - Repair Addressl: 3201 NE PINE RD APT 313 sito>: 25601 NE STATE ROUTE 3 BELFAIR Addressl: Map Number: City,State: BREMERTON WA Status: Zip: 98310 Description: TR 2 OF SE NE Comment: Current Tax Year Details /}: Statement Gross Tax Tax Exempt Ner Tax Assessments Total 1 Real Property 2012-123211400020 $4,067.48 $0.00 $4,067.48 $17.90 $4,0 Balances Due , , ., [ _ Balance(s) Duer Real Property 2012-123211400020 $2,042.69 $0.00 $0.00 Pay $2,0 * Please expect a delay of 3-5 business days for your payment to post. Note: The receipt date will reflect the day the payment was initiated. 5 Year Tax History type Assessments Fees balance Du Real Property 2012-123211400020 $4,067.48 $17.90 $0.00 $2,042.69 _ Taxes/Fees Interest Paid Total P: 315360-05/07/12-Julie 05/07/2012 $2,042.69 $0.00 $2,042. Statement Numbe; Assessments Fees Balance Dui. Real Property 2011-123211400020 $3,885.91 $22.90 $0.00 $0.00 Receipt i3+ ;;:;> Reeeipi Gate. Taxe91Fees Interest Paid 001 P� 222744-05/05/11-Julie 05/05/2011 $1,954.41 $0.00 $1,954. 262426-11/04/11-Julie 11/04/2011 $1,954.40 $0.00 $1,954. Assessments Fees Balance 1:ea Real Property 2010-123211400020 $4,022.34 $22.90 $0.00 $0.00 132762-05/06/10-Julie 05/06/2010 $2,022.62 $0.00 $2,022. 170603-11/05/10-Julie 11/05/2010 $2,022.62 $0.00 $2,022. property.co.mason.wa.us/Taxsifter/Treasurer.aspx?keyld=2972875&parcel Number-12321-14-00020&... 1/2 6/27/12 TerraScan TaxSifter-Mason County Washington • Type • ;Statement 1`411 __. Assessn,-: Fees Balance Due Real Property I 2009-123211400020 $3,835.86 I $22.90 $0.00 $0.00 _1, i 1 ar,11, I _ ; . . T Total Ps 2009-123211400020-R 11/05/2009 $3,853.76 $0.00 $3,853. 2009-123211400020-S 11/05/2009 $5.00 $0.00 $5.00 'Type !Statement Number Taxes Assessments Fees Balance Due Real Property !� 2008-123211400020 $3,523.21 $470.23 i $0.00 I $0.00 Receipt Number Receipt Datc Faxes/Fees Interest Paid Total P:1 2008-123211400020-R 11/05/2008 $3,541.11 $0.00 $3,541. 2008-123211400020-S 11/05/2008 $452.33 $0.00 $452.3 s , .; riu::Ii., a., ;;_ s; Assessments Fees Balance Due Real Property 2007-123211400020 $4,180.74 $465.61 $0.00 $0.00 Receipt Number Receipt Date Taxes/Fees Interest Paid I Total P: 2007-123211400020-R 11/07/2007 $4,195.24 $0.00 $4,195. 2007-123211400020-S 11/07/2007 $451.11 $0.00 $451.1 Property Images No images found. 1.0.4464.28257 TX Roll Yea i property.co.mason.wa.us/Taxsifter/Treasurer.aspx?keyld=2972875&parcelNumber--12321-14-00020&... 2/2 1 06 17 : 44 FIRE Incident Table : Page : 1 Incident Number: 12-2F0871 Nature : 24F. Fires Addr= 25603 NE STATE ROUTE 3 Area : F072 2E-TRI LAKES City: Belfair ST: WA Zip : 98528 Contact : Complainant& Lst : Fst : Mid: DOB : SSN: Adr: Rac : Sx: Tel : Cty: ST: Zip : Condition Codes : FIRE Reported: FIRE Observed: Circumstances : Rspndg Officers : F02-Any Unit E21-Any Unit F208 & Rspnsbl Officer: Hicks, Jeremy (FM Agency: F02 Determinant : Received By: Germain, Kim Orig Number: How Received: T Telephone CAD Call ID: 12-022065 When Reported: 01 :34 : 21 06/25/12 Last RadLog: 17 :42 :38 06/25/12 CM Occurrd between: 01 :33 : 35 06/25/12 Disposition: ACT Disp Date : 06/25/12 and: 01 :33 : 35 06/25/12 Misc Entry: MO: Narrative : RR MEH Supplement : INVOLVEMENTS : Type Record # Date Description Relationship CA 12-022065 06/25/12 01 : 34 06/25/12 24F.Fires *Initiating Call FIRE Conditions Detail : Fire Condition Codes Seq Code 1 FIRE Fire of Undetermined Type FIRE Incident Responder Detail Responding Officers Seq Name Unit 1 F02-Any Unit F02 2 E21-Any Unit E21 3 F208 F208 4 M21-Any Unit M21 5 T21-Any Unit T21 6 E27-Any Unit E27 7 T22-Any Unit T22 8 Baty, Byron 1P51 9 A21-Any Unit A21 10 Hicks, Jeremy (FM FM1402 Main Radio Log Table : Time/Date Typ Unit Code Zone Agnc Description 17 :42 : 38 06/25/12 f FM1409 CM F072 MCF incid#=12-FM0013 Completed Cal 06 : 09 : 04 06/25/12 f T22 OS F072 F02 06 : 08 : 59 06/25/12 f T21 OS F072 F02 06 : 08 : 55 06/25/12 f E21 OS F072 F02 06 : 08 : 51 06/25/12 f E21 CL F072 F02 call=7f 06 : 08 :43 06/25/12 f T22 CL F072 F02 call=7f 06 : 08 :41 06/25/12 f T21 CL F072 F02 call=7f 05 : 30 : 37 06/25/12 f FM1409 ST F072 MCF 05 : 30 :27 06/25/12 f F208 OS F072 F02 05 : 23 : 08 06/25/12 f F208 CL F072 F02 incid#=12-2F0871 Clear, back i 05 : 13 : 03 06/25/12 f E27 CM F072 F02 incid#=12-2F0871 Reassigned to 05 : 11 : 53 06/25/12 f F02 CM F072 F02 incid#=12-2F0871 Reassigned to 05 : 06 :40 06/25/12 f E27 AVL F072 F02 incid#=12-2F0871 Available cal 04 : 28 :47 06/25/12 f M21 OS F072 F02 04 : 28 :44 06/25/12 f A21 OS F072 F02 04 : 01 :45 06/25/12 f A21 AVL F072 F02 incid#=12-2F0871 Available cal 03 : 54 :34 06/25/12 1 1P59 CM L072 MCS incid#=12-08216 Completed Call 03 :45 :20 06/25/12 f M21 AVL F072 F02 incid#=12-2F0871 Available cal 03 : 26 : 20 06/25/12 1 1P51 CM L072 MCS incid#=12-08216 Reassigned to 03 : 23 :20 06/25/12 1 1P51 VH L072 MCS pl=063upx 03 : 21 : 04 06/25/12 1 1P59 CM L072 MCS incid#=12-08216 Completed Call 03 : 06 : 59 06/25/12 f FM1409 AR F072 MCF incid#=12-FM0013 Arrived on Sc 03 : 02 :22 06/25/12 f FM1402 OS F072 MCF 03 : 02 : 15 06/25/12 f FM1409 ER F072 MCF incid#=12-FM0013 Enroute to Ca 02 : 58 : 54 06/25/12 f T22 AR F072 F02 incid#=12-2F0871 full tank cal 02 : 56 : 56 06/25/12 f FM1402 ASN F072 MCF incid#=12-FM0013 Assigned to C 02 : 32 :28 06/25/12 1 1P59 BUSY L072 MCS incid#=12-08216 recorded state 02 : 32 : 12 06/25/12 1 1P51 AR L072 MCS incid#=12-08216 Arrived on Sce 02 :28 :25 06/25/12 f T21 AR F072 F02 incid#=12-2F0871 Arrived on Sc 02 :27 :47 06/25/12 f T21 RET F072 F02 incid#=12-2F0871 to scene w/wa 02 : 22 :44 06/25/12 f A21 AR F072 F02 incid#=12-2F0871 Arrived on Sc 02 : 19 :22 06/25/12 f A21 ER F072 F02 incid#=12-2F0871 Enroute to Ca 02 : 14 : 57 06/25/12 f T21 ER F072 F02 incid#=12-2F0871 for water cal 02 : 07 : 34 06/25/12 1 1P51 ER L072 MCS incid#=12-08216 Enroute to Cal 02 : 07 :25 06/25/12 f 1P51 ER F072 MCS incid#=FIX-283 Enroute to Call 02 : 04 : 21 06/25/12 f T22 AR F072 F02 incid#=12-2F0871 Arrived on Sc 02 : 04 : 15 06/25/12 1 1P59 AR L072 MCS incid#=12-08216 Arrived on Sce 02 : 02 : 33 06/25/12 f E27 AR F072 F02 incid#=12-2F0871 Arrived on Sc 01 : 58 : 09 06/25/12 f T22 ER F072 F02 incid#=12-2F0871 Enroute to Ca 01 : 53 : 53 06/25/12 f T21 AR F072 F02 incid#=12-2F0871 Arrived on Sc 01 : 50 : 13 06/25/12 f M21 AR F072 F02 incid#=12-2F0871 Arrived on Sc 01 :48 : 16 06/25/12 f E27 ER F072 F02 incid#=12-2F0871 Enroute to Ca 01 :47 :45 06/25/12 f T21 ER F072 F02 incid#=12-2F0871 Enroute to Ca 01 :46 : 56 06/25/12 f E21 AR F072 F02 incid#=12-2F0871 several fire 01 :46 : 00 06/25/12 f M21 ER F072 F02 incid#=12-2F0871 Enroute to Ca 01 :40 : 31 06/25/12 f E21 ER F072 F02 incid#=12-2F0871 Enroute to Ca 01 :40 : 11 06/25/12 f F208 ER F072 F02 incid#=12-2F0871 Enroute to Ca 01 :36 :44 06/25/12 f F02 ASN F072 F02 incid#=12-2F0871 Assigned to C 01 : 36 :40 06/25/12 f F02 PRET F072 F02 incid#=12-2F0871 Unit pretoned Case Number Mason County Office of the County Fire Marshal NOTICE OFF RELEASE OF PREMISES RE: Premises located at: 2 �� ! City: P ,Washington Date: Time: RIT Notice is hereby given at the above date and time that the Office of the Mason County Fire Marshal is removing all personnel from the premises indicated above. Possession and control of such premises is returned to the owner, occupant or other such designated person responsible for such premises. This notice is given so that the responsible person for the premises may take such action as necessary or desirable for the protection of the premises and/or contents therein. SPECIAL INSTRUCTIONS: 1. Maintain a fire watch once the fire department leaves the scene. Immediately call 911 if smoke or flame appears. Fw,4, f&b AaPA F-v2 14 )A 5 2. Do not enter the �n for any reason. exis roug e4erior. 3. If you have questions concerning the incident or if you have additional information, contact our office at 4. Contact your insurance company as soon as possible and report the loss. If evidence is tagged, advise your insurance company. Do not tamper, alter, manipulate, remove, damage, test or destroy these items. IF '0 . ' -Ab ANC 1���./Q�`7>� u� Iwo- lmylS 4'-40C,i 90 I certify that control of the premises and/or contents therein, have been returned to me and that I am responsib e for protectio of such pre sus and/or contents and evidence if present. Signed: t� Yl/- S �✓ �� (Signa re) (Print Name) Nr Address: 2 �G s✓� 3 Phone: ( �Co) '� �� WDL #: P ased to the above by: I .r- i IUD C, ���✓�`1 2cJ� (� 10 DAB) Alp _ vj c.4as Stl£U5 o- Iv`1 I� Washington state Patrol 13 3 4 9 l• p Fire.Protection Bureau. - Oboe Of-ne State Fire Marshal , = : 'VVAshmgton State Firewor" LAcense; r Pyrotechnic. O erator.-license Pyrotechnic Operator >.Robert A Niti'�'- r'^ Detach this wallet card i6d-biQywlih r uu for Licensee Location. 19399:Beach,Dnve Northeast "venfi cation.of xtafn ton :Pouls6o;WA 98370 -- — =7 .— - -n — 4 WasLmgton5tatie`Pnt j h6ne Number (360).620..1077 ; SreProfect<onBurean 13 3 9 to FueNf s hat Office Of_The S to 1- P rotechnic'O erator Nitz- v a i LtcenseNumber, 43 2 t • :Date of Issue : Expiration Date: License Number l - ` S e.4iicense.4 or February 3,2012 January 31,2013 P-04316• EatnrahoR Date bye .L 2l)13 3000.420-012(R MOS) State Fire Mwst> , ignature Licensee Signature FIRE PROTECTION BUREAU •'�`""`�. FIREWORKS LICENSING PROGRAM PO Box 42600 Olympia WA 98504-2600 (360)596-3914 FAX: (360)596-3934 WW, PYROTECHNIC OPERATOR LICENSE RENEWAL This renewal is hereby made to the Washington State Patrol {ems Fire Protection Bureau, pursuant to RCW 70.77, for re-licensing DEC 14 2011 in the State of Washington as a Pyrotechnic Operator. I have enclosed the annual re-licensing fee of$10. FIRE ,TION P