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Home My WebLink AboutFIR2010-00010 Fireworks Stand - FIR Permit / Conditions - 6/15/2010 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inspection Line(360)427-7262 Mason County Bldg.3 426 W. Cedar P.O. Box 186 Phone: (360)427-9670, ext. 352 Shelton, WA 98584 FIRE PROTECTION PERMIT FIR2010-00010 APPLICANT: NORTH MASON PEE WEE'S RECEIVED: 5/14/2010 CONTRACTOR: LICENSE: EXP: ISSUED: 6/15/2010 SITE ADDRESS: 201 NE STATE ROUTE 300 BELFAIR EXPIRES: 12/15/2010 PARCEL NUMBER: 123294290001 LEGAL DESCRIPTION: - LOT: B EX OF SP#591 LOT: 1 OF SP#2938 PROJECT DESCRIPTION: FIRE WORKS STAND AT QFC 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 Sprinkler?: N Standpipe?: N 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?:N Third Floor;: Total: $100.00 $100.00 FIR2010-00010 Please refer to the following pages for conditions of this permit 1 of 6 1.} Owner/A ent Is responsib a to past the assigned address and/or purchase and post private road signs in accordance with Mason County TMe 14.28. Ln X m 9. Valid Permit Must be Qn-si X 0 0 N Ln r- LD O f6 Ln m of 0 0 i -i -i 4 0 A 2 O - O K> Z� Q V Q w 4 Q T i i J V o� m� ry i 01 mCO Ln 3 of 6 (V FIR2010-00010 Please re#erto_the following pages far conditions of this per6t � 3.) Consumer fire works may be sold only on the following days and times. June 28th from 12 noon to 11 PM June 29th to July 5th from 9 AM to 11 PM Jul 6th fro��\p• 9 A�M�tno�92 t1Ron Only Wa hington Statp Fire Marshal approved class C common fire works may be sold. 0 X(,;_ A fire works stand shall not be located more than 150 feet from an approved access road.Shall be at least 100 feet from another tire,works stand or separated by a road,street or highway at least 20 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 dispensing facility. E X � >� m a 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 b m ked and flagged. X Motor vehicles or trailers may not be parked within 20 feet of the fire works stand except when delivering,loading or unloading fireworks. X y 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 hi hand in contrasting color shall be posted conspicuously on all sides of the structure. D ' No smoking shall be allowed within the fireworks stand or flagged off area_Signs stating"No Smoking Witin 100 feeP'in letters at least 2 inches high and in ontrastinq colors shall be posted conspicuosly on all sides of the structure. All battery powered equipment,electrical equipement and cords shall be UL listed and used in accordance with that listing. Extension cords shall he of an industrial grade`ty rid shall be protected from physical damage. A 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 o_ or open element heatih-q devices are p�ofiibited. - X > x.Rl-, ° ? Generators n�rsshshall be located a minimum of 20 Feet from any fire works stand. Fuel storage is limited to 5 gallons. a w 4 A minimum 24 incn wide isie siiaii be rnainiaii led inside the lull iungiii UI iho sidfld. 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. I hese exits shall remain unlocked and unobstructed during hours of operation or when stand is occupied. X X\ping inside a fireworks stand is prohibited. V (� NCn � o . 00 LA rA FIR2010-00010 Please referto the following pages for conditions of this permit 4 of 6 The locatfon 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 Ln local emergency phone number,911,and the address of the fireworks stand shall be conspicuously posted inside the stand. X�� Nu There shall be a minimum of 2 approved 2 112 gallon pressurized water fire extinguishers located adjacent to each exit door. 0 Cooking,open(lame or any type of open flame equipment is prohibited in a fireworks stand. Ln 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 locked when occupied. Fireworks maybe removed or transferred to a temporary storage structure or location approved as part of the license and ermlt. X \ 9nr�•� 6 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, bam or other accessary building that is at least 20 feet from the fireworks X I\ �1��4. Z•��" i ' 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 5 when open to the nublic. - ' 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 f proof of age.Driver's licensor photo 1D showing date of birth Issued by a public or private school, state,federal or foreign government is acceptable. X� -�sq� L � This permlt beoomes null and void if work or construction authorized is not commenced within 180 days,or Ifconstructlon or work Is suspended fora 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 orthe 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. o _ —OWNER-ORAENS: u� ��' - - - DATE � 0 , � r 0 O > a � z � Q F . w , a > a o , m� m � N O 00 Ln N FIR2010-00010 Please rderto tfte followina pegesfor conditions of this permit 5 of 6 -n CONCRETE MECHANICAL MANUFACTURED HOME . O IS) X Footings f Setbacks Data By Ribbons Gas Piping = Ginterior Date By Interio►-Date By Date By 00 Exterior Date By Exterior-Date B S�.up N CDPoint Load 1Isolated Footings INSULATION Date By O BG/SLAB INSULATION Z Date By Data By FIRE DEPARTMENT Foundation Walls Floors Date By m rn Date By Data By DECKS FRAMING waits Date By M rn Date By Data By PROPANE TANKS rn PLUMBING Vault Date By Date By OTHER Groundwork Attic Type: Date By Date By Date By D.w.v DRYWALL Type_ Int Brace Wall n, Dare By Date By Date �y FINAL INSPECTION ^� y Water Line Fire Seperation CD 3 Gate By Date By Date By C Pass or Request I nspect. o Type of Insp. Fail Date Date Done By Comments c � �iQyrt✓o>�LS /Z�S L�3fr�L ISff 7?fDT CLe�a��a'�' r�SS 8/6 o 777fS �T y 8 7 f2 :i a• 0 z u; 3 r► rn 0 rn ' Mason County Fireworks Permit Application PO BOX 186 Permit # FIR-�bl0-081))0 426 W Cedar St Shelton WA 98584 Receipt # (360) 427-9670 ext 273 CK # Date Received S_1q-CO WWM6505 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: Brett Bergdahl Mailing Address: 291 E Mountain View Dr City: Allyn State: WA Zip: 98524 Contact Number (3 6 0 ) 710-2121 Sponsor Information Name: NORTH MASON PEE WEES Mailing Address: 291 E Mountain View Dr City: Allyn __ State: WA Zip: 98524 Contact Number 360 710-2121 Washington State Fireworks License Information (Copy Required) License No.: Date of WSPFL-00506 Issue: 04/08/2010 ❑ Pyrotechnic Operator License Fireworks Stand License Bond or Certificate of Insurance (Copy of Certificate/ Bond Required) Provider: SEE ATTACHED Insured: Certified Holder: Location of stand/display Address: QFC NE 1403 OLD BELFAIR HWY BELFAIR, WA Directions to Site: Parcel Number: - - Legal Description: Legal Property Owner: * * Please see the reverse side to complete your application SITE DIAGRAM Date Updated: �J' Location #: Vv C,� Location Name: F61 Ordinance Of: COAV)'� Q Site Address: N�- ILW5 Old WOW OVY Structure Size: �i-e4IA CITY V STATE/ZIP Structure Faces: Parcel: z LFIA-, OLS :z Notes The following 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 landin area SEE ATTACHED DIAGRAM 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 maintai e Signed Brett Bergdahl Date FOR OFFICIAL USE ONLY BELOW THIS LINE Accepted By: Date: APPLICATION FOR RETAIL FIREWORKS STAND PERMIT WWM6505 TO: Governing body of city, town, or county in which DATE OF JAN. 02, 2010 fireworks stand will be located. 7APPLICATION: 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] NE 1403 OLD BELFAIR HWY QFC 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 2120 Milwaukee Way, Tacoma, WA 98421 - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - FIREWORKS STAND PERMIT For The Fireworks Sales Year Of: 2010 (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 I AG Consumer fireworks at the location designated herein between the following date and times: Sales For July 4th Sales For December 31st From: From: To: To: Sponsor: NORTH MASON PEE WEES Location: QFC NE 1403 OLD BELFAIR HWY 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: W(DQ4 3(M-420-013 (Rev.2A)5) Washington State Patrol w via V✓ 11355 Fire Protection Bureau Office Of The State Fire Marshal Fireworks Stand License Washington State Fireworks License License is Non-Transferable and Validfor Only One Stand Licensee Information North Mason Pee Wees wAr *441 2120 Milwaukee Way State Fire Marshal Signature Tacoma, WA 98421 License Number: WSPFL-00506 Detach this wallet card and carry with you for verification of certification. Stand Information —- - -— -- - — Washington State Patrol 11355 Contact Person: Brett Bergdahl Fire Protection Bureau Phone Number: (360) 710-2121 Office Of The State Fire Marshal ANNUAL FIREWORKS STAND LICENSE County: Mason Date of Expiration Date of Issue Licensee: North Mason Pee Wees Stand Number: SN-05056 January 31, 2011 April 8, 2010 Contact Person: Brett Bergdahl License Number: WSPFL-00506 Stand Number: SN-05056 [Valid For One Stand] Date of Expiration: January 31,2011 Stand Location: Location: (Stand Location To.Be Completed By Licensee] (Stand Location To Be Completed By Licensee) 3000-420-012 (R 9/05) State Fire Marshal Signature Licensee Signature CERTIFICATE OF INSURANCE ISSUE DATE ACORDrM 11/02/2009 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 800-476-2211 COMPANIES AFFORDING COVERAGE ComApany Columbia Casualty 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 4015727097 11/01/2009 EACH OCCURRENCE $ 1,000,000 ®Commercial General Liability 11/01/2010 FIRE DAMAGE $ 100,000 ❑Claims Made ®Occurrence ❑Owners'and Contractors'Protection MEDICAL EXPENSE $ EXCLUDED ❑ PERS.AND ADVERTISING INJURY $ 1,000,000 ❑ 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 $ El Any Automobile BODILY INJURY Perperson) $ ❑All Owned Automobiles ❑Scheduled Automobiles BODILY INJURY Per accident $ ❑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 $ This certificate only applies to Re:QFC located at 1403 Old Belfair Hwy in Belfair,WA (loc#WWM6505);. The Certificate Holder is named as Additional Insured 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 LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF North Mason Pee Wees ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. QFC Mason County Authorized Representative PO BOX 186 426 W Cedar Shelton,WA 98584 p..jg-.s. Page 1 of 1 Certificate ID# AP4QHWYC