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HomeMy WebLinkAboutFIR2013-00006 Final Fire Works Stand - FIR Permit / Conditions - 6/26/2013 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT action Line (360)427-7262 e: (360)427-9670, ext. 35� Mason County Bldg. 3 W. Cedar P.O. Box 275 • Shelton, WA 98584 i� FIRE PROTECTION PERMIT FIR2013-00006 APPLICANT: MASON COUNTY REPUBLICANS RECEIVED: 3/20/2013 CONTRACTOR: LICENSE: EXP: ISSUED: 4/17/2013 SITE ADDRESS: 18350 E STATE ROUTE 3 ALLYN EXPIRES: 10/17/2013 PARCEL NUMBER: 122205005001 LEGAL DESCRIPTION: ALLYN BLK: 4 LTS: 1-7 & S 20' LT: 8; BLK: 5 LTS 1-7 & S 20'LT: 8 &TX 674 A-B &VAC BENNETT& 10'VAC SHERWOOD PROJECT DESCRIPTION: FIREWORKS STAND GENERAL INFORMATION System Information Type of Use: STND Sprinkler Heads: Audible Switches: Pull Stations: Fire District: 5 Hood&Duct?: Flow Switches: Visual Devices: Door Releases: Pressure Switches:: Smoke Detectors: Duct Detectors: Dry Chemical?: Zones: Heat Detectors: Wet Chemical?: Sprinkler?: Standpipe?: 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?: Third Floor;: Total: $100.00 $100.00 FIR2013-00006 Please refer to the following pages for conditions of this permit. Page 1 of 6 1.) Consumer` re works may be sold only -.`:e following days and times. June 28th `rom 12 noon to 11 PM June 29th to !uly 5th from 9 AM to 11 P July 6th from 9 AM to 12 noon g)X � Only Waskngton State Fire Marshal approved class C common fire works may be sold. X � ) Afire 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 separated 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 exposures 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 storage or pensing facility. X The minimum 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 shall be marked and flagged. Motor vehicl s or trailers may not be parked within 20 feet of the fire works stand except when delivering, loading or unloading fireworks. X Fireworks shall not be discharged within 300 feet of any fireworks stand. A sign stating "No Fireworks discharge within 300 feet' in letters at least 2 inches high and in coftNasting color shall be posted conspicuously on all sides of the structure. Xd) No smoking shall be allowed within the fireworks stand or flagged off area. Signs stating " No Smoking Witin 100 feet' in letters at least 2 inches high and in contrastin colors shall be posted conspicuosly on all sides of the structure. X All battery powered equipment, electrical equipement and cords shall be UL listed and used in accordance with that listing. Extension cords shall be of an industrial a type and shall be protected from physical damage. X G 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 ele ent heating devices are prohibited. X Gq Generators 9NI be located a minimum of 20 feet from any fire works stand. Fuel storage is limited to 5 gallons. X A minimum 24 inch 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 inches in width located at oppsite ends of the stand. These exits shall ain unlocked and unobstructed during hours of operation or when stand is occupied. X Sleeping inside a fire orks stand is prohibited. FIR2013-00006 Please refer to the following pages for conditions of this permit. Page 3 of 6 • -e location of the nearest shall be posted in the fire. .