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HomeMy WebLinkAboutFIR2009-00014 Final Fire Works Stand - FIR Permit / Conditions - 6/28/2009 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 FIR2009-00014 APPLICANT: BELFAIR ASSEMBLY OF GOD YOUTH CONTRACTOR: LICENSE: EXP: RECEIVED: 3/2/2009 SITE ADDRESS: 23940 NE STATE ROUTE 3 BELFAIR ISSUED: 6/12/2009 PARCEL NUMBER: 123294190190 EXPIRES: 12/12/2009 LEGAL DESCRIPTION: TR 19 OF NE SE LOT: C OF SP#1059 PROJECT DESCRIPTION: Fireworks stand located in tl ie parking lot of the Rite Aid drugs 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?: Dry Chemical?: Pressure Switches:: Smoke Detectors: Duct Detectors: Wet Chemical?: I 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 FI R2009-00014 Please refer to the following pages for conditions of this permit 1 of 5 CASE NOTES FI R2009-00014 CONDITIONS FOR FI R2009-00014 FI R2009-00014 Please refer to the following pages for conditions of this permit 2 of 5 f zy oe soid only on the toiiowmg uate:s aana tmjus. � { .lurie 28th farm 12 noon to 11 PM, C: June 29th-July 5th SAM to 11 PM. z N July from 9AM tc 12 noon- w ' N m m Onlyn�shington State Fire Marshal Approved Class C fire�rorks maybe sold. D m cc��..YY 0 ry m A fireworks stand shelf not be located more than 150 feet from an approved access road, Shall be at least 100 feet from another fireworks stand or m separated by a road, street or highway at least 30 feet In width, Or bo located closer than 100 feet from any flammable frquid or gas dispensing device, or m 30D feet from an flammable liquid or as bulls star i 0 y q g age or dispensing facility.Steal not be located any closer than allowed by the table attached to the � per it to ather structures or exposures. 3 The minimum areas around fireworks stands as specified in the attached table shall be keep free of dr},grass, brush of combustible debris. This area shall be marked and flagged. Motor vehicles or trellers may not be parked within 20 feet of the fireworks stand except when dellveriing, loading or unloading fireworks. Fireworks shall not be discharges 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 contrasting color shall be posted conspicuously on all sidas of the structure. No smoking shall be allowed within within the fireworks stand or flagger off area. Signs stating No Smoking Within 100 feet In letters at least 2 inches high and in contrasting color shall be posted cm ously on all sides of the structure. X -i All battery powered equipment,electrical equipment and cords shall be UL listed and used in accordance with that listing. Extenslon cords shall be of an L Xdup�rla t grade type and shall be protected from physical damage, nAll heating devices shall be UL listed.Only heating delves with sealed-type elements shall be used I.e, oil filled or water Filed radiator type. Open flamme X en ators shall be located a mirrmum of 20 feet from any fireworks stand. Fuel slorgae is limited to 5 gallons, a A minl-mum 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 opposite ends of the stand,These exits shadremain unlocked and u--6a S1r&6f6d oaring hours of ----operation or-when stand is occupied, Sleeping4fiside a Fireworks-stand is prohibited.The location of the nearest phone shall be posted in the-fireworks stand.All occupants of the stand st atl be informed as to the location of this phone.The loci emergency phone number, 911, and the address of the 7 firo rks stand shall be conspicuously posted inside the stand. X r i The shall be a minimum of 2 approved 2 V2 gallon pressurized water fire extinguishers located adjacent to each exit door. n �+ X co Co1ing.open flame or any type of open flame equipment is prohibited Inside a fireworks stand.X i— _ Fireworks stands shall be locked when unoccupied and not open for business if fireworks are stored In the stand during tiese times Fireworks stand shall w y n FIR2009-00014 Please refer to the fo4owin2 pages for conditions of t.hls permit g of 5 not be locked when occupied—Fireworks.maybe removed or transferred to a ternporarystormge structure or location approved as part of the license and z perm' X T c �� �N 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 m business hours, or in a locked or secured metal or wooden garage , shed,barn or other accessary building that is at least 20 feet from the fireworks `0 stand,n — m X � �N co e�7 At least one person 16 yrs of age or alder shall be on duty In the fireworks stand when fireworks are being sold to the public. Such person shall be a,l.,[...1/....... .'„• ._[tL Cep VIMn., " A R. ...t1 d p+ll„V L.•.i„a A�.. n.1..r►F -i 4 a 'k-11 yy wii�uc�!fn r,rrl my the Rraurnr4c of-cord urhor+ 1GSrJVr]ILIIG IVI lllp pLI.IG YNIVII VI ll/� III lJ VIV JU VIV It 11 V11.1 V Y...