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HomeMy WebLinkAboutFIR2014-00007 Fireworks Stand - FIR Permit / Conditions - 6/24/2014 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 279 Shelton, WA 98584 Moto FIRE PROTECTION PERMIT FIR2014-00007 APPLICANT: NORTH MASON PEE WEES RECEIVED: 4/30/2014 CONTRACTOR: LICENSE: EXP: ISSUED: 6/24/2014 SITE ADDRESS: 201 NE STATE ROUTE 300 BELFAIR EXPIRES: 12/24/2014 PARCEL NUMBER: 123294290001 LEGAL DESCRIPTION: TR 10 OF NW SE - LOT: B EX OF SP#591 LOT: 1 OF SIP#2938 PROJECT DESCRIPTION: FIRE WORKS 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 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 FIR2014-00007 Please refer to the following pages for conditions of this permit. Page 1 of 6 1.) Consumer fireworks maybe sold only on the following days and times: June 28th from 12 noon toll PM and June 29th to July 5th from 9 AM toll PM. X Only Washin on State Fire Marshal approved class C common fire works may be sold. X A fire works s d 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 storage or dispensing facility. X IV The minimu 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 be marked and flagged. X Motor vehicles or tr .lers may not be parked within 20 feet of the fire works stand except when delivering, loading or unloading fireworks. X Fireworks shall t 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 and in con rasting color shall be posted conspicuously on all sides of the structure. X No smoking s all 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 contrastin o rs shall be posted conspicuosly on all sides of the structure. X- &Z All battery wered equipment, electrical equipement and cords shall be UL listed and used in accordance with that listing. Extension cords shall be of an industrial gra t pe and shall be protected from physical damage. X All heatin vices 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 eating devices are prohibited. X Generators s al be Jocated a minimum of 20 feet from any fire works stand. Fuel storage is limited to 5 gallons. X A minimum V4inch 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. These exits shall remain unlocked and unobstructed during hours of operation or when stand is occupied. X Sleepin side a fireworks stand is prohibited. X The locat 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 FIR2014-00007 Please refer to the following pages for conditions of this permit. Page 3 of 6 local emergency phone number, 911, and the address of the fireworks stand shall be conspicuously posted inside the stand. X Z,<- There4fhafl be a minimum of 2 approved 2 1/2 gallon pressurized water fire extinguishers located adjacent to each exit door. X Cooking, o n flame or any type of open flame equipment is prohibited in a fireworks stand. X 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 per X 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 on erson 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 i; IV 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 responsibility of the seller to require proof of age. Dr er's license or photo ID showing date of birth issued by a public or private school, state, federal or foreign government is acceptable. X 2.) Owner/ t is res nsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. X 3.) Valid Perm be on-site. X OWNER/ BUILDER acknowledges submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below. I declare that I am the owner, owners legal representative, or contractor. I further declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary parties, including any easement holder or parties of interest regarding this project. The owner or authorized agent represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure(s) for review and inspection. This