<.s stand. All occupants of t; _ stand shall be informed as tic r_ ocation of this phone. The -al emerge c phone nur rer. 911, and the address of tl- ' -eworks stand shall be cons, ic-:ously posted inside the staro There shall be 12rnimu o` 2 approved 2 1/2 gallon press-! zed water fire extinguishers located adjacent to each exit door X Cooking, op flame or any type of open flame equipment is prohibited in a fireworks stand. X < Fireworks stands shall be locked when unoccupied and not open for business if fireworks are storged in the stand during these times. Fireworks stand shall not be loc d when occupied. Fireworks maybe removed or transferred to a temporary storage structure or location approved as part of the license and permit. X Fireworks may be stored in a locked and secured retail fireworks stand, truck, container or trailer that is at least 20 feet from the fireworks stand during business hours, or in a locked and secured metal or wooden garage, shed, barn or other accessary building that is at least 20 feet from the fireworks stand. L�sX 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 responsible 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 when op a public. X It is illegal 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 least 2 inches 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 proof of ag river'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 null arp 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 Coi.Lnity access to the above 00cribe property and structure for review and inspection. OWNER OR AGENT L,(Z:�� 1 DATE: / FIR2013-00006 Please refer to the following pages for conditions of this permit. Page 4 of 6 55 CONCRETE MECHANICAL MANUFACTURED HOME In N Date By m L Footings !Setbacks Ribbons z Gas Piping Z C Interior Date By Interior-Date By Date By Q O Exterior Date By Exterior-Date B et-up S v _._..� Oj Point Load/Isolated Footings INSULATION p Date By < BG!SLAB INSULATION — -- -- m Date By Data By FIRE DEPARTMENT Foundation Wails Floors Date By Date By Date By DECKS Z FRAMING walls Date Byn Date By Data By PROPANE TANKS PLUMBING vault Date By Date By OTHER Groundwork Attic Dale By Date By Type: Date By D.W.v DRYWALL Type: Int Brace Wall pate By Date By Date B X y By FINAL INSPECTION c m Water Line Fire Seperation Date By Date By Date By C o Pass or Request Inspect. o Type of Insp. Fail Date Date Done By Comments a 0 f co c s ors e_ o C- S — v coo o rL c_)or`CS W O r-p e- '.4 Crzzeq L. k O 7 G :i O 7 y O S N M I S K N tL] fD O ATE AC" CERTIFICATE OF LIABILITY INSURANCEt to/2ot3 3/5/2013 3/5/2 DIDDIYYV/) �,i 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 Lockton Companies,LLC NAME; 3280 Peachtree Road NE,Suite 800 PHONE FAX A/C No Ext: A/C No): Atlanta GA 30305 E-MAIL (404)460-3600 ADDRESS: INSURERS AFFORDING COVERAGE NAIC N INSURER A:Scottsdale Insurance Company 41297 INSURED American Promotional Events,Inc. INSURER B: 1359629 DBA TNT Fireworks,Inc. INSURER C: P.O.Box 1318 INSURER D: 4511 Helton Drive INSURER E: Florence AL 35630 INSURER F COVERAGES CERTIFICATE NUMBER: 12219619 REVISION NUMBER: XXXXXXX 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MMIDD/YVYY A GENERAL LIABILITY N N CPS1612503 I1/1/2012 11/l/2013 EACH OCCURRENCE DAMAGE TO RENTED $ 100 000 X MMERCIAL GENERA ABILITY PREMISES(Ea occurrence) CLAIMS-MADE OCCUR MED EXP(Any oneperson) $ 5,000 X Blkt Contractual PERSONAL 8 ADV INJURY $ 1,000,000 X Hostile Fire Pol GENERAL AGGREGATE $ 2,000 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2000000 POLICY PRO- $ JECT [XI LOC AUTOMOBILE LIABILITY NOT APPLICABLE (Ea accident) $ }{}{X}{XXX ANY AUTO BODILY INJURY(Per person) $ XXXXXXX ALL OWNED SCHEDULED BODILY INJURY Per accident $ XXXXXXX AUTOS AUTOS PROPERTY DAMAGE $ XXXXXXX HIRED AUTOS NON-OWNED AUTOS (Per acc dent) $ XXXXXXX UMBRELLA LIAB OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX EXCESS LIAB HCLAIMS-MADE AGGREGATE $ XXXXXXX DED I I RETENTION$ $ XXXXXXX WORKERS COMPENSATION NOT APPLICABLE AND EMPLOYERS'LIABILITY Y/N TORY LIMIT ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ XXXXXXX OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ XXXXXXX If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ XXXXXXX DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Vacant Lot located at Hwy 3 in Allyn,Wa(Loc.W WM6502)Certificate holder is an additional insured on the General Liability as required by written contract subject to policy terms,conditions,and exclusions. FIRE MARSHAL CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 12219619 AUTHORIZED REPRESENTATIVE Mason County Republicans Mason County PO BOX 186 426 West Cedar Shelton WA 98584 ?