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HomeMy WebLinkAboutFIR2019-00013 Final Fireworks Stand - FIR Permit / Conditions - 7/19/2019 Mason County o Mason County - Division of Community Development 615 W. Alder St. Bldg. 8 Shelton, WA 98584 360-427-9670 ext 352 www.co.mason.wa.us FIR2019-00013 FIREWORKS DISPLAY & STAND APPLICATION & STANDARDS PROJECT DESCRIPTION: FIREWORKS STAND FOR NORTH MASON ISSUED: 05/22/2019 PEE WEES SITE ADDRESS: 23800 NE STATE ROUTE 3 BELFAIR EXPIRES: 11/18/2019 PARCEL: 123294100150 APPLICANT: NORTH MASON PEE WEE'S OWNER: JOLEEN REYNOLDS P O BOX 493 15110 94TH AVE NW BELFAIR,WA 98528 GIG HARBOR,WA 98329 1.360.551.2411 FEES: Paid Due Retail Fireworks Stand Permit $100.00 $0.00 Fee Totals : $100.00 $0.00 REQUIRED INSPECTIONS Fireworks Inspection CONDITIONS 3) Fireworks shall not be discharged within one hundred feet of a retail fireworks stand. Signs reading "NO (REWORKS DISCHARGE WITHIN 100 FEET" in letters at least two inches high, with a principal stroke of not less than one-half inch, on contrasting background, shall be conspicuously posted on all four sides of the stand. " STORAGE ASSOCIATED WITH RETAIL FIREWORKS: WAC 212-17-21517 Retailers of fireworks—Temporary fireworks storage associated with the retail fireworks stand operation. (1)Temporary fireworks storage is not permanent fireworks storage. Temporary fireworks storage is defined as storage associated with retail fireworks sales and may only be from June 13 through July 31 and from December 12 through January 10 of the following year. Permanent fireworks storage is associated with retail or wholesale fireworks activities when the period of time of storage is other than, or longer than that specified for temporary storage. Temporary fireworks storage shall be in accordance with this section. Permanent fireworks storage is subject to the International Fire Code and the and local ordinances. Printed by:Genie Mcfarland on:05/22/2019 11:44 AM Page 1 of 5 Mason County o Mason County - Division of Community Development 615 W. Alder St. Bldg. 8 Shelton, WA 98584 360-427-9670 ext 352 www.co.mason.wa.us FIREWORKS DISPLAY & STAND APPLICATION & STANDARDS FIR2019-00013 * WAC 212-17-21509 Retailers of fireworks-Location. (1)Activities or uses subject to this rule shall not be limited in location except where such activities or uses are prohibited or controlled by local development regulation, traffic safety or road construction standards. * (2) Cities and counties may require a clean-up bond, not to exceed five hundred dollars, as a condition of the permit, to ensure the removal of all structures and debris from the site. * (6) Retail sales of fireworks and other products which are holiday related shall be from buildings used for no other purpose. * (3)Any two retail fireworks stands shall be at least one hundred feet apart or shall be separated by a road, street or highway not less than thirty feet in width. * Licensees shall familiarize all persons working in a retail fireworks stand with the provisions of these rules. * (4) Retail fireworks stands shall be located as required by Table 212-17-21509 in this section. The minimum required area surrounding the stand shall be marked or flagged, except that flagging and marking shall not block a sidewalk or pedestrian pathway. Flagging need not exceed twenty feet in any direction. NOTE: Clearance distances are not cumulative *Measured from the outer edge of the nearest traffic lane. **If stand is equipped with 135 fusible links which will automatically close all sales doors in case of fire, or is equipped with a wire-mesh screen with openings of not more than one inch which covers not less than 90% of all sales openings * (8) No cooking is permitted in a retail fireworks stand or in a temporary fireworks storage structure. * APPROVED FIREWORKS: Only Division 1 AG consumer fireworks, obtained from state-licensed wholesalers, not otherwise prohibited by chapter 70.77 RCW or local ordinance, and holiday related products incidental but related to these products, may be sold in retail fireworks stands. * (9)Temporary fireworks storage structures may be inspected prior to use and other inspections may occur on other days as warranted. There shall be no additional charge for all such inspections. * SURROUNDING AREA AROUND FIREWORKS STANDS: WAC 212-17-21511 Retailers of fireworks-Area around the retail firework stand. (1)The minimum areas around the retail fireworks stand specified in WAC 212-17-21509 shall be kept free of accumulation of dry grass, dry brush and combustible debris. No parking shall be permitted within this minimum area. * (2) No motor vehicle or trailer may be parked within twenty feet of a retail fireworks