permit/application becomes null &void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. Signatur Date OWNER - REPRESENTATIV - CONTRACTOR Print Name (Circle one t icate) FIR2014-00007 Please refer to the following pages for conditions of this permit. Page 4 of 6 NWK Mason County M Fireworks Permit Application WV W PO BOX 186 Permit # FIR 2dl�i• d�� 426 W Cedar St Shelton WA 98584 Receipt # JI;R I`I -442-1 (360) 427-9670 ext 273 - CK # Cr&OUIAC' Date Received 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: RAYMOND MOW Mailing Address: 302 NE HAVEN LAKE DR City: TAHUYA State: WA Zip: 98588 Contact Number (253 ) 208-3235 Sponsor Information Name: NORTH MASON PEE WEES Mailing Address: 302 NE HAVEN LAKE DR City: TAHUYA State: WA Zip: 98588 Contact Number (253 ) 208-3235 Washington State Fireworks License Information (Copy Required) License No.: Date of WSPFL-00506 Issue: 02 .20 . 2014 ❑ Pyrotechnic Operator License R Fireworks Stand License Bond or Certificate of Insurance (Copy of Certificate!Bond Required) Provider: SEE ATTACHED Insured: Certified Holder: Location of stand/display Address: 4FC 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 The following pertinent information MUST he provided on the site diagram below Locations and Setback distances fronn 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 accurate and that compliance with all County, State and Federal laws pertaining to the sales or discharge of fireworks shall be maintained. Signed RAYMOND Mow Date �- FOR OFFICIAL USE ONLY BELOW THIS LINE Accepted By: Date: Washington State Patrol 15989 Fire Protection Bureau License Office Of The State Fire Marshal Fireworks Stand Washin ton State Fireworks License License is Non-Transferable and Valid for Only One Stand Licensee Information / North Mason Pee Wees State Fire Mars al Sig a WSPFL-00506 with you for 2120 Milwaukee Way Detach this wallet c d tryTacoma, WA 98421 License Number: verification of cert cation. Washington State Patrol ation e 15989 Stand Inform Fir Protection Bureau Office re The State Fire Marshal Contact Person: Raymond Mow ANNUAL FIREWORKS STAND LICENSE Phone Number: (253)208-3235 N0 Mason Pee wees Date of Expiration Date of Issue Licensee: and Mow County: Mason 2014 Contact Person: Ym January 31, 2015 February 20, License Number: �FLf©RSEIfI Stand Number: SN-08432 N-b843alid For One Stand) Stand Number: 3 Date of Expiration: u Location: 0 Stan anone Completed By Licensee] Stand Location: (Stand Location To Be Completed 6y Licensee] State Fire Mars S azure Licensee Signature 3000-420-012(R 9/05) 4 vv vv m (05 CONCEPTUAL SITE PLAN QuWl P.cl^- �� STORE#101 BEIFAIR t7 ' e m—xauwmw roles ORAVRELD REBERVE AREA \ THE KROGER COMPANI aom aumecst �audio oF++vo�coawar--too DRAMRELLD \ VICINITY MAP - - ""FAXMaa 40" KTA M. cw1 wm%+wo.vrn��urnucarvcer QFC GAS STAT UFC: �j Hi��1'( .y/� -r S ADDITI ON 3. `�a! a,,t3ssF, MIT CHANGES F OlDBKMMM ROA OR APPROVAL nMD"ortn�sMo snow p eartun,wn I l OR TO PERFORMING WORT( ��� a �.1 affm \ I ( 1\n�m-�oa i - I 1 I W1RMO�IM `p 0 0 ascrm 1 2� ----- _I OEM �.awf [fUN 6 Mf[u w1 IIM1Ln1MR f�R nM MI1S'Y7 lC611 .'onno w-wpm-..A.uw ra c[[�reawn�mrroa DD-1 Doom a couwnc xo+ce war.mn w cwwwro�a rM"cus..011tiRw�rtM.wwas xe wIn[xc a[emonon .gE6.ti64FIdR4�AY - � CONCEPTUAL w ww.fry ow wxan[u. ' - - - - - - G� Ov �LX) SITE PLAN .�p 1 nE F C� " r vA.(�A4 r W CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 11/1/2014 10/31/2013 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 Lockton Companies,LLC CONTACT NAME 3280 Peachtree Road NE,Suite#250 PHONE FAX AIC No): Atlanta GA 30305 E-MAIL (404)460-3600 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Everest Indemnity Insurance Company 10851 INSURED American Promotional Events,Inc. INSURER B: 1359629 DBA TNT Fireworks,Inc. INSURER C: P.O.BOX 1318 INSURER D: 4511 Helton Drive INSURER E: Florence AL 35630 INSURER F COVERA CERTIFICATE NUMBER: 12253602 REVISION NUMBER: XXXXXXX 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 ADD SUBR POLICY EFF POLICY EXP LIMITS LTR I R D POLICY NUMBER MMIDD/YYYY MM/DD/YYYY A GENERAL LIABILITY Y N SI8GL00242-131 Il/l/2013 Il/I/2014 EACH DAMAGE TO RENTED J{ MMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 300 000 CLAIMS-MADE OCCUR MED EXP(Any oneperson) $ 5,060 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY JECT JECT X LOC $ AUTOMOBILE LIABILITY NOT APPLICABLE COMBINED SINGLE LIMIT (Ea accident) $ XXXXXXX ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ XXXXXXX AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ XXXXXXX HIRED AUTOS AUTOS $ XXXXXXX UMBRELLA LU16 OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX EXCESS LIAB CLAIMS-MADE AGGREGATE $ XXXXXXX DED RETENTION$ $ }{}{}{XXXX WORKERS COMPENSATION NOT APPLICABLE AND EMPLOYERS'LIABILITY Y/N TORY LIMIT ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A XXXXXXX (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ XXXXXXX If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ }(}(}{XXXX DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) located at QFC,NE 1403 Old Belfair HWY,Belfaire,WA(WWM6505)Certificate holder is an additional insured on the 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 ACCORDANCE WITH THE POLICY PROVISIONS. 12253602 AUTHORIZED REPRESENTATIVE Mason County North Mason Pee Wees PO Box 186 426 W Cedar Shelton WA 98584 � r ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD © 88- 10 CORD CORP TION.All rights reserved FIRE PROTECTION BUREAU FIREWORKS LICENSING PROGRAM PO Box 42600 Olympia WA 98504-2600 1' •r1``� (360)596-3914 FAX: (360)596-3934 APPLICATION FOR RETAIL FIREWORKS STAND PERMIT WWM 6 5 0 5 TO Governing body of city,town,or county in which DATE OF 02/2014 fireworks stand will be located. I APPLICATION Applicant Name Address,City,State NORTH MASON PEE WEES 2120 MILWAUKEE WAY, TACOMA, WA 98421 Sponsor(If other than applicant) Address,City,State RAYMOND MOW 2120 MILWAUKEE WAY, TACOMA, WA 98421 Location of proposed fireworks stand [Enclose drawing of stand location] G QFC r ,,,,rvt^--r48 nr n 99T rFA i n`v�ir -�BEEFAIR, -WA �i n G st ej �L-) 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 -- - --- -- -- -- ---- -- - - - ---- - - - ------ --- - ------ -- - --- --- - ---- -- -- -- --- FIREWOIZKS STAND PERMIT For the Fireworks Sales Year of: 2014 (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 as the local governing authority,the named person,firm or organization is hereby authorized to sell U.N. 0336 1 AG Consumer fireworks at the location designated herein between the following date and times: Sales for July 4 b Sales for December 31st From: From: To: To: Sponsor NORTH MASON PEE WEES �O 1 V1 E7 Si- Location Q F C, /S/ /s/ i �' FOR RAYMOND MOW Signature of Official Granting Permit Si�of Applicant Title Agency Date Permit Number Licensee Name NORTH MASON PEE WEES License Number 00506 3000-420-013 (R 3/09) -n Z 55 CONCRETE MECHANICAL MANUFACTURED HOME O N Date BY • M 0 Footings/Setbacks Gas Piping Ribbons = Cintenor Date By Interior-Date By Date Byic OC Exterior Date By Exterior-Date B Set-up N y Point Load!Isolated Footings INSULATION Date By O BG f 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 Date By Data By PROPANE TANKS U) PLUMBING vault Date By Date By OTHER Groundwork Attic _ Date By Type. Date B y __.,_,...-- Date By n.w V DRYWALL Type: Date By InDat Brace Wail By Date By55 y FINAL INSPECTION c m Water Line Fire Seperation _& Date By Date By Date By 46 O o Pass or Request Inspect. o Type of Insp. Fail Date Date Done By Comments o 0 r .. -5 6 2 S-/� CD H O 1 n O 3 a o' y O N m (D 3 N (a (D (Yt O O)