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Home My WebLink AboutFIR2005-00025 Fireworks Stand - FIR Permit / Conditions - 6/27/2005 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inspection Line(360)427-7262 Phone: (360)427-9670,ext.352 Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Shelton, WA 98584 IrP4 FIRE PROTECTION PERMIT FIR2005-00025 APPLICANT: NORTH MASON PEE WEES RECEIVED: 5/31/2005 CONTRACTOR: AMERICAN PROMOTIONAL EVENTS INC 253-838-1099 LICENSE: EXP ISSUED: 6/27/2005 SITE ADDRESS: 201 NE STATE ROUTE 300 BELFAIR EXPIRES: 12/27/2005 PARCEL NUMBER: LEGAL DESCRIPTION: TR 10 OF NW SE - LOT: B EX OF SP#591 LOT: 1 OF SP #2938 PROJECT DESCRIPTION: FIREWORKS STAND GENERAL INFORMATION System Information Type of Use: STND Sprinkler Heads: Audible Switches: Pull Stations: Fire District: 2 Flow Switches: Visual Devices: Door Releases: Hood & Duct?: N Pressure Switches:: Smoke Detectors: Duct Detectors: Dry Chemical?: N Zones: Heat Detectors: Wet Chemical?: N Spdnkler?: N Standpipe?: N SQUARE FOOTAGE FEES Monitoring Company: First Floor: Type Amount Due Amount Paid Monitoring Phone No.:0 - Second Floor: Fireworks Stand Permit $100.00 $100.00 Auto Fire Alarm?: Third Floor;: Total: $100.00 $100.00 FIR2005-00025 Please refer to the following pages for conditions of this permit. 1 of 3 CASE NOTES FIR2005-00025 CONDITIONS FOR FIR2005-00025 1.) This gation shall meet the minnimum requirements of the Mason County Standards for the Operation of Retail Fireworks Stands (see attached). X An inspection by the Fire Marshal is required prior to opening on June 28th. X r t4- This permit becomes null and 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 ownerorthe agent on the owners behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. I OWN ER OR AGENT: -,\ DATE: FIR2005-00025 Please refer to the following pages for conditions of this permit. 2 of 3 CONCRETE MECHANICAL MANUFACTURED HOME X K3 Footings I Setbacks Date BY Ribbons C) Date By Gas Piping Date By O Foundation WeIla Date By Set-up CD K) Date By INSULATION Da#e By Ln Footings t Setbacks Floors FINAL I NSPECTION Date By Date By Date By FRAMING Walls FIRE DEPARTMENT Date By Date By Date By PLUMBING Attic OTHER Groundwork Date By Date gy WALLBOARD NAILING Date By D.W.v Date By N water Line FINAL INSPECTION CD CD Date By 1 Date By Date ' Type of Insp. Pass/Fail Request Date InspeCt. Date Done By Comments 0 _ 0b- off' 06- A, 8-0-5 u1L77-1L 0 t-/F- > rn � z � O o R o Ln 1 0 6 0 o D O O z O rn s C Sm CD N � G --- - rn n rn U) f W 0 W 1Jl(A Y 1 V1V 11V J Ui�AIV L,>v ISitVriC 1tJ, 11V l.. 2500 CENTER POINT ROAD,SUITE 301 POST OFFICE BOX 94067 BIRMINGHAM,ALABAMA 35215 BIRMINGHAM,ALABAMA 35220 TELEPHONE: (205) 854-5806 FAX: (205) 854-58" CERTIFICATE OF INSURANCE NO. We certify that insurance as outlined below is afforded the Named Insured under Policy No.CA000001858-16 issued by Admiral Insurance Company. NAMED INSURED American Promotional Events,Inc. d/b/a TNT Fireworks Certificate No. 525247 P.O.Box 1318 Florence,Alabama 35631 PERIOD November 1,2004 to October 31,2005. Both Days Inclusive. COVERAGE Commercial General Liability including Premises&Operations Liability and Products&Completed Operations Liability LIMIT OF LIABILITY Each Occurrence $1,000,000 Products Aggregate $2,000,000 General Aggregate $2>000>000 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 lnsured(s),but only in respect of the legal liability of such Additional Insured(s)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 limit 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 No. WW 66505 QFC NE 1403 OLD BELFAIRHWY BELFAIR,WA 98528 ADDITIONAL INSUREDS: MASON COUNTY QFC N MASON PEE WEES Their officers,agents and employees when acting in their official capacities as such. 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 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 policy 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 written notice to the above named Additional Insured. DRAYTON INSURANCE BROKERS,INC. 04/11/05 DATE OF ISSUE A.J.STRINGER, PRESIDWf STAND DIAGRAM Date Drawn: fo L �� ! �' Loc No. Address: �' Ordinance of: Parcel No: Store/Center: Stand Faces Direction of: City& State-_�Gf��`�/' Stand Size: Cross Streets- ��'" S `' � 6' `� Notes: 4 � o l (10) APPLICATION FOR RETAIL FIREWORKS STAND PERMIT WWM6505 TO: Governing body of city,town, or county in which DATE OF 4/13/2005 fireworks stand will be located. iAPPLICATION: Applicant Name (Licensee): Address, City, State: NORTH MASON PEE WEES 2120 MILWAUKEE WAY, TACOMA, WA 98421 Contact Person (If other than applicant): Address, City, State: RANDY NEATHERLIN 2120 MILWAUKEE WAY, TACOMA, WA 98421 Location of proposed fireworks stand: [Enclose drawing of stand location] QFC, NE 1403 OLD BELFAIR HWY, BELFAIR, WA. Manner and place of storage prior, during, and after sales dates: ON SITE WITH SECURITY State Licensed Fireworks Supplier: American Promotional Events NW, PO BOX 1436, Tacoma, WA 98401 - - - - - - - - - - - - -- -- - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - FIREWO]D.KS STAND PERMIT For The Fireworks Sales Year Of: - 2005 (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 local governing authority, the named person, firm or organization is hereby authorized to sell U.N. 0336 I AG Consumer fireworks at the location designated herein between the following date and times: Sales For July 4th Sales For December 31Sc From: From: To: To: S sor: NORTH MASON PEE WEES 'an l he-' �5+- 1- BOO oc ion: -E,-1403-OLD-H -13ELFAIR W /s/ 6 F r RANDY NEATHERLIN ig ature Official ting Permit Signature of Applicant Agency: 3v7t/ Date: 06- >8 <9-5 Permit Number: R 42----.k)A5 Licensee Name:NORTH MASON PEE WEES License Number: 00506 "I 04'ashington State Patrol Fire Protection Bureau Office Of The State Fire Marshal Washington State Fireworks License Fireworks Stand License License Is Non-Transferable And Valid For One Stand Licensee Information w North Mason Pee Wees 2120 Milwaukee Way Date Of Issue: April 8, 2005 "- State Fire Marshal Detach this wallet card and carry with you for Tacoma,WA 98401- Expiration Date: January 31, 2006 verification of certification. Stand Information Washington State Patrol - Fire Protection Bureau Contact Person: Randy Neatherlin Office Of The State Fire Marshal Phone Number: (360) 275-3194 Count Mason FIREWORK STANDLICI;NSE [Valid For Otte Stand] Licensee: North Mason Pee Wees License Number: WSPFL-00506 Stand Number: SN-0001425 Contact Person: RandyNeathertin Stand Number: SN-0001425 License Number: WSPFL-00506 Expiration Date: January 31,2006 Stand Location: Locati° rl Location To Be Completed BY Licensee] y ' [Stand Location To Be Completed By Licensee] 1 _ ------"-� �1��1. � r v f�.. .. .: •:,` ,,.s z =,a..o.r L, try ��..h.....3'w21.?1r_1,w,i.....x...,.`,._i.1.�..a..�.�•-3': 0.. ❑a— ARorchal Cinno}nrn I.ir'emee Signature