stand except when delivering, loading or unloading fireworks. * (4) Generators which use combustible fuel and which are at least twenty feet from the retail fireworks stand or the temporary fireworks storage structure shall be allowed. Generator fuel shall be limited to not more than five gallons and stored at least twenty feet from all stands. * (4) No open flames nor any type of open flame equipment shall be allowed in any temporary fireworks storage structure. Printed by:Genie Mcfarland on:05/22/2019 11:44 AM Page 2 of 5 ' Mason County Mason County - Division of Community Development 615 W. Alder St. Bldg. 8 Shelton, WA 98584 360-427-9670 ext 352 www.co.mason.wa.us FIREWORKS DISPLAY & STAND APPLICATION & STANDARDS FIR2019-00013 " ELECTRICAL SUPPLY & USAGE: WAC 212-17-21513 Retailers of fireworks-Stand use and construction. (1) Fireworks may be sold from: (a)A permanent structure which meets provisions of WAC 212-17-21505(3). (b)Temporary, stable structures made from wood, metal, fiberglass or other material. Any temporary fireworks retail stand greater than four hundred square feet shall meet the requirements of a permanent structure, except tents or canopies as defined in the International Fire Code retail stand greater than four hundred square feet shall meet the requirements of a permanent structure, (c)Tents, canopies, or structures utilizing temporary membrane material.All tents, canopies or Temporary membrane materials structures shall be made from fire retardant material or treated with a fire retardant as identified in the International Fire Code. Any tent, canopy or temporary membrane material structure falling within the scope of the International Fire Code shall comply with those requirements. When those requirements are in conflict with other provisions of these rules, the more restrictive provisions shall apply. * (4) No smoking shall be allowed within the retail fireworks stand or within the minimum flagged off area. Signs reading "NO SMOKING WITHIN 20 FEET' in letters at least two inches high, with principal stroke of not less than one-half inch, on a contrasting background, shall be conspicuously posted on all four sides of the stand. " WAC 212-17-21505 Retailers of fireworks—General provisions. Fireworks may be sold from 12:00 noon to 11:00 p.m. on June 28 through 9:00 p.m. on July 5. Fireworks may not be sold between the hours of 11:00 p.m. and 9:00 a.m. from June 28 through July 3. Fireworks may not be sold from 12:00 midnight on July 4 through 9:00 a.m. on July 5. " (6) Fireworks may be stored: (a) In a locked or secured retail fireworks stand; or (b) In a locked or secured truck, container, trailer, other vehicle or anything similar which is not less than twenty feet from the retail fireworks stand during hours of retail sales; or (c) In a locked or secured truck, container, trailer, other vehicle or anything similar which is not less than twenty feet from an inhabited building where the term "inhabited building" is defined as in the International Fire Code; or (d) In a magazine which meets the minimum standards of Type 4 as prescribed by the International Fire Code, and which is not less than ten feet from an inhabited building where the term "inhabited building" is defined as in the International Fire Code; or (e) In a locked or secured metal or wooden garage, shed, barn or other accessory building, or anything similar which is not less than: 20 feet from an inhabited building for storage of fireworks for one or two retail stands; or 30 feet from an inhabited building for storage of fireworks for three or more stands. The term "inhabited building" is defined as in the International Fire Code. " (2) Battery powered equipment, electrical equipment and electrical cords which are used in conjunction with a retail fireworks stand or a temporary storage structure or location must be listed by a recognized laboratory and used in accordance with that listing. If electrical power is supplied by an extension cord, the size of the cord, the length of the cord and the amperage and the voltage supplied shall be in compliance with the requirements of the National Electrical Code, current edition. The cord shall be protected as necessary from "drive-over" and other physical damage. No additional permits from a city or county or state official having jurisdiction shall be required for these temporary uses except as specified in subsection (5) of this section. (3)All heating units shall be listed by a recognized testing laboratory and shall be used in accordance with the listing. Heating sources shall have "tip-over" and temperature overheat protection. All heating devices shall have sealed type elements (i.e., oil filled or water