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HomeMy WebLinkAboutFIR2012-00019 Final Fire Works Stand - FIR Permit / Conditions - 6/28/2012 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 Ir Shelton, WA 98584 flo FIRE PROTECTION PERMIT FIR2012-00019 APPLICANT: MASON COUNTY REPUBLICANS RECEIVED: 6/21/2012 CONTRACTOR: LICENSE: EXP: ISSUED: 6/27/2012 SITE ADDRESS: 18350 E STATE ROUTE 3 ALLYN EXPIRES: 12/27/2012 PARCEL NUMBER: 122205005001 LEGAL DESCRIPTION: ALLYN BILK: 4 LTS: 1-7 & S 20' LT: 8; BILK: 5 LTS 1-7 & S 20'LT: 8 &TX 674 A-B &VAC BENNETT & 10'VAC SHERWOOD PROJECT DESCRIPTION: FIRE WORKS STAND GENERAL INFORMATION System Information Type of Use: STND Sprinkler Heads: Audible Switches: Pull Stations: Fire District: 5 _ 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 Stand Permit $100.00 $100.00 Auto Fire Alarm?:N Third Floor;: Total: $100.00 $100.00 FIR2012-00019 Please refer to the following pages for conditions of this permit. Page 1 of 6 T n 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 loca cy phone number, 911, and the address of the fireworks stand shall be conspicuously posted inside the stand. x_ _ T all a minimum of 2 approved 2 1/2 gallon pressurized water fire extinguishers located adjacent to each exit door. X Co g, open flame or any type of open flame equipment is prohibited in a fireworks stand. Fire s stands shall be locked when unoccupied and not open for business if fireworks are storged in the stand during these times. Fireworks stand ,.ha t e locked when occupied. Fireworks maybe removed or transferred to a temporary storage structure or location approved as part of the license and i X Fireworks may be ored in a locked and secured retail fireworks stand, truck, container or trailer that is at least 20 feet from the fireworks stand during bus' ours, or' a locked and secured metal or wooden garage, shed, barn or other accessary building that is at least 20 feet from the fireworks fan X At least one person 18 yrs of age or older shall be on duty in the fireworks stand when fireworks are being sold to the public. Such person shall be res .ble for the supervision of the fireworks stand and its operation. No person under tha age of 16 shall be allowed to occupy the fireworks stand whe a to the public. It is p egal to knowingly sell fireworks to persons under the age of 16. A sign stating "No Sales Of Fireworks to Persons Under the age of 16" in letters at leas i hes high and in contrasting color shall be posted on the front of the stand. A photo ID is required and it is responsiblity of the seller to require pro . Driver's license or photo ID showing date of birth issued by a public or private school, state, federal or foreign government is acceptable. X This permit becomes I nd 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 comme ce 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 w rk is by means of a progress inspection.The owner or the agent on a owners behalf, represents that the information provided is accurate and grants employees of Mason Co a cess t he a\ a described property and structure for review an inspection. OWNER OR AGEN \ DATE. I FIR2012-00019 Please refer to the following pages for conditions of this permit. Page 5 of 6 1.) Owe t is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. X t` 2.) Vali it eon-site. X FIR2012.00019 Please refer to the following pages for conditions of this permit. Page 3 of 6 3.) Consumer fire works may be sold only on the following days and times. June 28th from 12 noon to 11 PM June 29t to July 5th from 9 AM to 11 PM July l m 9 AM to 12 noon X Only gton State Fire Marshal approved class C common fire works may be sold. X A fire works stand shall not be located more than 150 feet from an approved access road. Shall be at least 100 feet from another fire works stand or sdpa ed by a road, street or highway at least 30 feet in width. Shall not be located any closer than allowed by the attached table to other structures or expos or be located closer than 100 feet from any flammable liquid or gas dispensing device, or 300 feet from any flammable liquid or gas bulk stor r di pensing