/,o ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD '© 988- 1 O CORD-CORM NATION.All rights reserved FIRE MARSHAL Washington State Patrol ��vV ��V� 14752 Fire Protection Bureau Office Of The State Fire Marshal Fireworks Stand License Washin0on State Fireworks License License is Non-Transferable and Vaiid for Only One Stand Licensee Information Mason County Republicans 2120 Milwaukee Way State Fir Marshal Siggnet Tacoma, WA 98421 License Number: WSPFL-01360 �etach this wallbt o'er d�atry with you for verification f ce fication. Stand Information Washington State Patrol �@i✓r /T as c�uJ yt Fire Protection Bureau 14752 Contact Person: Vr Office Of The State Fire Marshal Phone Number: (360)4_� �43Z-- a�y3 ANNUAL FIREWO STAND LICENSE County: Mason Date of Expiration Date of Issue Licensee: Mas ublicans Stand Number: SN-07555 January 31, 2014 February 14 2013 Contact Person: Ge _Y" t ;hx ' License Number: W Stand Number: S '` ~:;; id For One Stand) Date of Expiration: Jan , on: Stand Location: /4 C roSc �`^'""� W�'10�etr Ntr N 't. (n '"�.t ' Locati rand Location 'ompleted By Licensee) [Stand Location To Be Completed By Licensee i G ✓ 3000 420 012(R 9/05) fate Fire azs /9i ature Licensee Signature APPLICATION ' FIRE FOR RETAIL FIREWORKS STAND PERMIT MA WWM6502 overning body of city, town, or county in which DATE OF I MAR. 1, 2013 fireworks stand will be located. APPLICATION: Applicant Name: Address, City,State: MASON COUNTY REPUBLICANS 2120 MILWAUKEE WAY, TACOMA„ WA 98421 Sponsor (If other than applicant): Address, City,State: JERRY GOODWIN 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: 2013 (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 1 AG Consumer fireworks at the location designated herein between the following date and times: Sales For July 41h Sales For December 31" From: .. e. 0 13 From: To: S fl 2 L ( j To: Y Suonsov MASON COUNTY REPUBLICANS Location: STAND 0 HWY 3 WA /s/ /s/ FOR JERRY GOODIN 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.2105) 50 l z z z sz�o THESE PLANS MUST BE ON THE JOB SITE FOR INSPECTION. APPR MASON C U^d FI7zt:��E DATE /, —6-1, �ay SUBJECT TO FIELD IN 1 SPEGTit?>"� ALL APPLICASL CODES SHALL APPLY Epp. AND/OR OMISSIONS ON PLANS ARE SOI :7r SPONSIBIL17y OF OWNER/CO'd'R, TIONS REOUtRED FROM FIE!.0 ID.;S?Fr �•; .;BE AT OWNER/COMTa;;rTOF.'S PROVAL DOES :SOT 0a<,M1T TO Atv`. ;RIGHT TO "IOL:,Tk."I-ly CITY 0t, FIRE MARSHAL 1sz-1co S i Mason County Fireworks Permit Application PO BOX 186 426 W Cedar St Permit# FIR Shelton WA 98584 (360) 427-9670 ext 273 Receipt # FIRE CK # 5'772--) MARSHAL 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: u bl Mailing Address: City: h¢.I PAL A. State: WA Zip: � Contact Number Q) 32, r-- 3 � Sponsor Information Name: �C J Mailing Address. City: State: Zip: Contact Number ( ) Washington State Fireworks License Information (Copy Required) License No.: LA-) io r-L_ 0 13 LP� Date of Issue: ❑ Pyrotechnic Operator License Fireworks Stand Li dense Bond or Certificate of Insurance (Copy of Certificate/Bond Required) Provider: Insured: Certified Holder: Location of ta �/display Address: ' f �o0tE�_3 ��Directions to Site: _ � Parcel Number.: :;k _ 6C Legal Description: -4 ,Lo� _ Legal Property Owner: j n� * * Please see the reverse side to complete your application The f6flowing 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 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: