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FIR2011-00030 Final Fire Works - FIR Permit / Conditions - 6/29/2011
� w MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inapecllon Lkia(360)427.7262 Phone:(360}427-9870,W.352 Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Sheiton, WA 98584 0 FIRE PROTECTION PERMIT FIR2011-00030 APPLICANT: NORTH MASON PEE WEES RECEIVED: 6/8/2011 CONTRACTOR; LICENSE: EXP: ISSUED,6I2312011 SITE ADDRESS: 24121 NE STATE ROUTE 3 BELFAIR EXPIRES, 12/23/2011 PARCEL NUMBER. 12328329004D LEGAL DESCRIPTION: PCL 6 OF SLA#01-71 (R) PTN NW SW PROJECT DESCRIPTION: FIRE WORKS PERMIT U E' GENERAL INFORMATION System Infonrnadon Type of Use: STND Sprinkler Heads: Audible Switches: Pull Stations: a, Fire District: 2 Hood&Duct?: N Flow Switches Visual Devices: Dour Releases: Pressure Switches:: Smoke Detectors: Duct Detectors: o Dry Chemical?: N Zones; Heat Defectors: Wet Chemical?: N Sprinkler?: N Standpipe?; N SQUARE F 0 'AGE FEES Monitoring Company: FIrstFloor: Type Amount Due Amount Paid Monitoring Phone No.;()- Second Floor: Auto Fire Alarm?: Third Floor; Fireworks Stand Permit $100.00 $100.00 Totali $100.00 $100.00 r ti N O to M M Lt. N O O .-1 N � h N �+ C 0 FIR2011-00030 Please refer to the following pages for conditions of this permit. Page 1 of 6 CASE NOTES FIR2011-00030 N Q' N O P CONDITIONS FOR FIR2011-00030 H yryM W a . 0 U Q ae a! ti N N a D O n �0 c N O o .a � o N � h (�J N FIR2011-00030 Please-refer,to the following pages torcondwone of this permit. Pagel of 6 ` own er J Rgent is responsible to post the assigned address andl or purchase and post private road signs in accordance with Mason County I itte 14,1ti, m Q- H 0 0 E' M a , 0 U 2 O 00 h N O m yyHqq r0 w U) N Q O N m � N N m o Pleasrre r to the following pages for conditions of this permit. Page of 6 �, FlR20 40030 7) Consumer fire works may be sold only on the touowing days and times. June 29th from 12 ncon to 11 PM June 29th to July 5th frcm 9 AM to 11 PM July 61h from 9 AM to 12 noon 0 X p 0 Only W gton Stale Fire Marshal approved class C common fire works may be sold, X A fire works stand shall not be located more than 150 feel 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 ispensing 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 sh 11 be marked and flagged, X Motor v�eh��i�les or trailers may not be parked within 20 feet of the fire works stand exceptwhen delivering, loading or unloading fireworks. X 4— H 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 w high and j ntrasting color shall be posted conspicuously on all sides of the structure. w _ X 0 V zs No smoking shalt 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 N in contr i g colors shall be posted conspicuosly on ail 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 gr de type and shall be protected from physical damage. X M AI1_j��ati�g devices sl>�II be UL listed, Q�ly_he�urag devices tivj h 58�1ed type elements shalt be used,l.e,off filled orwater filled radiator type. Gpen flame or open element heating devices are prohibited. N X m Generator,shall be located a minimum of 20 feet from any fire works stand. Fuel storage is limited to 5 gallons. n X A minlmum 24 inch wide isle shall be maintained inside the full length of the stand. �* r-ustornera arP nnr allpwari Inside the fireworks stand. There shall be a minimum of 2 exits at least 26 aches in width located at or?psite ends of the stand. N 0 o These a i}=all remain unlocked and unobstructed during hours of operation or when stand is occupied. X N Sleeping i ide� a fireworks stand is prohibited. M n X {� N "+ C o FIR2011-00030 Plwweyraferto+the fogowing pages for conditions of this permit. Page4:.of 6:.. The location of the nearest phone shall be posted