rotechnic Operator Seeking Renewal Name tJ k v Complete � Address License Home Phone Work Phone Number P Number '���'-('i'"f°�? Number F-Mail Address A040ZA C-,4 0otyi LA,( Four Recent Displays I is la s the Pyrotechnic O erator Has Partici ated In At Least One To Remain Active DATE OF NAME OF LICENSED OPERATOR COUNTY AND CITY OF DISPLAY DISPLAY °g,"l-T A)rTL P-J96Aq- I�,;dry ¢fit►� ae•o 6�� tic g,�J —2y- I� �' � � v �•��Fh° Sr�v�n•O�l� Pyrotechnic Operator Backeround Questions Yes o (explain any"YES"responses on 1he back) Have you been cited for state or federal fireworks violations? — No Have you been convicted of a felony or misdemeanor in the past year? Have you ever had a fire or accident as a result of fireworks activity? �0 Have you ever done damage to another's property as a result of fireworks activity? t,)o In making this application for renewal,I agree to continue to abide by all requirements of the State Fireworks Law (RCW 70.77)and the rites and regulations(WAC 212-17)of the Washington State Fire Marshal's Office. 1 further certify that all information contained in this renewal is true and complete. I understand that omitted or misrepreseu d information can constitute sufficient grounds for denial or revocation of the license I am applying for. Signature of Applicant Date of Application Mail your completed renewal and licensing fees to: Washington State Patrol Fire Protection Bureau PO Box 42600 Olympia WA 98504-2600 FIRE PROTECTION BUREAU FIREWORKS LICENSING PROGRAM PO Box 42600 tw� Olympia WA 98504-2600 (360)596-39I4 FAX: (360)596-3934 GENERAL DISPLAY LICENSE RENEWAL This renewal is to the Washington State Patrol Date Received Fire Protection Bureau,pursuant to RCW 70.77, for an annual vzF_CEWE0 license to continue business in the State of Washington as a licensed Q 91 Fireworks General Display Licensee. I have enclosed JAN the annual license fee of$50. M TAQ14 Company Seeking A General DisplayLicense Renewal .Name Phone of Firm Number 360-67,o--101-1 Complete Busuiess Address 664co UA- i,ie.` l�O�o1p� W►� �i a T�� Complete Mailing Address(if different Chief Executive License Officer Number E-Mail Federal Identification Address A✓ oL9 t'�xE�ors �t.eG IwiMru i eaM Number(FDID) Des1 nated A "ent Within Washington State License Contact Person-Will Appear On License Phone Name - N q-L- Number 3Cti- 620-is t Complete Mailing Z`13`l9 ��g`tl 0� N� Poo�g6v .u4 `}y3 7� Address I hereby certify that I am familiar with the provisions of the State Fireworks Law,RCW 70.77,and the regulations of the director of the Fire Protection Bureau relating to fireworks,\VAC 212-17,and will comply with all provisions contained therein. I further certify that all information contained in this renewal is true and complete and that any changes in information previously submitted have been indicated on this form(see back). I understand that omitted or misrepresented information can constitute s icient ground for denial or revocation of the license I wish to renew. Signature of Applicant(Primary) Signature of Applicant(Co-Applicant) QW.J�- Title Title Date Date You renewal must include the proper annual licensing fee and be mailed to: Washington State Patrol Fire Protection Bureau PO Box 42600 Olympia WA 98504-2600 FIRE PROTECTION BUREAU •�'"'"'`�• FIREWORKS LICENSING PROGRAM PO Box 42600 Olympia WA 98504-2600 ''•.�,;;, (360)596-3914 FAX: (360)596-3934 All information submitted from previous application or subsequent renewals must be current. Should any circumstances or conditions of licensure change,you must provide this information as a part of your renewal application. Please complete this information before submission. Fireworks Storage Information han es ew storage Information❑ List ALL new firework storage sites,giving address or location,type and quan i y of fireworks to be stored in each. The director of the Fire Protection Bureau shall immediately be notified of any changes, ADDRESS/LOCATION TYPE OUANTl1 Y Fireworks Storage Licenses No change ew fireworks storage licenses ❑ The Fireworks Storage Site(s)is(are)licensed by-gBATF ,f L&1 Please irrclirde a copy(copies) Fireworks Activities Information No chan New activity information ❑ Describe in detail any various additional firework active mcs you intend to engage In. Licensee Background Questions o change ew background information ❑ Licensed Company Background Questions Yes/No Has any member of the firm been cited for state or federal fireworks violations? �)o Has any member of(lie firin been convicted of felony or misdemeanor in the past ten years? do Has any member of the firm forfeited a bond for a felony or misdemeanor in the past ten years? do New/Additional Details: �0 FIRE PROTECTION BUREAU FIREWORKS LICENSING PROGRAM PO Box 42600 f1 IN W, 1 U� t� Yras,c• M Olympia WA 98504-2600 � 3`•v„n.. ¢ (360)596-3914 