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HomeMy WebLinkAboutFIR2012-00012 Final Fire Works Stand - FIR Permit / Conditions - 6/28/2012 ` 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 1� FIRE PROTECTION PERMIT FIR2012-00012 APPLICANT: TYSON DEVRIES RECEIVED: 5/17/2012 CONTRACTOR: LICENSE: EXP: ISSUED: 6/25/2012 SITE ADDRESS: 23940 NE STATE ROUTE 3 BELFAIR EXPIRES: 12/25/2012 PARCEL NUMBER: 123294190190 LEGAL DESCRIPTION: TR 19 OF NE SE LOT: C OF SP #1059 PROJECT DESCRIPTION: FIRE WORKS STAND... LOCATED IN THE RITE AID PARKING LOT IN BELFAIR 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?: Pressure Switches:: Smoke Detectors: Duct Detectors: Dry Chemical?: Zones: Heat Detectors: Wet Chemical?: Sprinkler?. Standpipe?: 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?: Third Floor,: Total: $100.00 $100.00 FIR2012-00012 Please refer to the following pages for conditions of this permit. Page 1 of 6 11.) Consumer fire works may be sold only on the following days and times. June 28th from 12 noon to 11 PM ,tune 29th to July 5th from 9 AM to 11 PM July 6th frorL9 AM to 12 noon X ► Only Wash ingto State Fire Marshal approved class C common fire works may be sold. 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 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 Xorage or ing facility. 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 bei7gr d and flagged. X Motor vehicles oL Milers 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 and in co sting 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 contrasting coIQrs shall be posted conspicuosly on all sides of the structure. X 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 industrial grade tVDe 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 elemeriLbeating devices are prohibited. X Generators shaLbe located a minimum of 20 feet from any fire works stand. Fuel storage is limited to 5 gallons. X ��}+ 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. These exits sh ISemain unlocked and unobstructed during hours of operation or when stand is occupied. X 5� Sleeping inside a fireworks stand is prohibited. FIR2012-00012 Please refer to the following pages for conditions of this permit. Page 3 of 6 .-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 emergent"hone 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 Cooking, opeqAame 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 locko when occupied. Fireworks maybe removed or transferred to a temporary storage structure or location approved as part of the license and permit. 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 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 t ublic. X 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 a is license or photo ID showing date of birth issued by a public or private school, state, federal or foreign government is acceptable. X 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 described property and structure for review and inspection. OWNER OR AG DATE: FIR2012-00012 Please refer to the following pages for conditions of this permit. Page 4 of 6 o CONCRETE Gas piPi"� MANUFACTURED HOME o hterior-Date By N Footings I Setbacks Ribbons Exterxx-Date By CD Da toBY INSULATION Date By o Foundation walls Set-up BG I SLAB INSULATION Date By Date By Date By . FRAMING Floors FIRE DEPARTMENT Date By Date By Date ey Walls DECKS PLUMBING pate By Date By Groundwork vault TANKS Q Date By Date By Date By Attic o.w.v Date By OTHER Date By DRYWALL Type: Date By Water Line Date By Type: Date B Int,Brace Wall Date v y By y MECHANICAL Date FINAL INSPECTION co Fire Seperation (� fD Date By Date BY Date By l; m ° Pass or Request Inspect. -� C Type of Insp. Fail Date Date Done By Comments o �` v Cn i CD O ` A O 3 O 3 V O S (n CD tU �Q 0 WWH6552 • Mason County Fireworks Permit Application PO BOX 186 Permit# FIR a0[a -Q[xj l dl 426 W Cedar St Shelton WA 98584 Receipt #�j a b[a (360) 427-9670 ext 273 CK #06D)LpJ5O J5 Date Received 5-0 -,�Z[ a 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: TYSON DEVRIES Mailing Address: 23001 NE STATE RT 3 City: BELFAIR State: WA Zip: 98528 Contact Number (360) 275-2858 Sponsor Information Name: BELFAIR ASSEMBLY OF GOD Mailing Address: 23001 NE STATE RT 3 City: BELFAI_R State: WA Zip: 98528 Contact Number (360 ) 277-3778 Washington State Fireworks License Information (Copy Required) License No.: Date of WSPFL-00848 Issue: 02/01/2012 ❑ Pyrotechnic Operator License Fireworks Stand License Bond or Certificate of Insurance (Copy of Certificate/Bond Required) Provider: SEE ATTACHED INSURANCE Insured: _ Certified Holder: Location of stand/display Address: RITE AID #6544 23940 NE SR 3 BELFAIR, WA Directions to Site: Parcel Number: f 'A 3dq - 441 - q6190 Legal Description: Legal Property Owner: RITE AID * * Please see the reverse side to complete your application Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/VYYY) 5/4/2012 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 CONTACT NAME: Britton-Gallagher and Associates, Inc. PHONE FAX 6240 SOM Center Rd. MAID° Ertt - - Cleveland OH 44139 ADDRESS: INSURERS AFFORDING COVERAGE NAIC p_ INSURER A: INSURED 5530 INSURERS: American Promotional Events Inc. INSURERC: dba TNT Fireworks INSURERD: P O Box 1318 Florence AL 35631 INSURERE: INSURER F COVERAGES CERTIFICATE NUMBER: 1958696063 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 ADDLSUBR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR IN SR WVD POLICY NUMBER MMMD/YYYY MM/DDIYYYY GENERAL LIABILITY 44272132 1/1/2011 1/1/2012 EACH OCCURRENCE $1,000,000 X DBI]t MMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $50,000 CLAIMS-MADE �OCCUR MED EXP(Any one person) $ X 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 I I PRO- X LOC $ AUTOMOBILE LIABILITY Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS BODILY INJURY(Per accident) $ AUTOS NON-OWNED PPeOPPEE�RY DAMAGE $ HIRED AUTOS AUTOS S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS $ WORKERS COMPENSATION I WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN LIM FR ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 7OF under OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Additional Insured: Rite Aid#6544 located at 23940 NE SR3 in Belfair, WA(Loc#WWH6552). 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 Belfair Assembly of God ACCORDANCE WITH THE POLICY PROVISIONS. Mason County 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 THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE m FIREWORKS LEASE AGREEMENT This agreement is made between Thrifty Payless lnc. Lessor and AMERICAN PROMOTIONAL EVENTS NORTHWEST as Lessee. 1. AMERICAN PROMOTIONAL EVENTS- NW,will lease a portion of the property located at See Addendum "B' for the sale of approved fireworks from the following premises (hereafter called the"Location'): 2. The lease payment will t �r year for the period of June 20'"thru July 7`" hereafter called the "Season". Payment shall be paid Upon Execution. 3. Lessor represents that the Location is owned and/or controlled by the Lessor and furthermore that the Lessor agrees to grant the Lessee the exclusive right to operate a fireworks sales structure (hereafter the "Structure") through the year 2012 or the above-mentioned period. 4. The Lessor herby grants Lessee a first right of refusal to match any bona fide offer to lease the Location for fireworks sales during the renewal Seasons. 