filled radiator type). Open flame heating devices are prohibited. Printed by:Genie Mcfarland on:05/22/2019 11:44 AM Page 3 of 5 7 ' Mason County o Mason County - Division of Community Development 615 W. Alder St. Bldg. 8 Shelton, WA 98584 360-427-9670 ext 352 www.co.mason.wa.us FIREWORKS DISPLAY & STAND APPLICATION & STANDARDS FIR2019-00013 * Retailers of fireworks—Cleanup. (1)At the end of the legal selling period, all fireworks must remain in the retail fireworks stand, temporary storage location authorized by the retail permit or another location approved by the local authority having jurisdiction or his or her designee until returned to the suppliers from which they were obtained, or until transferred to an approved location. * (2) Delivery of fireworks to a location, or storage of fireworks in a facility, not authorized by the license and permit is prohibited. If the approved storage location is outside the jurisdiction issuing the permit, the authority issuing the permit shall notify the appropriate authorities of the jurisdiction in which the storage is to be located. * Failure to comply at any time with the provisions of this rule or any other applicable regulation shall constitute a violation of chapter 70.77 RCW and may result in the temporary suspension or immediate revocation of the license or permit, closure of the fireworks sales or storage structure, the seizure and/or forfeiture of some or all of the fireworks, and other criminal penalties as specified by law. * (3)A temporary fireworks storage facility or a temporary fireworks storage location shall be authorized as a part of a license and permit if it meets the requirements specified herein. * (7) The local authority having jurisdiction may reduce the minimum separation requirements of this section provided that safety of life and property is not diminished. * Fireworks may be sold from 12:00 noon to 11:00 p.m. on each day from the 27th of December through the 31st of December of each year. * (2)Temporary retail fireworks stands shall not be located more than one hundred fifty feet from a private way, fire department access road, public road, street or highway as measured by an approved route around the exterior of the stand. The minimum requirements for a private way shall be determined by the local authority having jurisdiction, but shall not exceed the requirements of locally adopted street, road and access standards. * (4) Failure of the licensee to comply with subsection (3)of this section shall constitute forfeiture of the clean-up bond and the licensee shall be liable for any clean-up costs incurred by the city or county which exceed the amount of the bond. * (5) Compliance with the National Electrical Code, current edition, shall be required for all new, permanent electrical installations, including temporary power drops, subject to possible permit fees. * (5) Storage of fireworks authorized by a retail license and permit is legal only during the periods specified in this section. * (3) In order to obtain return of a clean-up bond, cleanup of debris associated with the retail fireworks activity and the removal of all temporary structures authorized by the license and permit shall be completed no later than 11:59 p.m., July 15 for the Fourth of July selling period or no later than 11:59 p.m., January 10 for the New Year's selling season. * (5) Retail fireworks stands shall not be located closer than one hundred feet from any motor vehicle dispensing station, retail propane dispensing station, flammable liquid storage, or combustible liquid storage. Retail fireworks stands shall not be located closer than three hundred feet from any bulk storage of flammable or combustible liquid or gas, including bulk plant dispensing areas. EXCEPTION: 1. Fuel for generators as allowed by WAC 212-17-21513(4). 2. Fuel within the tanks of motor vehicles. Printed by:Genie Mcfarland on:05/22/2019 11:44 AM Page 4 of 5 Mason County IVA Mason County - Division of Community Development 615 W. Alder St. Bldg. 8 Shelton, WA 98584 360-427-9670 ext 352 www.co.mason.wa.us FIREWORKS DISPLAY & STAND APPLICATION & STANDARDS FIR2019-00013 I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of Laws and Ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state/local law regulating construction or the performance of construction. Issued By: C L101 Contractor or Authorized Agent: ( I Date: Printed by:Genie Mcfarland on:05/22/2019 11:44 AM Page 5 of 5 I t . �AgoN �oUH�A MASON COUNTY (360)427-9670 Shelton ext.352 DEPARTMENT OF COMMUNITY DEVELOPMENT (360) 275-4467 Belfairext. 352 BUILDING• PLANNING • FIRE MARSHAL (360)482-5269 Elma ext. 352 Y Mason County Bldg. III, 426 1kreeL V PO Box 279, Shelton, WA 98 ED www.co.mason.wa.us APR 3 0 2019 FIR20 615 W. Al er Street Mason County Fireworks Permit Application Incomplete applications will not be accepted A permit for 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: Owner: /✓�e2Tf� ��Soy✓ f'�L WC_ -S Mailing Address: moo• ,&X e/95 City: ,&7 14597o State: wv4 Zip: 9$,528 Phone #: 31eo -- 5-57 - ZY// Email: C-oby d, Jre;�dalay rA av lam. Sponsor Information: Name: (f 6,6 Y =Ae-fYD h/Ay Address: 3 9/ UA✓I&A/ )e-ivy-212Xity: ,&e7,6220-1rL State: t449 Zip: �BS� Phone #: 3&D 6-3-1 - 2!/ 1 f Email: C06Y A. e w4y 4 Washington State Fireworks License Information (Copy Required): License Number: L/� Z Ob S 7 Date of Issuance /Z I z Z o/9 ❑ Pyrotechnic Operator License Xireworks Stand License Bond or Certificate of Insurance (Copy of Certificate/Bond Required): Provider: oB 77eiW Insured: WC3/ �✓ G//r'Gy✓� S �'y� Certified Holder: ,/ex?7/ dr op✓ pc� til Location of Stand/Display: Site Address: 2_ 3 goo /✓F %f�7Z- lZe V/2 Directions to Site: 1;3�99- J41 - 00150 Parcel Number: (twelve digit number) Legal Property Owner pLE-Fig/ I�E3/No,c !�S "Please see reverse side to complete your application' DocuSign Envelope ID 58AE8BA7-B356-4E15-BE06-3FE25C1E13A1 Western Fireworks, Inc. Fireworks Lease Agreement 14592 Ottaway Rd.NE Aurora,Or. 97002 A This agreement is entered into on this 6 day of prl 1 ,2019 ,by and between Western Fireworks,Inc.at P.O. Box 426, 14592 Ottaway Rd.,N.E.,Aurora,OR 97002,hereinafter referred to as "LESSEE"and Joleen Reynolds ,hereinafter referred to as"LESSOR",for the purpose of leasing space for the sales of approved fireworks from the following premises,hereinafter referred to as"LOCATION". Location: Name: SEABECK PIZZA Address: 23800 SR 3.BELFAIR WA 98528 Leased Area: GRASS AREA,LEFT HAND SIDE OF PIZZA PARLOR(FACING) lot space to erect a 20 x 40 tent with a 20' aerimeter as required by fire marshal . 1) Lessor agrees to grant the Lessee the exclusive right to operate a fireworks sales outlet,hereinafter referred to as the"STRUCTURE". Permission is hereby given to erect a Structure for the period of June 24`h to July 9', 2019,hereinafter referred to as"SEASON". Lessor represents that the Location is owned and/or controlled by the Lessor. 2) Lessee agrees to the following terms and conditions: a) Provide liability insurance coverage and upon request to the Lessor,prior to occupancy, a certificate of insurance,evidencing liability insurance in force covering the erection and operation of the Structure. Said insurance shall name Lessor as additional insured,and Lessor shall be held harmless from any claims arising from the maintenance or operation of the Structure. b) Pay any and all costs involved in erection,maintenance,and operation of the Structure, and shall guarantee that the Location will be returned to its original condition. c) Obtain and pay for all necessary permits and licenses required by law,post with local authority any debris or performance bonds as required,and guarantee that all laws and regulations shall be adhered to. d) 3) This agreement is contingent upon Lessee securing necessM permits and licenses. Lessee may cancel this agreement if the sale of fireworks is prohibited at this Location by a public authority or such sale,in the good faith opinion of Lessee,becomes commercially unreasonable. In such an event any deposit shall be refunded to Lessee. Lessee maintains exclusive right to operate a fireworks outlet on said property for season. 4) The Lessor hereby grants Lessee a first right of refusal to match any bona fide offer to lease the Location for fireworks sales during the renewal Seasons. LESSOIE� K el ohs LESSEE: i Fireworks, Inc By. 5207ME9292"Ft By. I At P...4 .4 Print Name M1 en.Reaolds Print Name:"°`'I MY Pavlicek Address: 1'� —� a nw Date: Gig Harbor WA V83Z9 PHONE: 253-358-9296 Tax ID/SS Number: 536823743 EMAIL: ]-ooeen sea ec plzza.com PAYABLE TO: Jol een Reynolds AC" CERTIFICATE OF LIABILITY INSURANCEF4/25/2019 DATE(MMIDDIYVYY) 1111.� 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 endorsements. PRODUCER CONTACT NAME: Britton Gallagher PH ONE 1 - - A/C No: 1Sz6�$_7_1 One Cleveland Center, Floor 30 E-MAIL 1375 East 9th Street ADDRESS: Cleveland OH 44114 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:EVe rest IndemnityInsurance 10851 INSURED INSURERB:Everest Nation-all Insurance.0Qmpany. 10120 Western Fireworks, Inc. INSURERc_Axis Surplus Insurance Company 26620 P.O. Box 426 INSURER D: Aurora OR 97002 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:701668992 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. INSRR TYPE OF INSURANCE INSR POLICY NUMBER MPOLICY EFF POLICY EXP LIMITS A GENERAL LIABILITY SIBML00104-191 3/1/2019 3/1/2020 EACH OCCURRENCE 51,000,000 DAMAGE To RENTEU X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $500,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) 5 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $1,000,000 POLICY PRO- _X ' LOC $ B AUTOMOBILE LIABILITY SISCA00050-191 3/1/2019 3/1/2020 Ea accident 1 000 000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X X NON-OWNED PROPERTY DAMAGE _ HIREDAUTOS AUTOS Pera.deM S C UMBRELLA LIAB X OCCUR P-001-000087407-01 3/1/2019 3/1/2020 EACH OCCURRENCE $1,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DED RETENTIONS $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN , ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT E OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE 9 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement. LOCATION: 23800 SR 3 BELFAIR WA 98528. SEABECK PIZZA ADDITIONAL INSURED: SEABECK PIZZA, JOLEEN REYNOLDS, MASON COUNTY IT'S EMPLOYEES,AGENTS,AND VOLUNTEERS, COBY TREADWAY. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE NORTH MASON PEE WEES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. BOX 493 ACCORDANCE WITH THE POLICY PROVISIONS. BELFAIR WA 98528 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD •�'"�"` "'ram Washington State Patrol Fire Protection Bureau Office of the State Fire Marshal G20087 -- . ' CONSUMER FIREWORKS RETAIL SALES (CFRS) FACILITY LICENSE �.,R�f Stand Number: SN-12465 Licensee Data Operational Data Western Fireworks, Inc. Wholesaler: Western Fireworks, Inc. Post Office Box 426 County of Operation: Mason Aurora, OR 97002 Operates For: �,vr/ �� L✓ License Number: WSPFL-02781 Stand Operated By: Phone Number: (503) 678-2378 Date of Issue:January 9. 2019 Date of Expiration January 31 , 2020 Consumer Fireworks Retailer Licenses issued after May are ONLY valid for New Years Sales is license is NOT valid without a permit from a local fire code official/authority having jurisdiction This license allows for operation of a single location/stand fo retail sales to the public of state legal consumer fireworks purchased only from a licensed fireworks wholesaler. SURRENDER THIS PORTION OF THE LICENSE TO THE FIREWORKS WHOLESALER 3000-420-041(10/18) ------------------- - - -- ------- - ------------------ + °T0N"'� Washington State Patrol Fire Protection Bureau a+r t Office of the State Fire Marshal G20087 CONSUMER FIREWORKS RETAIL SALES (CFRS) FACILITY LICENSE r Stand Number SN-12465 �Fy4BSNAlS OAA\ Licensee Data Operational Data Western Fireworks, Inc Wholesaler: Western Fireworks, Inc. Post Office Box 426 County of Operation: Mason Aurora, OR 97002 Operates Forte y✓ 3 License Number: WSPFL-02781 Stand Operated By: Phone Number: (503) 678-2378 ` Date of Issue:January 9, 2019 Date of Expiration:January 31, 2020 Consumer Fireworks Retailer Licenses issued after May are ONLY valid for New Years Sales This license is NOT valid without a permit from a local fire code official/authority having jurisdiction. This license allows for operation of a single location/stand for retail sales to the public of state legal consumer fireworks purchased only from a licensed fireworks wholesaler THIS LICENSE PORTION ACCOMPANIES YOUR LOCAL PERMIT APPLICATION 3000-420-041(10/18) Washington State Patrol Fire Protection Bureau Office of the State Fire Marshal G20087 CONSUMER FIREWORKS RETAIL SALES (CFRS) FACILITY LICENSE t�+F'*,q�„AO' Stand Number: SN-12465 Licensee Data Operational Data Western Fireworks, Inc Wholesaler: Western Fireworks, Inc. Post Office Box 426 County of Operation: Mason _ Aurora, OR 97002 Operates For: /v�'X70 Af,,'f5e1V '.0e--L License Number: WSPFL-02781 Stand Operated By: f„21-71 y� �.v ��-� �,✓��3 Phone Number: (503) 678-2378 Date of Issue-.January 9, 2019 Date of Expiration:January 31 , 2020 Consumer Fireworks Retailer Licenses issued after May are ONLY valid for New Years Sales This license is NOT valid without a permit from a local fire code official/authority having jurisdiction. This license allows for operation of a single location/stand for retail sales to the public of state legal consumer fireworks purchased only from a licensed fireworks wholesaler 3000-420-041(10/18) THIS PORTION OF THE LICENSE MUST BE POSTED AT THE STAND AT ALL TIMES The following pertinent information MUST be provided on the site diagram below Location and Setback distances from the back, sides and front of retail sales stands or designated display areas to: Fire Hydrants Property Lines Mortar separation distance Combustibles Parking Designated landing area Fire Lanes Public Roads and Right of Ways Trees/Brush Private Roads and Right of Ways Utilities Landmarks .T f f t �� 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 VA��v�/9