FAX: (360)596-3934 STATE FIREWORKS IMPORTER, MANUFACTURER, AND/OR WHOLESALER LICENSE APPLICATION Date Received This application is hereby made to the Washington State Patrol Fire DEC Protection Bureau,pursuant�to RCW 70.77, for an annual license to 2 1 9��0 engage in business in the State of Washington as a Fireworks: FIRE PROTECTICIN Importer ❑Manufacturer ❑ Wholesaler BUREAU $1,000 License Fee $2,000 License Fee $2,000 License Fee For Off Mal Use Company Seeking a Washington State Fireworks License Name of Phone Firm AJ+toKA Number G lo7-1 Complete Business Address 2q 391 $ Act+ PA_ NE aJ(,56,, wL4 9`8Vla Complete Mailing Address(if different Chief Executive Years s Officers Business E-Mail Federal Identification Address 1��Rap A t•�t�-wox-k,3 Ut. Co I.6(- A t, .C,,1, Number(FDID) Designated Agent Within Washington State License Contact Person—Will Appear On License Phone Name `�o3�t-r 14 iJ�s 2 Number Complete Mailing Address I 293919 6k.* Dpt Oe Pe„t,5 a LOA B 310 List the Name Position Address,and Phone Number of Three Industry References ahis or other states Phone Name -t?00 Number 1 2c�(.-4f9-o917 t) Complete Mailin Address '�6l6 45"' Ad 46 415A St:M* (4n 9 10 Name t Phone 2) Ct)(,IN tI�O I�+^I Number -3L6-�{1?^ 2?b Complete Mailing Address 112.4 1k6 0 b? Aff $6A,16krA WA qqwS Phone Name NAM Number I-ZK q04 6699 3) Complete Mailing Address 7.0 q314 S G WA 810 Applicant Company Background Ouestlons Yes/No Has any member of the firm been cited for state or federal fireworks violations? 00 Has any member of the firm been convicted of a felony or misdemeanor in the past ten years? b(o Has any member of the firm forfeited a bond for a felony or misdemeanor in the past ten years? jo Does the firm hold a current Fireworks License in another state?(If yes,please provide a copy) Has the firm ever had a fire or accident as a result of fireworks activity? Has the firm ever done damage to another's property as a result of fireworks activity? N o ti FIRE PROTECTION BUREAU t h, FIREWORKS LICENSING PROGRAM PO Box 42600 Olympia WA 98504-2600 ` •u,;n•<`'' (360)596-3914 FAX: (360)596-3934 List ALL firework storage sites,giving address or location,type and quantity of fireworks to be stored in each. The director of the Fire Protection Bureau shall immediately be notified of any changes. ADDRESS/LOCATION TYPE QUANTITY 24'Go$ 06 904 3 Btsyrrrw.. wa 48528 � 1.54 I The Fireworks Storage Sites)is(are)licensed by:dBATF EK&I Please include a copy(copies) Describe,in detail,the various firework activities you intend to engage in. I FL0W1W0rzP 0%S PW4-'1.f l; i Additional Details GENE' DEC 2 1 Pnnq FIRE PROTECTION BUREAU I hereby certify that I have carefiitly read and am familiar with the provisions of the State Fireworks Law,RCW 70.77 and the regulations of(lie director of the Fire Protection Bureau relating to fireworks, VAC 212-17,and will comply with all provisions contained therein. 1 further certify all information contained in this application is true and complete. I understand that omitted or misreprese n formation can constitute sufficient grounds for denial or revocation of the license(s)I am applying for..�� I Signature of Applicant(Primary) Signature of Applicant(Co-Applicant) Title Title 121 1001 Date Date Your completed application must be returned to this office by January 31 of the year you wish your company to be licensed. Your application must include articles of incorporation and the proper licensing fee and be mailed to: Washington State Patrol Fire Protection Bureau PO Box 42600 Olympia WA 98504-2600 [Please note these licenses are valid fi•oin the date of issue until January 31 ol'the subsequent year.] t FILED 7 SECRETARY OF STATE State �� of Washington SAM REED December 10,2007 Seel,etal•y of State 5TATEOFWASHINGTON CORPORATIONS DIVISION lames M.Dolliver Building 801 Capitol Way South 602 786 305 PO Box 40234 Olympia WA 98504.0234 360.753.7115 Application for Limited Liability Company Office Information Application ID 1025257 Tracking ID 1415501 Validation ID 118972 1-001 Date Submitted for riling: 12/10/2007 Contact Information Contact Name Robert Nitz Contact Address 29399 NE Beach Dr Poulsbo WA 98370 Contact Ismail robertnitz@110tillail.com hotmail.com Contact Phone 360-620-1077 Certificate of Formation Prererred Name AURORA FIREWORKS LLC Physical Address 29399 NE Beach Dr Poulsbo WA 98370 Purpose Any Lawful Purpose Duration Perpetual rormation Date Effective Upon Filing by the Secretary of*State Expiration Date 12/31/2008 Limited Liability Company Manageotetlt Ikhmager 11•lenlbcrs Signature On Mile RECEIVED DEC 2 1 ?nn4 Registered Agent Information Agent is Individual Agent Name Robert Nitz Agent Strect Address 29399 Beach Dr NE Poulsbo WA 98370 Agent Mailing Address Sanic as Street Address Agent Email Address robertnitz a hotmail.com Submittcr/Agent