in the fireworks stand.All oocupants of the stand shall be informed as to the location of this phone. The in local em r ncy phone number, 811, and the address of the fireworks stand shall be conspicuously posted Inside the stand. X � N - There sill be a minimum of 2 approved 2112 gallon pressurized water fire extinguishers located adjacent to each exit door. 15 X m� Cooking„o�n flame or any type of open flame equipment is prohibited In a fireworks stand. X ��-- Fireworks stands shall be locked when unoccupled and not open for business if fireworks are storggd in the stared during these times. Fireworks stand shall not be locked when occupied. Fireworks maybe removed or transferred to a temporary storage structure or location approved as part of the license and pern r ` X `� Firemrks 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 H 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 the age of 19 shall be allowed to occupy the fireworks stand w when op n the public. a x - 0 v z 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 H 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 responslblity of the seller to require proof of a Driver's Ilcenae or to 1D showing date of birlh issued by a public or private school, state, federal or foreign government is acceptable. X - --- - . 3.) Valid Permit Must be on-site. X Ij� 'r - This permit becomes null and void If work or construction authorized is not commenced wrihin 1 BD days,or if construction orwork Is suspended for a period or 160 days at any time m after work Is commenced. Evidence of continuallon of work is a progress Inspection within the IN day period. Final inspection must be approved before building can be occupied. W P_root_of continuation of.work is-by.me8rrs 4f a_t�roBr� Instigo,.Ttlggyv�_r,o[t}le ogga!pp t onerapehalf, represents that the inform2t4on provided Is accurate and grants employees of Mason County access to the above described property and structure for review and inspection, r_ OWNER OR AGENT: amj� DATE: j-3 -[J 0 m n �0 Q1 w V' c N 0 co o -4 N m N N C o FIR2011-00030 Please refer to the following p&ges for conditions or this permit. Page 5 of 6 -n " Z CONCRETE MECHANICAL MANUFACTURED HOME O Date Footings/Setbacks Gas Piping By Ribbons Y O Interior Date By Interior-Date By Date By Exterior Date By Exterior-Date SX Set-up y O Point Load!Isolated Footings gGs SLAB O ULATION Date By Z Date By Data By FIRE DEPARTMENT Foundation Walls Floors Date By M Date By Data By DECKS FRAMING Walls - Date By M Date By Data By PROPANE TANKS CA PLUMBING Vault ' vats 13y Date By OTHER Groundwork Attic Date g Date By Type: y Date Sy o.W.v DRYWALL Type: Int.Brace Wall Date By Date By X y Date By FINAL INSPECTION N Water Line Fin Saps ration Date By Date By Date By O o Pass or Request Inspect. c Type of Insp. Fail Date Date Done By Comments c L -.17- V IF re0114,1 , C) O 7 O 7 ' �^ 11 w f',' ,%(,k 45> G- Z - P✓L t of-f Jvow. ni s T � O CA CD i i i i i i P i t11 CD (D CA O lY) 1 Mason County Fireworks `Permit Application BOX 426 W Cedarar St Permit# FIR Shelton WA 98584 (360) 427-9670 ext 273 Receipt # CK # OLf �76 Date Received to 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: Y-4-h Mailing Address. City: V-&—Ok �State:4 ►- �,t� Zip: Contact Number _420) "7I0 _T2-i 21 Sponsor Information Name: 44n,nq-s Mailing Address. City: State: - Zip: Contact Number ( ) Washington State Fireworks License Information (Copy Required) License No.: 12L4, 3 W VV VO(oS [Z Date of j t Issue: ❑ Pyrotechnic Operator License Fireworks Stand License Bond or Certificate of Insurance (Copy of Certificate/Bond Re uired1 Provider: Y�(l� �i -�� , i U-00S 4 0011(iC4-YYN Insured: i9yo Certified Holder: y L, Location of stand/display Address: 2-4 f 2( Wt�- e--r •3 Directions to Site. Parcel Number: 1 ?Z _ -32— - Legal Description: Legal Property Owner: ��i * * Please see the reverse side to complete your application �`\ The followin pertinent information MUST be provided on the site diagram below i �Oojs and Setback distances from the back, sides and front of retail sales stands or display areas to: • Fire Hydrants --T • Prope rty Lines • Buildings . parking • Combustibles • Public Roads and Right of Ways • Fire Lanes 0 Private Roads and Right of Ways • Trees /Brush • Landmarks • Utilities and Gas • Mortar separation distance • Desi ated Iandin area Applicants Affidavit 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 mpintained. Signed h� Date FOR OFFICIAL USE ONLY BELOW THIS LINE Accepted By: Date: SITE DIAGRAM A Date Updated: 2 Location #: \N w LAL- Location Name: Ordinance Of: V) �(? Site Address: Structure Size: S"ta n 'l CITY �bel rl i '( STATE/ZIP VV 4 Structure Faces: Parcel: Show all setback from structures gas, fire lanes, public and private roads property lines trees and landmarks --' , P y I �bkk L� I U �{ ,\ /\ r Notes � a APPLICATION FOR RETAIL FIREWORKS STAND PERMIT WWM6512 TO: Governing body of city, town, or county in which PL DATEApril 12, 2011 fireworks stand will be located. APICATION: Applicant Name: Address, City, State: NORTH MASON PEE WEES 2120 MILWAUKEE WAY, TACOMA„ WA 98421 Sponsor(If other than applicant): Address, City,State: BRETT BERGDAHL 2120 MILWAUKEE WAY, TACOMA„ WA 98421 Location of proposed fireworks stand: [Enclose drawing of stand location] 24121 NE HWY 3, BELFAIR WA VACANT LOT 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 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - FIREW ORKS STAND PERMIT For The Fireworks Sales Year Of: 2011 (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 1.4G Consumer fireworks at the location designated herein between the following date and times: Sales For July 4th Sales For December 31s' From: From: To: To: Sponsor: NORTH MASON PEE WEES Location: VACANT LOT 24121 NE HWY 3, BELFAIR WA /s/ /s/ FOR BRETT BERGDAHL Signature of Official Granting Permit Signature of Applicant Title: Agency: Date: Permit Number: Licensee Name: NORTH MASON PEE WEES License Number: 00506 3000-420-013 (Rev.2/05) CERTIFICATE OF INSURANCE ISSUE DATE ACORDr� 10/29/2010 PRODUCER This certificate is issued as a matter of information only and confers no rights MCGRIFF,SEIBELS&WILLIAMS,INC. upon the Certificate Holder. This Certificate does not amend,extend or alter the P.O.Box 10265 coverage afforded by the policies below. Birmingham,AL 35202 COMPANIES AFFORDING COVERAGE PHONE:800-476-2211 Company Liberty Surplus Insurance Company INSURED Company American Promotional Events,Inc. B dba TNT Fireworks P.O.Box 1318 Company Florence,AL 35631 C Company D Company E This is to certify that the policies of insurance described herein have been issued to the Insured named herein for the policy period indicated. Notwithstanding any requirement,term or condition of 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,conditions and exclusions of such policies. Limits shown may have been reduced by paid claims. CO TYPE OF INSURANCE POLICY NUMBER EFFECTIVE LIMITS OF LIABILITY LT EXPIRATION A GENERAL LIABILITY DGLB00810581 11/01/2010 EACH OCCURRENCE $ 1,000,000 ®Commercial General Liability 11/01/2011 FIRE DAMAGE $ 200,000 ❑Claims Made ®occurrence MEDICAL EXPENSE $ EXCLUDED ❑Owners'and Contractors'Protection 1,000,000 1-1 PERS.AND ADVERTISING INJURY $ ❑ GENERAL AGGREGATE $ 2,000,000 General Aggregate Limit applies per. PRODUCTS AND COMP.OPER.AGG. $ 2,000,000 ❑Policy ❑Project ®Location AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ❑Any Automobile BODILY INJURY Perperson) $ ❑All Owned Automobiles