5. In return, Lessee agrees to the following terms and conditions: a. Provide an A+ rated$10,000,000.00 certificate of insurance, prior to occupancy, evidencing liability insurance in force covering the erection and operation of the Structure. Insurance shall name Lessor as additional insured, and Lessor shall be held harmless from any claims arising from the maintenance or operation of the Structure. b. Pay any and all costs involved in erection, maintenance, and operation of the Structure, and Lessee shall guarantee that the Location will be returned to its original condition. c. Obtain and pay all necessary permits and licenses required by law,post with local authority any debris or performance bonds as required, and guarantee that all laws and regulations shall be adhered to. 6. This agreement is contingent upon Lessee securing necessary permits and licenses. Lessee may cancel this agreement if the sale of fireworks is prohibited at this Location by a public authority or such sale,in the good faith opinion of Lessee, becomes commercially unreasonable. In such an event any deposit shall be refunded to Lessee. Agreed to a e this day of , 2012 Accepte Accepted: Lessor: Rob Lambrlecht Lessee: Ken eth A. Spence Thrifty Payless Inc. AMERICAN PROMOTIONAL EVENTS-NW 14625 SW Allen Blvd, Suite 101 Beaverton, OR 97007 AMERICAN PROMOTIONAL EVENTS,INC. 2120 MILWAUKEE WAY-TACOMA,WA 98421 TACOMA(263)922-0800-SEATTLE(253)838-1099 FAX(253)830-2930 www.tntfireworks.com 1 � Rite Aid Addendum "B" P;STORE ADDRESS City State 5180 1 119107 Bothell Way NE Bothell WA 6544 23M NE State Route 3 BeKair IWA Total: �' 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 • Desi ated landing area **PLEASE 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 1 �;��,� FOR TYSON DEVRIES Date 05/07/2012 FOR OFFICIAL USE ONLY BELOW THIS LINE Accepted By: Date: APPLICATION FOR RETAIL FIREWORKS STAND PERMIT WWH6552 TO: 1Governing body of city, town, or county in which DATE OF I MAY 4, 2012 fireworks stand will be located. I APPLICATION: Applicant Name: Address, City,State: BELFAIR ASSEMBLY OF GOD 2120 MILWAUKEE WAY, TACOMA, WA 98421 Sponsor(If other than applicant): Address, City,State: TYSON DEVRIES 2120 MILWAUKEE WAY, TACOMA„ WA 98421 Location of proposed fireworks stand: [Enclose drawing of stand location] 23940 NE SR 3 BELFAIR, WA RITE AID#6544 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. 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 1 AG Consumer fireworks at the location designated herein between the following date and times: Sales For July 4tn Sales For December 31" From: From: To: To: Sponsor: BELFAIR ASSEMBLY OF GOD Location: RITE AID#6544 23940 NE SR 3 BELFAIR. WA /s/ /s/ .r FOR TYSON DEVRIES Signature of Official Granting Permit Signature of Applicant Title: Agency: Date: Permit Number: Licensee Name: BELFAIR ASSEMBLY OF GOD License Number: 00848 RM-420-013(Rev.2/W) c Washington State Patrol 13227 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 Belfair Assembly of God 2120 Milwaukee Way State Fire Marsh 1 Sig*of Tacoma, WA 98421 License Number: WSPFL-00848 Detach this walletany with you for verificati 'fication. Stand Information Washington State Patrol 13227 Contact Person: Tyson Devries Fire Protection Bureau Phone Number: (360)277-3778 Office Of The State Fire Marshal ANNUAL FIREWORKS STAND LICENSE County: Mason Date of Expiration Date of Issue Licensee: Belfa' ss of God Stand Number: SN-0653,5 January 31, 2013 February 1, 2012 Contact Person: Tys n Uevrie License Number: WPFL-0484k. Stand Number: SA(=06535 id For One Stand] Date of Expiration: Janary; µ <' Stand Location: Location: (Stand Location To Be Completed By Licensee) ) ( rand Location ompleted By Licensee) 3000-420-012(R 9/05) State Fire Mars i ature Licensee Signature 6 May 07, 2012 Fire Marshal Mason County PO sox 186 426 W Cedar Shelton, WA 98584 Dear Fire Marshal, In preparation for the upcoming 2012 4 t h of July season, please find enclosed with this letter all information to apply for a fireworks stand permit. have also enclosed 1 check, totaling $100.00, check # 30016505, for the Permit Fee. If you have any questions or require further information please feel free to contact me at (253) 922-0800. Thank you for your time and attention to this matter. Sincerely, Brenda Merritt Licensing & Permits American Promotional Events, Inc. - Northwest 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.tnffireworks.com