Relationship Submittcr is Registered Agent Members Information Submittcr is Only Member Nlcmber it Member Name Robert Nitz Member Address 29399 NE Beach Dr Poulsbo WA 98370 Signature Information Signed By Robert Andrew Nitz R SC F IV F t DEC 219W, F1�� P�U�ACTION \I Explosive Licensing MAGAZINE Department of Labor&Industries PO Box 44655 INSPECTION REPORT Olympia WA 98504-4655 Open Close Report numb-, 4791 Inspection date Owner/Licensee: Last name First name f9 A„ " Phone number I f z 1Z0be�� .I1W 11Y"L �, 3t�o—b2b- 107-7 Address 2�2 �� � . City�Uu/S D �M � $2�b State Z1P+4 Qualified person In charge of iinagazine: J Last name First name Phone number Silo location I Z5 b 0 3 a CA Magazine# Approved A protveJ Corrections required per WAC 296.52 Lq , It�f W gI n pq yl ptc - Zt Q S SPK CC/ aH d a 4-p� tal o L ?? re dv�!L Noleslcomments: dtagazlne license will be cancelled if corrections have not been Slgnatun of qualified person named above completed and inspector notified wltlda 15 days from date of inspection. Hate. Phnno number I sienaluro of Inspector i SUoerviSorS Iniltals U.S.Department of Justice ..-Federal Explosives Li brg Center BureauIII.of Alcohol,Tobacco,Fircarnis �. Aplosives 244 Needy Road 04/22/2003 !!! Federal Explosives Licensing Center(FELC) Man;risburg,West Virginia 25405 www.atf.gov telopli6ne':,(877)283-3352 fax: (304)616.4401 ----- --- - ---- NOTICE OF CLEARANCE .----__— _ for individuals transporting, shi hi receivin�r or y�opessin ex losive materials. P �� PP gFeacot erp,osi+•c:llbase�pennl w g P ISSUED TO: AURORA FIREIVORKS LLC 9-WA-035-51-1E-00688 Expiriqtioa mtc: N;6),1,2011 NOTICE DATE: 04/22/2008 - E ptostvsLiccosOpermitiype:;5l=IMPORTEROFFIREIVORKS(DISPLAY) EXPIRATION DATE: This Notice oxplrei when.superseded by a newer Notice which:wilhlist•all current responsible persons and employee possessors,or when the license or permit exp`h•es-whlchi:yer comes first. .. © WARNING. Only those Individuals lisled ItENPONSIBLE PERSONS ar�(i,C\•1P►.pl'EE POSSESSORS svith it background clearance status of"CLEARED"or"PENDING"me authoi'tzcd to n-ifuspi n 1,chip,receive)or possess ex., materials in the course of employment with you. ® "DENIED"S-I'A'I'US, if an employer possessor-lips a background cl arnnee stnttis:pf!'.DENIED",you,%I UST take inunedlate steps to remove the cnnployce frrnn a position requiring the transporting,shipping,receiving,or linssesshiE of explosive materinls. Also,If the employee has been listed ns a person authorized to accept delivery of explosive inatcrinl;,}'oti;t�lt)ti;l`i-6'iove the enployee from such list and Intntedintely,and hn no event later than(lre second business clay after such chntnge,nailiv-disli•Ibutors al`sueh change,as stated In 27 Ci-R 555.330). ® CHANGE IN ItESI'Oi\'SIi3Lt:PERSONS. Yon dIUST 2 rrcmisesAddress 399gEACNpR{YNE report any change litresponsible persons to the Cider,Federal POl[iS$0,1VA ta8370 Explosives Licensing Center,within 30 days of the change and new responsible persous\1US1'include"appropriate idcutifying 1lfallfng Address i information"as defined In 27 CFIt 555.11. Fingerprints and AURQRA FIR$WORKS I I C- photos ore NO'I•required,however they%vi11 be required upon 2099.81?A-C --DRIVE,NE � rcuctval of the license or permit. ' POUI S$0,WA.9$374 0 CHANGE OF EMPLOYEES. You MUST report any change , of employee/possessors to the Chief,FELC,within 30 days. Reports relating to newly hired employees must beowJ submitted an ATF Fonn 5400.28 fur EACH employee. -- _ -- This'Notice of Clearance'is provided to you as required by 18 U.S.C.843(h)and MUST be retained as part of your permanent records and be made available for examination or inspection by ATF officers as required by 27 CFR 555.121. If you receive a Notice subsequent to this Notice,this Notice will no longer be valid. In accordance with 27 CFR 555.33,Background Cheeks and Clearances,and 27 CFR 555.57,Change of Control,Change in Responsible Persons,and Change of Employees,ATF's Federal Explosives Licensing Center(FELL)has conducted background checks on the individual(s) you identified as a responsible person(s)and an employee/possessor(s)on your application,or reported after the issuance of your license/permit. The follow utg is a SUMMARY of the results of the background checks conducted on the individuals you reported as responsible persons , and employee/possessors. ATF will be notifying ALL individuals listed on this document of their respective status by separate letter ¢mailed to their residence address. s PLEASE BE ADVISED THAT IT IS UNLAWFUL FOR ANY PERSON REFLECTING A STATUS OF•"DENIED"TO TRANSPORT,SHIP,RECEIVE,OR POSSESS EXPLOSIVE MATERIALS. Please carefully review this Notice to ensure that all the information is accurate. If this Notice is incorrect,please return the Noticc to the x Chief,FELC,with a statement showing the nature of the error(s). Tile Chief,FELC,shall correct the error,and a return a corrected Notice. � _ r Number;dRESPONSIBLE PERSONS) : I continued Nutnbet of EIVIPLOYEE POSSESSOR(3)` 0 , LASf X.