BODILY INJURY Per accident $ El Scheduled Automobiles ❑Hired Automobiles PROPERTY DAMAGE Per accident $ ❑Non-owned Automobiles COMPREHENSIVE ❑ COLLISION WORKERS'COMPENSATION WC Statutory Limit Other AND EMPLOYERS'LIABILITY EL EACH ACCIDENT $ EL DISEASE Each employee) $ EL DISEASE(Policy Limit $ EXCESS LIABILITY EACH OCCURRENCE $ ❑Occurrence ❑Claims Made AGGREGATE $ $ $ Re:Reid Realty at 23861 NE Hwy 3 in Belfair,WA(WWM6512) The Certificate Holders are named as Additional Insureds with respect to General Liability as required by written contract subject to policy terms,conditions,and exclusions. CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE Cady Family LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF Reid Realty ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. North Mason Pee Wees Mason County Authorized Representative PO Box 186 426 W Cedar f� Shelton,WA 98584 Page 1 of 1 Certificate 10# 4VDQYFRY Washington State Patrol `a 12 413 Fire Protection Bureau Office Of The State Fire Marshal Fireworks Stand License Washington State Fireworks License License is Non-Transferable and Yalid for Only One Stand Licensee Information North Mason Pee Wees 2120 Milwaukee Way State Fire M rshalYFa t e Tacoma, WA 98421 License Number: WSPFL-00506 Detach this and catty with you for verifi f certification. Stand Information Washington State Patrol 2 A 4 Contact Person: Brett Bergdahl Fire Protection Bureau 13 Phone Number: (360) 710-2121 Office Of The State Fire Marshal ANNUAL FIREWORKS STAND LICENSE County: Mason Date of Expiration Date of Issue Licensee: Northpvfas©ri. Wees Stand Number: SN-05833 January 31, 2012 April 1, 2011 Contact Person: BreBergdah�C �> . License Number: WSPROaSt16- ., t d Number: - Q San 1� b r. SN A5: 33 xi id For One Stand] Date of Expiration: Jantaar}_:3�, Stand Location: Location: v"'! ( rand Location ompleted By Licensee) [Stand Location To Be Completed By Licensee] 3000-420-012(R 9/05) State Fire Mars alfnature Licensee Signature I II MASON COUNTY FIRE MARSHAL . > Mason County Bldg.III 426 W Cedar St PO BOX 186 Shelton,WA 98584 (360)427-9670 Ext.273 CODE ENFORCEMENT FIRE INSPECTIONS FIRE INVESTIGATION PUBLIC EDUCATION STANDARDS FOR THE OPERATION OF RETAIL FIREWORKS STANDS Sales Consumer fire works may be sold only on the following days and times. • June 28 h from 12 noon to 11PM • June 29th—July 5t' from 9AM to 11PM • July 6th from 9AM to 12 noon • December 27th—31" from 12 noon to 11PM Approved Fireworks Only Washington State Fire Marshal approved Class C common fireworks may be sold. Fireworks Stand Location • A fireworks stand shall not be located more than 150' from an approved access road, • Shall beat least 100' from another fireworks stand or separated by a.road, street or highway at least 30' in width, • Shall not be located any closer than allowed by the table below to other structures or exposures, • Or be located closer than 100' from any flammable liquid or gas dispensing device, or 300' from any flammable liquid or gas bulk storage or dispensing facility. Retail Fireworks Stands—Minimum Clearances Buildings Combustibles Property Line Parking Motor Vehicle Motor Vehicle Traffic, Traffic, Public Road Private Way Back of Stand 20' 20' 5' 20' 20' 5' Side of Stand 20' 20' 5' 20' 20' 5' Front of Stand 20' 20' 20' 20' 20' 20' Surrounding Area around Fireworks Stands • The minimum areas around fireworks stands, as specified above, shall be kept free from dry grass, brush or combustible debris. This area shall be marked and flagged. • Motor vehicles or trailers may not be parked within 20' of the fireworks stand except when delivering, loading or unloading fireworks. • Fireworks shall not be discharged within 300' of any fireworks stand. A sign stating No