facility. X, h, The i um areas around a fire works stand, as specified in the attached table, shall be kept free from dry grass, brush, or combustible debris. This area sh a marked and flagged. Xv�, Moto r trailers may not be parked within 20 feet of the fire works stand except when delivering, loading or unloading fireworks. X Firew shtaa discharged within 300 feet of any fireworks stand. A sign stating "No Fireworks discharge within 300 feet" in letters at least 2 inches high a g color shall be posted conspicuously on all sides of the structure. No sm llowed within the fireworks stand or flagged off area. Signs stating " No Smoking Witin 100 feet" in letters at least 2 inches high and in cont shall be posted conspicuosly on all sides of the structure. X All batte wered equipment, electrical equipement and cords shall be UL listed and used in accordance with that listing. Extension cords shall be of an industri and shall be protected from physical damage. X -All h t1evices 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 t heating devices are prohibited. XE Ge or shall be located a minimum of 20 feet from any fire works stand. Fuel storage is limited to 5 gallons. Xj A min' _ m 24 . ch wide isle shall be maintained inside the full length of the stand. Cus re not allowed inside the fireworks stand. There shall be a minimum of 2 exits at least 28 inches in width located at oppsite ends of the stand. The s s all remain unlocked and unobstructed during hours of operation or when stand is occupied. X ` idea ireworks stand is prohibited. X J FIR2012-00019 Please refer to the following pages for conditions of this permit. Page 4 of 6 55 CONCRETE MECHANICAL MANUFACTURED HOME D N -_ __.,_.. ......____ Cl) Footings /Setbacks Date By L Ribbons O Gas Piping Z Cinterior Date By Interior-Gate By Date r 0 00 Exterior Date By Exterior-Date _ _ By Setup C INSULATION tp Point Load l Isolated Footings Date By Z BG f SLAB INSULATION _ -_. Date By Data By FIRE DEPARTMENT Foundation Walls Floors Orate By � M Date By Date _ By DECKS C FRAMING Wails Date By 00 Date BY Dec' _ By PROPANE TANKS n PLUMBING vault Datu By D Date n y � - OTHER Cl) Groundworic Attic Type= Date ay bake By Date By D.W.V DRYWALL Type: Int.Brace Wall Date By TI Date By Gate By � � X y FINAL INSPECTION N Water Line Fire Soperation 0 Date By Date By Data By N 0 o Pass or Request Inspe . o ct Type of Insp. Fail Date Date Done By , Comments 3 " to m lC rD N O n O 7 a t O N O S N (D I � E E N t� (D 0) O 0) QVA Mason County I22ZO . 50. 001 ' 13Fireworks Permit Application PO BOX 186 Cl NMI 426 W Cedar St Permit# FIR Shelton WA 98584 (360) 427-9670 ext 273 Receipt # 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: 1 Mailing Address: City: v N State: l�p Zip: 1c� Contact Number 3 Sponsor Information Name: S k Mailing Address: City: ��.� State: �. Zip: Contact Number Washington State Fireworks License Information (Copy Required) License No.: Date of kj Issue: `� Z© ❑ Pyrotechnic Operator License ❑ Fireworks Stand License Bond or Certificate of Insurance (copy of Certificat nd R quired) Provider. �. �S Insured. Certified Holder: Location of stand/display Address: ' Directions to Site: Parcel Number: -�- 7 ����� _ ��-� Legal Description: Legal Property Owner: * * Please see the reverse side to complete your application i 4qp ' - w 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 designated display areas to: • Fire Hydrants • Property Lines • Buildings Parking • Combustibles • Public Roads and Right of Ways • Fire Lanes Private Roads and Right of Ways • Trees /Brush • Landmarks • Utilities and Gas • Mortar separation distance • Designated landing area 2v� 'gD OFCLG. CYl V T rG ( -F ♦C-,Jdv ks t r- Applicants Affidavit I certify that the information provided herein is accurate and that compliance with all County, State and Federal laws pertaining to the sales or discharge of fireworks shall be maintained. Signed Date FOR OFFICIAL USE ONLY BELOW THIS LINE Accepted By: Date: APPLICATION FOR RETAIL FIREWORKS STAND PERMIT WWM6502 TO: Governing body of city, town, or county in which DATE OF MAY 10, 2012 fireworks stand will be located. I APPLICATION: Applicant Name: Address, City,State: MASON COUNTY REPUBLICANS 2120 MILWAUKEE WAY, TACOMA„ WA 98421 Sponsor(If other than applicant): Address, City,State: GEORGE RICKLE 2120 MILWAUKEE WAY, TACOMA„ WA 98421 Location of proposed fireworks stand: [Enclose drawing of stand location] 23861 HWY 3 ALLYN, WA ALLYN STAND Manner and place of storage prior, during,and after sales dates: ON SITE WITH SECURITY State Licensed Fireworks Supplier: American Promotional Events NW 2120 Milwaukee Way, Tacoma, WA 98421 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - FIREWORKS STAND PERMIT For The Fireworks Sales Year Of: 2012 (Must be conspicuously displayed at all times while the stand is open to the public) By virtue of having been granted a license by the State of Washington and this permit from MASON COUNTY the local governing authority, the named person, firm or organization is hereby authorized to sell U.N. 0336 1AG Consumer fireworks at the location designated herein between the following date and times: Sales For July 41h Sales For December 31s' From: From: To: To: Sponsor: MASON COUNTY REPUBLICANS r Location: ALLYN STAND 23861 Y WA H g f e /s/ FOR GEORGE R Signature of Official Granting Permit Signature of Applicant Title: Agency: Date: Permit Number: Licensee Name: MASON COUNTY REPUBLICANS License Number: 01360 3000-420-013 (Rev.2/05) Washington State Patrol W W �"� ` 14117 Fire Protection Bureau Office Of The State Fire Marshal Fireworks Stand License Washington State Fireworks License License is Non-Transferable and Valid for Only One Stand Licensee Information Mason County Republicans 2120 Milwaukee Way State Fire Marshhl Sign t Tacoma, WA 98421 License Number: WSPFL-01360 Detach this wallet ar an carry with you for verification of ce 'fication. Stand Information ——- — -— Washington State Patrol 14117 Contact Person: George Rickle Fire Protection Bureau Phone Number: (360) 556-7279 Office Of The State Fire Marshal ANNUAL FIREWORKS STAND LICENSE County: Mason Date of Expiration Date of Issue Licensee: Maso qpn . epublicans Stand Number: SN-07143 January 31, 2013 May 7, 2012 Contact Person: Ge ge_Rickle' License Number: W P�=0k360='; Stand Number: S 971'43= Y, id For One Stand] Date of Expiration: Jartua"r-y= - Stand Location: Location: %: • ( land Locatio mpleted By Licensee] [Stand Location To Be Completed By Licensee] 3000-420-012(R 9/05) State Fire Mars 1 i ature Licensee Signature 1 � ® DATE(MMIDD/YYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE 5/4/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: Britton-Gallagher and Associates, Inc. PV Nr o >n:4 0- 4 7 A/c No):440-W-1234 6240 SOM Center Rd. E-MAIL Cleveland OH 44139 ADDRESS: INSURER(SI AFFORDING COVERAGE NAIC 0 INSURER A:Lex'naton Insurance Company 19437 INSURED 5530 _ INSURER B: American Promotional Events Inc. INSURERC: dba TNT Fireworks INSURERD: P. O. Box 1318 Florence AL 35631 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1726964223 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE A R POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MM/DD/YYYY MMIDDIYYYY LIMITS A GENERAL LIABILITY 44272132 1/1/2011 1/1/2012 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $50,000 CLAIMS-MADE KI OCCUR MED EXP(Any one person) $ X Blkt Contractual PERSONAL&ADV INJURY $1,000,000 X Hostile Fire Pol GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO X LOC COMBINED SINGLE:LIMII $ AUTOMOBILE LIABILITY Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident i UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC LIMITS I O R AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Additional Insured: Property located at the vacant lot at Highway 3 in Allyn,WA (Loc#WWM6502) The Certificate Holder is named as Additional Insured with respect to General Liability as required by written contract subject to policy terms, conditions, and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Mason Co. Republicans/Mason County ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 186 426 West Cedar AUTHORIZED REPRESENTATIVE Shelton WA 98584 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE