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HomeMy WebLinkAboutFIR2012-00009 Fireworks Stand - FIR Permit / Conditions - 5/1/2012 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 FIR2012-00009 APPLICANT: BRETT BERGDAHL RECEIVED: 4/4/2012 CONTRACTOR: LICENSE: EXP: ISSUED: 5/1/2012 SITE ADDRESS: 201 NE STATE ROUTE 300 BELFAIR EXPIRES: 11/1/2012 PARCEL NUMBER: 123294290001 LEGAL DESCRIPTION: TR 10 OF NW SE - LOT: B EX OF SP#591 LOT: 1 OF SP#2938 PROJECT DESCRIPTION: FIREWORKS STAND.. LOCATION IS THE PARKING LOT OF THE QFC..FOR NORTH MASON PEE WEES GENERAL INFORMATION System Information Type of Use: STND Fire District: 2 Sprinkler Heads: Audible Switches: Pull Stations: Hood& Duct t: Flow Switches: Visual Devices: Door Releases: Pressure Switches:: Smoke Detectors: Duct Detectors: Dry Chemical?: Wet Chemical?: Zones: Heat Detectors: Sprinkler?: Standpipe?: SQUARE FOOTAGE FEES Monitoring Company: First Floor: Type Amount Due Amount Paid Monitoring Phone No.:() - Second Floor:Auto Fire Alarm?: Third Floor,: Fireworks Stand Permit $100.00 $100.00 Total: $100.00 $100.00 FIR2012-00009 Please refer to the following pages for conditions of this permit. Page 1 of 7 2.) 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 July 6thl from 9 AM to 12 noon Only Washington State Fire Marshal approved class C common fire works may be sold. X 6 w— 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 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 stora a or dispensing 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 s all be marked and flagged. X t" Motor vehicles or trailers may not be parked within 20 feet of the fire works stand except when delivering, loading or unloading fireworks. X 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 high�an��d in contrasting color shall be posted conspicuously on all sides of the structure. X �%� No smoking shall 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 in X contrasting 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 be of an industri I grade type and shall be protected from physical damage. X 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. X , Gener tors shall be located a minimum of 20 feet from any fire works stand. Fuel storage is limited to 5 gallons. X 164 A minimum 24 inch 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 inches in width located at oppsite ends of the stand. Xhexits shall remain unlocked and unobstructed during hours of operation or when stand is occupied. Sleeping inside a fireworks stand is prohibited. FIR2012-00009 Please refer to the following pages for conditions of this permit. Page 4 of 7 x 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. X There shall be a minimum of 2 approved 2 1/2 gallon pressurized water fire extinguishers located adjacent to each exit door. X L, 4 Cooping, open flame or any type of open flame equipment is prohibited in a fireworks stand. X 'L-1{ 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 permit. X L, �— 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, barn or other accessary building that is at least 20 feet from the fireworks stand X 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 when open to the public. X a_-n 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 proof of age. Driver's license or photo ID showing date of birth issued by a public or private school, state, federal or foreign government is acceptable. X iL.14-4- 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 owner or the agent on the owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above describ(e�d property and structure for review and inspection. OWNER OR AGENT: DATE > I FIR2012-00009 Please refer to the following pages for conditions of this permit. Page 5 of 7 Mason County b Fireworks Permit Application PO BOX 186 Permit # FIR 426 W Cedar St Shelton WA 98584 # (360) 427-9670 ext 273 ReceiptS J o2_a I CK # to55 Date Received A 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: 01/11/2012 ❑ Pyrotechnic Operator License x❑ Fireworks Stand License Bond or Certificate of Insurance (Copy of Certificate/ Bond Required) Provider: SEE ATTACHED Insured: Certified Holder: Location of stand/display 5 f P—i- &00 Address: QFC NE "*63 oTL- N BELFAIR, WA Directions to Site: 2.01 Parcel Number: - - Legal Description: Legal Property Owner: * * Please see the reverse side to complete your application 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 landing area SEE ATTACHED DIAGRAM Applicants Affidavit I certify that the information provided herein is and that compliance with all County, State and Federal laws pertaining t sales or discharge of fireworks shall be maintained. Signed Brett Bergdahl Date /yf��z- 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, 2012 fireworks stand will be located. APPLICATION: 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] 070 i n 5, + P t* j I Q P& Y y BELFAIR, WA Q `" C.N Manner and place of storage prior,during,and after sales dates: G ON SITE WITH SECURITY _ f State Licensed Fireworks Supplier: A American Promotional Events NW 2120 Milwaukee Way, Tacoma, WA 98421 f - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - FIREWORKS STAND PERMIT For The Fireworks Sales Year Of: 2012 (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 IAG Consumer fireworks at the location designated herein between the following date and times: Sales For July 4rh Sales For December 31" From: From: To: To: Sponsor: NORTH MASON PEE WEES 2u i 6 f P-fi 360,_B. 61 lt,t Location: OFC NE TP OLD per F*rm r k Y u9r 9 A ru W d /s/ /s/ FOR BRETT BERGDAHL Signature of Official Granting Permit Sign re of Applicant Title: Agency: Date: Permit Number: Licensee Name: NORTH MASON PEE WEES License Number: 00506 3000-420-013(Rev.2/05) Washington State Patrol �`' `' ' 134196 Fire Protection Bureau Office Of The State Fire Marshal Fireworks Stand License Washington State Fireworks License License is Non-Transferable and Valid for Only One Stand Licensee Information North Mason Pee Wees 2120 Milwaukee Way State Fire M rshal gat e Tacoma,WA 98421 License Number: WSPFL-00506 Detach this 11 car and carry with you for verifi ion certification. Stand Information Washington State Patrol 13196 Office Contact Person: Brett BergdahlFire Protection Bureau Of The State Fire Marshal Phone Number: (360) 710-2121 ANNUAL FIREWORKS STAND LICENSE County: Mason Date of Expiration Date of Issue Licensee: North asorr- Wees Stand Number: SN-06507 January 31, 2013 January 11 2012 Contact Person: Bre, 1-O ih; % ' License Number: W P10059_ , Stand Number: S1T= id For One Stand) Date of Expiration: Jan `a3+3 , Location• "� Stand Location' [ tand L cation ` ompleted By Licensee) (Stand Location To Be Completed By Licensee) 3000 420.012(R 9/05) State Fire Mars 1 i ature Licensee Signature J ACOKO CERTIFICATE OF LIABILITY INSURANCE DP.TE(MM/DD/`YYY) 1/27/2012 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 endorsement(s). PRODUCER CONTAC NAME: Britton-Gallagher and Associates, Inc. PHONE 44 FAXAIC No: -1 234 6240 SOM Center Rd. E-MAIL Cleveland OH 44139 ADDRESS: INSURERS AFFORDING COVERAGE NAIC M INSURER A:Lexington Insurance Compa INSURED 5530 INSURER B: American Promotional Events Inc. INSURER C: dba TNT Fireworks INSURER D: P. O. Box 1318 Florence AL 35631 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:972143488 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. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MMIDD/YYYY MM/DD LIMITS GENERAL LIABILITY 44V2132 1/1/2011 1/1/2012 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMDAMAGE ( RENTED PREMISESS Ea occurrence) $50,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $ X Blkt Contractual PERSONAL&ADV INJURY $1,000,000 X Hostile Fire Pol GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO X LOC $ AUTOMOBILE LIABILITY Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PRO RdT DAMAGE $ HIRED AUTOS AUTOS P $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- -AND EMPLOYERS'LIABILITY Y/N LIMITS ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ H yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Additional Insured: Property located at QFC, 1403 Old Belfair Hwy in Belfair,WA(WWM6505). North Mason Pee Wees/QFC/Mason County 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 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Mason County ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 186 426 W Cedar AUTHORIZED REPRESENTATIVE Shelton WA 98584 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD February 7, 2012 REF: WWM6505 & WWM6512 ***URGENT*** Brett Bergdahl 291 E Mountain View Dr. Allyn, WA 98524 Dear Brett Bergdahl, Enclosed are your City/County permit application, State permit, and insurance. You are required to file with your local authorities as soon as possible. You must have the following items: ® Permit Fee $100.00 (NEEDED) ® Washington State Fireworks License ® Insurance ® Stand Diagram ® Local Application (fill out) • Deadline for filing is June 18th or earlier, LICENSING IS ON A FIRST COME BASIS! Late filing will cause non-issuance of your permit. Should you have any questions or concerns, please feel free to contact me at (253) 922-0800. Thank you for your time and attention to this matter. Have a great season! Sincerely, flR�ti Brenda Merritt Licensing & Permits Enclosure(s) AMERICAN PROMOTIONAL EVENTS, INC. 2120 MILWAUKEE WAY • TACOMA, WA 98421 TACOMA(253) 922-0800 • SEATTLE (253) 838-1099 FAX (253) 830-2930 www.tntfireworks.com wW rvi CONCEPTUAL SITE PLAN -� FC naBq lWa Werra r.pp• \ BEIFAIR sA DRANF LD y� FlE09iVE AREA THE KROOER COMPAM210 aem WusoEaernier.Bure2a DRANP[LD \ VICINITY MAP NTH9 vAxpWpao�/Bt1 r amr++YmA.,.wr \ ,ate i�im'�iu.100•iiw �JCHANCES T CHANGES FOR APPROVAi QFC GAS PR TO PERFORMIING sdi?Rk STATION QFC ADDITION 4G•GUQ SF. OIDOOVAIRNOBWAY ANDHORM OMMKOAD BWAOIB WA atxr _ 1 nsawne,n arJenw M'>J'iJ\Jpy,J 01�1p DDA OtHIWMII•JWOWf Wf�1•Pa,� �EaTAWJ%YI Yt `_.. '.�-.--- - - - - n wi rAnao m awwiluo. ®kiJIDGFJ�IA•MGFIWh?._.__.__ - CONCEPTUAL SITE PLAN �ws%"�u.s•.:ne`ri:unue uurca�am �•+ �t 2 ,5 MASON COUNTY FIRE- b-7AR'SlHAL DATE, 40-6Z: 1311, -SUBJECT TO FIELD IPA SFEQT ;,_I�J- U 5 THE-).- ALL APPLIGABL CODES RHALL APPLY. of Z.)AfE AND/OR OMIS.l;IONS ON PLAN.F. ARE I-Cli 1\1 SPONS I OIL I TY OF OWNEWCONTR-,CTo,;�'. ioN. TIONS REC)OWED FROM wllrEf;T;()t' , FoR -ACY0*' . ".E BE AT OWt4EP/CONT, F, I PROVAL DOES - f TC,• AN`: Plrw-r TO VIOL-Tr AN, C!T', �'w tI., I' -n 00 CONCRETE MECHANICAL MANUFACTURED HOME M L�idc- By X Footings I Setbacks Ribbons G) Gas Piping 0 Interior Date By interior-Date By Date By > Exterior Date BY Exterior-Date CD Set-up 0 -- Point Load/Isolated Footings -fN—SUE4tfdN— 03 BG jSLAB INSULATION X Date BY Dart By FIRE DEPARTMENT M Foundation Walls Floors Date By r;!tF- By Data By DECKS FRAMING Walls Date By Date By Dale PROPANE TANKS PLUMBING Vault Date By Date By OTHER Groundwork Attic Type. Date. Date By y Date By D.W.'V DRYWALL Type- -n Int.Brace Wall Date By CD y ;0 Date FINAL INSPECTION VQ (D Water Line Fire Seperation 10, Date By Date By Date By 1`0 (D 6 0 Pass or Request Inspect. E C)CD C) Type of Insp. Fail Date Date Done By Comments (D 0 0 Et e\— 3 (o-28—IZ- 4�241,1'Z i La tv '0 (D U) 0 0 0 (h 0 fA :r (D cc (D 0) 0 ---j