HomeMy WebLinkAboutFW94-0008 Fireworks - FIR Permit / Conditions - 6/23/1994 MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
M JE S C iC L L A N E C3 U S3 R 1-= R h�� F f FOR INSPECTIONS CALL 427-9670
FW94-0008 PARCEL : 1232942-0-00f7T �-(PLAT : DIV: ? BLK : ? LOT : ?
JOB ADDRESS : NE 201 STATE ROUTE 300 BELFAIR
APPLICANT : PYRODYNE AMERICAN CORPORATION
OWNER : PYRODYNE AMERICAN CORPORATION
LEGAL : Tr 11 of NH SE
PROJECT DESCRIPTION :
FIREWORKS PERMIT
PROJECT LOCATION :
201 OLD BELFAIR HWY
PROJECT NOTES :
TYPE AMOUNT BY DATE RECEIPT
PRMT $ 10 . 00 KS 06 /23 /94 0048
TOTAL : 10 . 00 OWNER ORZff I&G NT — DATED/
MIS_PNMT, rev: 04/01/92
APPLICATION DATE OF APPLICATION
FOR RETAIL FIREWORKS STAND PERMIT
TO: Governing body of city, town or county in which fireworks stand will be located
APPLICANT
NAME ADDRESS
SPONSOR(IF OTHER THAN APPLICANT) ADDRESS
AS(W-i PEE WEES
LOCATION OF PROPOSED FIREWORKS STAND
MANNER 8 PLACE OF STORAGE PRIOR,DURING & AFTER SALES DATES
FIREWORKS SUPPLIER
(ALL FIREWORKS MUST BE RETURNED TO SUPPLIER OR OTHERWISE DISPOSED OF'BEFORE JULY 31ST)
SIGNATURE OF APPLICANT
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;:_ PERMIT �qa�
Year 'd
_ (Must be conspicuously displayed at all times stand is open to the public)
By virtue of having been granted a permit by the local governing authority and a license by
the State of Washington, the named person, firm or organization is hereby authorized to sell
Class C Common fireworks at the location designated herein between the hours of 12 noon on
June 28th and 12 noon on July 6th, in accordance with RCW 70.77.
Sponsor
Location "
/s/ /s/
Signature of Official Granting Permit /Signature of Official Issuing ense
Title UhVV LW Licensing Division
= Agency OFFICE OF STATE FIRE MARSHAL
Olympia, WA 04
Date Permit # OO? Date ! License il
PERMIT NOT VALID UNLESS SIGNED BY BOTH LOCAL AUTHORITY AND STATE FIRE MARSHAL
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AUTHORIZATION TO PURCHASE CLASS C COMMON FIREWORKS
Possession by the applicant of this completed application, signed by both the local issuing
authority and the State Fire Marshal, authorizes the applicant to purchase Class C common
fireworks for retail sale from the supplier shown at the location indicated.
COPY "B"—Local Authority (instructions on reverse side of form) Form SF 601 QX A-252
RETAIL FIREWORKS STAND LICENSEE REQUIREMENTS
1. Fireworks may be sold only in roadside stands or buildings used for no other purpose.
2. A license and permit to operate a fireworks stand does not authorize the sale of articles other than fireworks.
Only Class C common fireworks, not otherwise prohibited by RCW 70.77, may be sold in fireworks stands.
4. Only fireworks obtained from licensed wholesalers may be sold in licensed retail stands.
5. Fireworks can be sold only between the hours of 12:00 noon, June 28th and 12:00 noon, July 6th.
6. Fireworks may not be sold between the hours of 11:00 P.M. and 9:00 A.M.
7. At least one adult person(age 18 or over)shall be present at all times the fireworks stand is open to the public.No person under 16
years of age shall be allowed to sell fireworks or remain within a fireworks stand when it is open to the public.
3. Fireworks must be displayed in a manner to prevent handling by the public prior to sale.
9. At least two fire extinguishers, 21/2 gallon water or equivalent, must be accessible to sales personnel.
10. Smoking and the discharge of fireworks shall be prohibited within 25 feet of the fireworks stand.
11. No fireworks shall be discharged within 100 feet of the fireworks stand.
12. "No Smoking" signs, with red letters at least two inches high, shall be posted at conspicuous locations and in plain view of all
purchasers.
13. A list of fireworks that may be sold to the public,as furnished by the State Fire Marshal,must be prominently posted at each retail
stand.
14 Fireworks stands shall be maintained free from any condition which increases,or may cause an increase of the hazard or menace of fire
or explosion,or which may become the cause of any obstruction,delay or hindrance to the prevention,suppression or extinguishment
of fire.
15. Adequate and safe means of exit shall be provided from all areas where fireworks are sold.
16. Fireworks stands shall be securely locked when not open for business,or all fireworks removed to a safe location approved by the local
fire official.
17. Fireworks shall be promptly removed from the fireworks stand and either returned to the supplier or transferred to an approved
storage facility, pending ultimate disposal prior to July 31st, at conclusion of the season.
18. Licensees are responsible to instruct all employees in these requirements.
19. Violation of these requirements constitutes a misdemeanor and may cause the immediate closure of the stand and seizure of remaining
fireworks in addition to the criminal penalties of law.
INSTRUCTIONS
Applicant.
1. Complete the application,giving the name of the person or firm applying for the license and,if other than the applicant,the name of
the sponsor under which name the fireworks stand will be licensed and operated.
2. Provide the location of the stand,i.e.the address plus sufficient descriptive information to identify the specific site or structure to be
used.
3. Indicate where the fireworks are to be stored prior to sales date,during sales period when stand is closed,and after sales date prior to
July 31st(possession of fireworks by other than licensed wholesalers not permitted after this date). Storage locations are subject to
local Fire Dept. approval.
4. Indicate the name of the licensed fireworks wholesaler.from whom the fireworks are to be obtained.
5. Fill in the name of the sponsor,or name under which the stand will operate,and the address where the fireworks stand will be located,
on the Permit.
6. Sign the completed application and present to the chief fire official of the city, town,county or fire protection district in which the
stand is to be located.
Fire Official/Local Governing Authority.
1. Make an investigation of the proposed fireworks stand location to determine whether it will be hazardous to property or dangerous to
life.
2. Exercise reasonable discretion in evaluating fire and traffic hazards during hours of operation and the safe storage of fireworks before,
during and after the sales period.
3. Submit your findings and recommendations to the governing body of the city,town,county or fire protection district for final decision
or, in the event that this authority has been delegated to you, approve or deny the permit.
4. If approved, retain Copy B as your record for follow-up inspections and return Copies A and C to the applicant.
Applicant.
1. Forward the completed Copies A and C to the State Fire Marshal.Include the$10.00 license fee.The license and completed Copy A
will be returned to you,which will authorize the applicant to purchase Class C common fireworks from the licensed wholesaler.License
applications must be made to the State Fire Marshal by June 10 of the year for which the license is desired.
2. The Permit must be conspicuously displayed at all times the fireworks stand is open to the public.
3. The storage of fireworks and any requirement/restrictions imposed by the local governing authority must be strictly observed.
4 Unsold fireworks must be returned to the supplier or otherwise disposed of prior to July 31st.
NOTES The applicant may apply to the State Fire Marshal for a license prior to obtaining local approval.However,the Permit is not
valid nor the purchase of fireworks authorized until local approval has been obtained.License fees paid are non-refundable
in the event local approval is denied.
DR.AYTON INSURANCE BROKERS, INC. Z> C CC,- ( :t L y
� eC24kH cKfIl/
2500 CENTER POINT ROAD POST OFFICE BOX 94067
BIRNIINGHAM. ALABANIA 35215 BIRMINGHAM,ALABAMA 35220
TELEPHONE-: (205) b54-5806 FAX:(205)854-5699
CERTIFICATE OF INSURANCE
We certify that insurance as outlined below is afforded the Famed Insured under Policy No.A93EG23040 issued by Admiral Insurance
Company.
FAMED INSURED. Pyrodyne American Corporation Certificate No: 455313
Humdinger Fireworks
American West Marketing,Inc. D
Freedom Fireworks.Inc. EDUAmerican Pyrotechnic Importers,Inc. 0
P. O. Box 1436
Tacoma,Washington 98401 1994
PERIOD: November 1. 1993 to October 31, 1994;Both Days Inclusive. GENERAL SERVICES
COVERAGE: Commercial General Liability including Premises&Operations Liability and Products&Completed Operations
Liability.