\.1iE;1'hShNannc;atiddtc\ ftte I�'arnnjccStaluslustlnbnt��ti�IJl V;��n+ CI��+�,ilzctStrrtis` RES,I'41VSIBLE P1 RSON5;. s 4 1 ` r i000.j Nnz ROBERT ANDRBW Cited .''L EMPLOYEE POSSESSORS. 0 U.S.Department of Justice Federal Explosives L't uig Center Burcou ofAlcohol,Tobacco,Firearms st<. xplosivcs `-244 Needy(toad 04/22/2008 Federal Explosives Licensing Center(FELC) Marihisbuig;Nest Virginia 25405 wnvtv.etfgo�t tclopH6iie:.(877)283-3352 fax: (304)616-4401 NOTICE OF CLEARANCE for individuals transporting, Shipping, receivin , oi• � ossessin explosive materials. I ISSUED TO: AURORA FIREWORKS LLC f Fedcral Expiosi%rs license/pciimiitno.:.`• VA-035-51-1E-00688 NOTICE DATE: 04/22/2008 Expirarionvate I•1i 1,2011 Esploshu LicvnWPennii Typo::S 1=IMPORTER OF FIREWORKS(DISPLAY) EXPIRATION DATE: This Notice expires when superseded by a nesver Notice whicli,%vlll INt•d11 current responsible persons and employee possessors,or wheu the license or permit expires-whichever conies first. O WARNING. Unl} tl►ose Individuals!(sled llQldy ns KF.SPUNSII3LK I'ls1iSUNS aiicj r\11'LQ1'1•:E I'USSESSORS synth a background clearance status of"CLEARED''or"I'ENI)ING"are an5tl oi'ized to traiisport,ship.reeelve;ur posi!est,eD.Njiloslve materials Ur the course of enrplayment svllh you,- © "DENIEM"STATUS, Iran employee possessoi•Ina:st background clearance status uf''•'DENIED",you M UST take Immediate steps to rennuve (lie employee from a position requiring the transporting;slrilipi ng,receiving,or posse's;tag of explosh c ornterinls. Also,tf the cnnploycc has been listed as a person authorized to accept delivery of cspluslte 1)nrtoi lals,)'oti INIUS'i'rer»ove tlrc employee from such list and humetliutely,and In no event Inter than the second business day after such change,notify distributor of such chnnge,as stated In 27 CFR 555.33(a). ® CHANGE IN RESPONSIBLE PC,RSONS. You MUST Pico,(sesAddress 293 $EACWD ;IV8NE report any change in responsible persons to tlrc Chief,federal POl1LS13fJ,i�'A9.8370 Explosives Licensing Center,withiln all days of the change and new responsible persons MUST Include"appropriate identifying Alalting Addressil inforn►ntiun"as defined in 27 CFR 555.11. Fingerprints and A111ZORA`FICZBWORKS l.l;. photos nre NOT required,however they will be required upon 29399MACH DRIVE NE reucm•al of tine license or permit. POUGSBO,WA 98370 ® CHANGE OF ENI PLOYEES. You M UST report any change of employee/possessors to the Chief,FELC,within 31)bays. Reports relating to nearly hh•ecl employees must be } submitted on ATF Fo•un 5400.28 for EACH employee• This'Notice of Clearance is provided to you as required by 18 U.S.C.843(h)slid MUST be retained as part of your permanent records and be made available for examination or inspection by ATF officers as required by 27 CFR 555.121. If you receive a Notice subsequent to this Notice,this Notice will no longer be valid. In accordance with 27 CFR 555.33,Background Checks and Clearances,and 27 CFR 555.57,Change of Control,Change in Responsible Persons,and Change of Employees,ATF's Federal Explosives Licensing Center(FELL)has conducted background checks on the individual(s) you identified as a responsible person(s)and an eniployee/possessor(s)on your application,or reported after the issuance of your license/permit. The following is a SUMMARY of the results of the background checks conducted on the individuals you reported as responsible persons and employee/possessors. ATF will be notifying ALL individuals listed on this document of their respective status by separate letter €mailed to their residence address. e PLEASE BE ADVISED THAT iT IS UNLAWFUL FOR ANY PERSON REFLECTING A STATUS OF•"DENIED"TO r TRANSPORT,SHIP,RECEIVE,OR POSSESS EXPLOSIVE MATERIALS. a Please carefully review this Notice to ensure that all the information is accurate. if this Notice is incorrect,please return the Notice to the Chief,FELC,with a statement showing the nature of the error(s). The Chief,FELC,shall correct the error,and s return a corrected Notice. Nucttber of.RESPONSIBLE PT;_MON(S).: J continued NullAer oft POSSI✓SSOR(S)+ 0 t y (ASI;NAME*first\i'me,Mkidic Name C tu)k't f►cc staus 1.ASI \t\11,7 nisi i�lannc;\titldle\iznu�� C,tealnuci Statti¢ E RI+SPOINSIBLE MOONS +•, r•.. f ,, s•t. `t1 000J NilZ,R08ERT•ANDREIY t )'WLOY)E P � OSSESSORS 0 - ='y .. • -":`;.�.•..' Y •:n;.�a-.::a,• <jq;•.•:<^=;ro.:;�.;.�;•�. h�r�• Secpn gg'k•'':e:,t:z:.ys:<f:w.., .r.. � S .�.. 1 is ♦ � R •„�?^5��;5<<.�y��Sys:i.... ., t:�y�.:ri,S ! '"i..� 1 bi .L27 T.fi, n, F 1 t•j�•Tjv..E,:'! ':t' _�;�i4 1 l�.:::. �:'. t.i .r;i � '�.:s.:i'' :'i�.''y,•'.•'t7..�t 1 3as��:i7•': i' 1 �4 � O 1n.�` {�k �z,�l.. 1p�l�q`N`S.n�tyYrf'Aj:\��,ra•"'1.s .�•• - p � C t vJ t'•'. - iPP"` yt 6) O :'F '+_ - "� -. _ _ _•a '�li.ems_ r _ Y ti y y. r a c�1 r vk�{ .00 `M° rA ct i s 4N 34x xr�f �+�1 r� W �•4 y C� 1 Li S.Department of Justice Federal Explosives Licensing Center Bureau of Alcohol,Tobacco,Firearms and Explosives 244 Needy Road 06/27/2011 Federal Explosives Licensing Center(FELC) Martinsburg,West Virginia 25405 www.atf.gov telephone:(877)283-3352 fax: (304)616-4401 NOTICE OF CLEARANCE for individuals transporting, shipping, receiving, or possessing explosive materials. ISSUED TO: AURORA FIREWORKS LLC Federal Explosives licenselpermit no.: 9-WA-035-514EM688 Expiration Date: 'May 1,2014 NOTICE DATE: 06/27/2011 Explosives License/PermitType: 51-IMPORTER OF FIREWORKS(DISPLAY) EXPIRATION DATE: This Notice expires when superseded by a newer Notice which will list all current responsible persons and employee possessors,or when the license or permit expires-whichever comes first. 0 WARNING. Only those individuals listed below as RESPONSIBLE PERSONS and EMPLOYEE POSSESSORS with a background clearance status of"CLEARED"or"PENDING"are authorized to transport,ship,receive,or possess explosive materials in the course of employment with you. ® "DENIED"STATUS. If an employee possessor has a background clearance status of"DENIED",you MUST take immediate steps to remove the employee from a position requiring the transporting,shipping,receiving,or possessing of explosive materials. Also,if the employee has been listed as a person authorized to accept delivery of explosive materials,you MUST remove the employee from such list and immediately,and In no event later than the second business day after such change,notify distributors of such change,as stated in 27 CFR 555.33(a). 0 CHANGE IN RESPONSIBLE PERSONS. You MUST Premises Address: 29399 BEACH DRIVE NE report any change in responsible persons to the Chief,Federal POULSBO,WA 98370 Explosives Licensing Center,within 30 days of the change and new responsible persons MUST include"appropriate identifying Mailing Address: Information" as defined in 27 CFR 555.11. Fingerprints and AURORA FIREWORKS LLC photos are NOT required,however they will be required upon 29399 BEACH DRIVE NE renewal of the license or permit. POULSBO,WA 98370 0 CHANGE OF EMPLOYEES. You MUST report any change of employee/possessors to the Chief,FELC,within 30 days. Reports relating to newly hired employees must be submitted on ATF Form 5400.28 for EACH employee. - ----- - ----- — --- - This Notice of Clearance'is provided to you as required by 18 U.S.C.843(h)and MUST be retained as part of your permanent records and be made available for examination or inspection by ATF officers as required by 27 CFR 555.121. If you receive a Notice subsequent to this Notice,this Notice will no longer be valid. In accordance with 27 CFR 555.33,Background Checks and Clearances,and 27 CFR 555.57,Change of Control,Change in Responsible Persons,and Change of Employees,ATF's Federal Explosives Licensing Center(FELC)has conducted background checks on the individual(s) you identified as a responsible person(s)and an employee/possessor(s)on your application,or reported after the issuance of your license/permit. The following is a SUMMARY of the results of the background checks conducted on the individuals you reported as responsible persons and employee/possessors. ATF will be notifying ALL individuals listed on this document of their respective status by separate letter mailed to their residence address. PLEASE BE ADVISED THAT IT IS UNLAWFUL FOR ANY PERSON REFLECTING A STATUS OF"DENIED"TO 3 TRANSPORT,SHIP,RECEIVE,OR POSSESS EXPLOSIVE MATERIALS. ii Please carefully review this Notice to ensure that all the information is accurate. If this Notice is incorrect,please return the Notice to the 1 Chief,FELC,with a statement showing the nature of the error(s). The Chief,FELC,shall correct the error,and return a corrected Notice. Number of RESPONSIBLE PERSON(S) : 1 continued s Number of EMPLOYEE POSSESSOR(S): 0 LAST NAME,First Name,Middle Name Clearance Status LAST NAME,First Name,Middle Name Clearance Status 3 RESPONSIBLE PERSONS: 1 a 0001 NITZ,ROBERT ANDREW Cleared 3 a EMPLOYEE POSSESSORS: 1) page 1 of 1 Tom DEPARTMENT OF THE TREASURY-BUREAU OF ALCOHOL,TOBACCO AND FIREARMS y°r��tx LICENSE/PERMIT(18 U.S.C. CHAPTER 40, EXPLOSIVES) � In accordance with.the provisions of Title XI,Organized Crime Control Act of 1970,and the regulations Issued thereunder (27 CFR Part 555)you may engage in the activity specified in this licenselpermit within the limitations of Chapter 40,Title 18,United �.� •9�a States Cade and the regulations issued thereunder,until the expiration date shown.See"WARNING"and"NOTICES"on back. • 11C�NSE/ Christopher R.Reeves PEf#uT 1 1 1 . : DIRECT ATF Chief,Federal Explosives LIG®rt�adfl�Gf R { LG� NDNIBEfI CORRESPONDENCE Bureau of Alcohol,Tobaccdr F@�rtr1�2f+ FptQsiv�S - fxPY17 TO (ON: Road 2 4 4 Needy oa E. ... Martinsburg,West VIC9 01:} 25�Q5 :::. ':;:: 1 14 Telephone: 1-877 S 3362- :. NAME - PrernTsbAdtlres G»A!'Ud.ES9 You must notify the FELL at least 10 days ore t s mow AURORA FIREWORKS LLC 29399 BElCI pka[V NE TYPE OF LICENSE OR PERMIT 51-IMPORTER OF FIREVt 6 kS t;OSPLAY) ;:s >• :r3 ;, <y f3� 5, .?x3 ?3 ) CHIEF,FEDERAL D(PLOSNES LICENSING CENTfRjPEIC q W.yx�k� X. ti �r P'Jr }(.}:-S.3?,{•. )} ti®r Ft.Reeves ;:•:,:re.=:3�a,?:z:;.. +•'�\:vn3)?h C. ....3,3}.,..:.is 3 i hchange 1 da s b be fore e I 0 f he FELC a t east must notify t Y h1�6E .cYbu Y PURCHASING CEF�7�I(�;,'; : �.,�� .Ma>)lif>I �Atfr�. .*�..:: I cenii that this is a true copy • lfCpn.?,,,-. -.•;,.;,,,Y,:,,,, ::;;;:::<; y issued to me to engage in the aCftitlfy`SpeC.9d'` :':' AURORA FIAEWOt.1,S LLC �639SSM-S H 96:WE NE PELfLSF3D W,A 8370- (SIGNATURE OF LICENSEE1PERwrr:Mi The licensee/permittee named herein shall use&feQtQdUcttQn W Eh�s license/permit to assist a transferor of explosives faysrtfy`1f Iderttfty and status of the licensee/permittee as provided In 2F.QX. PSit(5 The signature on each reproduction must be an ORIGINAL'$igiralure ATF F 5400,1415400.15,Part 1 (8/89) Tw � ,Vr I h • I E I 1 I w 7f t rt k. Y .At t K � � I Y; t 1 S 1 1• 1 1 w �. a i " c!; t • . • r _ + •, �'.�.:` VA + •• yam=� /�•-► � •- t k.\ ��`j � Y '�.•� R.r •' :y. or .�'� � -% . „ . 3'• !t a trl �bt `+R ;�, ' _ ' - ram'" ''t✓��,���ti/`.'%. ��r��� •, wiN�'t `i�.�c.+l{ • . tf ' •fir; i T , . xk, Nol ON13313 do 9`30N i„ 3 + OW A110 SVSNVY AVMV Rld d33H . ;. Allfid M 31ONVH VS ONfI S21311N90 ' jam,'// 44 y .r y 4L . �,,�y �. flow ' . ,i�•'t 'y. '-' ` Ole +ggam 1'•` r\ «r. Y T 5 y S _ -lwi� _ •` ,. T-46 �� ,r7J♦•,�# �. ; •�, __ a• .._..__ !� i 1. 13N�'N�yal .a •'• � /A 5 ,~ '; ; �i�� t�+a °I l �- a�� lk�ii I�Itl �f,�,(�1,� ;�C ro ti • !��' � ND.�� tie y'_ � � �lr'� 1�.� �� .,,, •.G ' '0 \s AS _ i r 1 . � A i J , k. s31 �. 'i tl. t v': � 'dal. •• r• �.Z ►�.��ti�.��,'. J �tI d i 4— lit JU < A 5.7 i' r �� ���•��r 1''1 ` e *' � d ' 14 . 1 Y r i 'G 17 o 4.4 ;? r-wZf i 1 �- �St�'r� f�i • �� + � 'F ,��/y{� r'' - F� ,ten _ � .•� �'� `"��ii A�'(}���}I t- Q w � -c 0 T O r D. 3� �•.•+ I . is -,--• 4:�. WL, 08-05-'12 12:00 FROM- T-825 P0001/0001 F-186 ONM i7o.1140-0026(N5012I012) U.S.Department of Justice Bureau of Alcohol,Tobacco,Firearms and Explosives Report of Theft or Loss -Explosive Materials For ATF Use Only Date Received Date Faked to JSOC&Field Division Unique Identifier Case Numbct To Be Completed By Person Malting Report Upon discovery of any theft or loss of any of your explosive materials: First,contact ATF toll free at 1-900-461-994I between 8:00 am.-5:00 p-m.EST or after hours and weekends contact ATF at 1-800-800-3855 to report the theft or loss; Second,contact your local law enforcement office to report the theft or loss to obtain a police report;and Third,complete this form and auach any additional reports,sheets or invoices necessary to provide the required information,and fax the form with additional material(s)to the ATF U.S.Bomb Data Center(USBDC)at 866-927-4570. 1. Date 2. Type of Report(Chuck one): th ❑ eft ❑ Loss ❑X Supplement 06R512012 -3---Full Name of Person Making the Report(Last.First.htddle) 4. Corporate or Business Name(!applicable) Robert A Nitz Aurora fireworks LLC Sa. Office Address(StreetAddrers.Ciry,Stare,and Zip Code) 5b. Telephone Number 29399 Beach Drive NE 360-620-1077 Poutsbo Wa 98383 6. Actual Location of Theft or Loss(tf different front item Sa) 25603 n State Route 3 Belfair,WA 98M (360)275-6677 7 Theft �� Date Ttme 8. Name of Local Law Enforcement Officer to Whom Reported David Johnson a. Discovered 0&25I2012 06:15 AM 9 Agency Name and Address of Local Authority to whom Reported ATF On site b. Occurred(Show approximate if 06252012 1.30 AM 915 2nd Ave suite 790 esacf not known) Seattle Wa 98174 c. Reported to ATF by Telephone 06/252012 12:45PM 10. Telephone Number: 1-206-3"942 11. Police Report Number. d. Reported to Local Authorities 0625/2012 Was not given one 12. Explosive Materials Lost or Stolen (Attach invoices or additional sheets.if necessary} L Type and Description C.Quantity (Dynamite,Blasting Agents.Detonators, (founds of Explosives, e1c. Include for each type,size,AIS delay a. Manufacturer b.Brand Name r;Dste Shift Code d.Size Number ofDers) or length ofaegwire as applicable) Lidu 2.5" 281 - 13g Frewoti3 assorted Legend 3" 2601 manufacturers for each shell site. Wolverine d" 949 C-Amen USD 5„ 897 Vulcan 6" 607 Yang Feng 8- 259 Domiaater +1-0� 63 'wizard Display calves 109 , s.+t t car ►a iYs — S 13. Theft or Loss Occurred From (Check applicable box) Permanent Q Portable ❑ Truck ❑ Work Site ❑ Other(Fsplain)❑ Magazine Magazine ATf E-Fam 54003 Reis.d Mu-h 2008