Fireworks Discharge Within 300' in letters at least 2"high and in contrasting color shall be posted conspicuously on all sides of the structure. • No smoking shall be allowed within the fireworks stand or flagged off area. Signs stating No Smoking Within 100' in letters at least 2"high and in contrasting color shall be posted conspicuously on all sides of the structure. Electrical Supply & Usage • All battery powered equipment, electrical equipment and cords shall be UL listed and used in accordance with that listing. Extension cords shall be of an industrial grade type and shall be protected from physical damage. • All heating devices shall be UL listed. Only heating devices with sealed-type elements shall be used, i.e. oil filled or water-filled radiator type. Open flame or open element heating devices are prohibited. • Generators shall be located a minimum of 20' from any fireworks stand. Fuel storage is limited to 5 gallons. Fireworks Stand Operations • A minimum 24"wide isle shall be maintained inside the full length of the stand. • Customers are not allowed inside the fireworks stand. • There shall be a minimum of 2 exits at least 28"in width located at opposite ends of the stand. These exits shall remain unlocked and unobstructed during hours of operation or when stand is occupied. • Sleeping inside a fireworks stand is prohibited. • The location of the nearest phone shall be posted in the fireworks stand. All occupants of the stand shall be informed as to the location of this phone. • The local emergency phone number, 911, and the address of the fireworks stand shall be conspicuously posted inside the stand. • There shall be a minimum of 2 (two) approved 2 1/2 gallon pressurized water fire extinguishers located adjacent to each exit door. • Cooking, open flame or any type of open flame equipment is prohibited in a fireworks stand. • Fireworks stands shall be locked when unoccupied and not open for business if fireworks are stored in the stand during these times. Fireworks stands shall not be locked when occupied. Fireworks may be removed or transferred to a temporary storage structure or location approved as part of the license and permit. • Fireworks may be stored in a locked and secured retail fireworks stand, truck, container, or trailer that is at least 20' from the fireworks stand during business hours, or in a locked or secured metal or wooden garage, shed,bam or other accessory building that is a least 20' from the fireworks stand. • At least one person 18yrs of age or older shall be on duty in the fireworks stand when fireworks are being sold to the public. Such person shall be responsible for the supervision of the fireworks stand and its operation. No person under the age of 16 shall be allowed to occupy the fireworks stand when it is open to the public. • It is illegal to knowingly sell fireworks to persons under the age of 16. A sign stating"No Sale Of Fireworks to Persons Under the Age Of 16"in letters at least 2"high and in contrasting color shall be posted on the front of the stand. A photo ID is required and it is the responsibility of the seller to require proof of age. Driver's License or Photo ID showing a date of birth issued by a public or private school, state, federal or foreign government is acceptable. o � 232 3 1-/0 vH ANGES 5UEM11 C`'A��GES FOR APPROVAL G�R.,)t; r NEt?fORPJIING WORK APPROVED MASON COUNTY FIRE DATE��"// gy C�j ` " _ I SWBJECT TO FIELD fNSPEC T f ';•f 1 -- 1 ALL APPLIGAYL CODES RHALL APPLY. EPRC)=±S ANO/OR C-tSSIONS ON PLANS ARE SOLE Fr 1 LRPONSIBILITY OF OWNER/CONTRACTOR. „)p;RL G. i TIONS REOUIRED FROM FIELD INSP?CTIO'- sw L 9E AT OWNER/COnTPACTOR'S E%HEN^E. H:: p. PROVAL DOES NOT GRANT TO ANY PUnS'.!M1; ;: + RIGHT TO VIOLATE ANY CI'1-Y OR ;"ATE l