LIMITS OF LIABILIT')': A) Each Occurrence 51.000,000
b) Products 6c Completed Operations Aggregate S1,000.000
The above stated limits of liability apply to each occurrnce but,as respects Products and Completed Operations liability only,in the
ac-gtegate.
It is certified that in accordance with, and subject to, the terms of the above policy the following SPONSORS AND/OR COMMITTEES
AND/OR PROPERTY OWNERS AND/OR LICENSING AUTHORITIES are included as Additional Insured(s), but only in respect of the
legal liability of such Additional Insureds for Bodily Injury and Property Damage arising out of; 1) the ownership or use of the Insured
Premises stated below, which are used for the sale of fireworks distributed by the Named Insured, 2) the sale by the Additional Insured of
fireworks distributed by the Named Insured. The limits of liability stated above shall not be increased either; 1)by the inclusion of more than
one Insured; nor 2) by the receipt of more than one certificate by any Insured.
INSURED PREMISES: Location Id: WWM-6505
STOCK MARKET
201 OLD BELFAIR HWY
BELFAIR, WA
ADDITIONAL INSUREDS:
COUNTY OF MASON
N MASON PEE WEES C/O JEFFERY R BISHOP
NE 1280 LARSON BLVD
their officers,agents and employees when acting in their official capacities as such.
Notwi,hstanding any requirement,term or condition of any contract or other document with respect to which this certificate may be issued. or
may penatn. the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions of such policy. For
particulars concerning such terms.exclusions,and conditions each Additional Insured is referred to the poltc} documents in the possession of
the Named Insured. Should the above described policy be cancelled before the expiration date thereof,the issuing company will mail 30 days,
prior w ntten notice to the above named Additional Insured.
DRA)'TON INSURANCE BROKERS,INC.
01/04/93
DATE A.J. STRINGER.PRESI tNT
J U H 15 94 1 5: 58 PY'PClD PAGE . 02
tMER�vCAN
F C ]RATION
P.O. Box 1436 --- Tacoma, WA 98401 — (206) 922-871g
FIREWORKS STAND LEASE AGREEMENT �
This agreement is made between Keith Uddenber Tnc.
PYRODYNE AMERICAN CORPORATION as Lessee, for the as Lessor purpose th
of allowing the retailing,of
approved fireworks from the location of:
NAME: See attached ADDRESS: See Attached
ORDINANCE OF: CITY:
STATE:..____..._.
Lessor represents that the parking lot or Commonly occupied premises as listed above is owned
and/or controlled by the Lessor and furthermore that the Lessor agrees to grant Lessee the exclusive
right to operate a Retail Fireworks Stand on these premises for the period from:
June 28th 1922 to July 6th
19-92,_
In return, Lessee agrees to the following terms and conditions:
1. Provide liability insurance coverage and upon request post with Lessor, prior to occupancy,a
certificate of insurance, evidencing liability insurance in force covering the erection and operation of
the retail stand. 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 stand.
2. Pay any and all costs involved in erection, maintenance, and operation of the stand and
Lessee shall guarantee that the premises will be returned to their original condition.3. Obtain and pay for all necessary '
authority any debris or performance bonds which might be required, and guarrancenses required by �teeth t a with local
regulations will be adhered to: at all Taws and
4. If the sale of fireworks is prohibited by public authority, then this lease agreement shall
automatically become null and void, If the local municipality having
limits the sale of fireworks or makes any other local rules changing he state statutes, this leaurisdiction se
agreement is subject to revision, se
5. Pay in full to Lessor, on or before June 1st
19 92 a rental
fee of $ _ � attached
-- with a deposit of $
6. This agreement shall be automatically renewed at the same terms and conditions asset forth
above, unless cancelled by either party prior to January 1 st of the renewal year, through the selng
season of 19^ 94 _, Furthermore, Lessor hereby9 and conditions as set forth above change prier to January 1 Lessee
of thetright
e ewal refusal should terms
AGREED AND DATED THIS
day of 1 g�
THIS AGREEMENT CONTINGENT UPON LESSEE SECURING LOCAL AND STATE LICENSES,
L - ENSES.
1J LESSEE: '
ddress:
PYRO NE AMERICAN CORPORATION
Tax I.b.# I Social Security #:
d Corporation d individual or Partnership
DEPOSIT RECEIVED: AMOUNT
a
3d
1 �
t