�uvr� wrvvr ar u • ry r. r. . .. �.. vr� • v .r... .. .. .. ..r. it X [�is n to the public. 3 c.. It Is illegel to knowingly sell fireworks to persons under the age of 16.A sign stating No Sale of Fireworks to Persons Under the Age of 16 in letters at least 2 inches Ngti and ffi contrastlrg color shall be posied on the Front oflhe stand. A phato 16 Fs reguirdd acid it Is the seiner fo-- requare proof=of age:Dritirer's=license or photo lD-showing-a-date_of_birth_issued-by a-public-or_private schoolrstat,e;.federal_or_foreign-government=is -- a� � this permit becomes nail and void if work or construction authorized Is not commenced within 180 days, or Irconstruction or work is suspended fora period of 150 days at any ime afterwork is commenced. Evidence of continuation of work is a progress Inspection vtthin the 160 day period. Final inspection must be approved before building can be mcupled.Proof of continuation of work is try meads cfa progress inspection.TM owner or the agent on the owners bchalf, represents that the informahon provided is accurate ind gra-lts employees of Ma;sn County axes the above described property and structure far review and inspection. OWNER OR AGENT; _ DATE: Zo D r C r i • O k,D N W Q1 0 41 N lD Co �N r. <N e FIR2009A0014 Please refer to the following pagesfor conditions of this permit 4 of 5 -n W To CONCRETE MECHANICAL MANUFACTURED HOME m (D Datep Footings!Solb eks Gas Piping By Ribbons D OInterior Date By Interior-Date By Date By X O Exterior Date By Exterior-Date B O INSULATION Set-up N �a Date By N Point loan 1 isolated Footings BG!SLAB INSULATION m Date By Data By FIRE DEPARTMENT 9 Foundation Wails Floors Date By r_ Date By Data By DECKS FRAMING walls Date By T Date By Data By PROPAN E TANKS n PLUMBING vault Date By p Date By OTHER Groundwork Attic C Type: Date By Data By Date By D.W.v DRYWALL Type: Int Brace Wall Date By T CD Date By Date By FINAL INSPECTION Iv y Water Line Fire Separation CD O Date By Date By Data By O O Pass or Request Inspect. o Type of Insp. Fail Date Date Done By Comments , 0 m H 8 7 d a' N O y C" Cn O_ Ui SITE DRAM Date Updated:. Location #: W VV R USC�2'2 Location Name: ?�'kb Ordinance Of: �/lOtStN1 C oLt Site Address: 23°i H D N �Z SP'�5 Structure Size: '2-H I' CITY aeIkC( STATE/ZIP _�v!� Structure Faces: Parcel: Sh(no, ali setback from StrUCU11es qa.S, fire lamas )Lbiic and private, roads t i re.� gees and r i� t? bra I�r E r ' Y'C2 SS S ' �'✓al$s ! I LQ T 111 — �\ I I APPROVED ---_. � MASON COUNTY FIRE AL DATE L 1/4—()�'BY r SUBJECT TO FiEI.D EN PE�'TE ALL APPLICABL CODES SHALL APPLY, ERNU:ir AND/OR OMISSIONS ON PLANS ARE SOLE SPONSIBIL,ITY OF OWNER/CONTRACTOR. C;': ` TKI?%,S REOUIPEO FROM FIELD INSPE — ON N Z;I41LL k✓ BF AT OWNER/CONTRACTOR'S E.4FENSF. i nJc qF F PROVAL DOES NOT GRANT TO ..+.!1Y ?c:!',5 r; :HV ; RIGHT TO VIOLATE ANY CITY U.'; '-A," ,.A,;;;, I( Notes Mason County Fireworks Permit Application PO BOX 186 Permit# FIR 4jDOq �0I� 426 W Cedar St I " Shelton WA 98584 Receipt # S 2 2- ©O (360) 427-9670 ext 273 C K # 1 Z (0 7E)-2 Date Received 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) 277-3778 Sponsor Information Name: BELFAIR ASSEMBLY OF GOD Mailing Address: 2 000 1 NNE STATE RT 3 City: BELFAIR _ State: WA Zip: 98528 Contact Number _(360 ) 277-3778 Washington State Fireworks License Information (Copy Required) License No.: Date of WSPFL-00848 Issue: 02/09/2009 El Pyrotechnic Operator License 0 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: a - 41 - Legal Description: le ( cA n S1— c� Legal Property Owner: RITE AID n * 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 fiom 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 landh 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 � X FOR TYSON DEVRIES Date 02/26/09 FOR OFFICIAL USE ONLY BELOW THIS LINE Accepted By: Date: R IVBD �r June 4, 2009 MASONI' dCS+ON Tl( T; Fire Marshal 426 W. CEDAR S Mason County PO BOX 186 426 W Cedar Shelton, WA 98584 Dear Fire Marshal, In preparation for the upcoming 2009 4t" of July season, please find enclosed with this letter all information to move our fireworks stand from the Safeway to the Rite Aid. There is construction on the Safeway location so we are moving them to the Rite Aid. Please update your records to reflect the new location. 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.tntfireworks.com i m �? %4� Feb. 26, 2009 Fire Marshal Mason County PO BOX 186 426 W Cedar Shelton, WA 98584 Dear Fire Marshal, In preparation for the upcoming 2009 4 t h of July season, please find enclosed with this letter all information to apply for 1 retail fireworks stand permit. I have also enclosed 1 check, totaling $100.00, check # 126207 for the Permit Fee of $100.00. 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.tntfireworks.com Mason County Fireworks Permit AppiHication PO BOX 186 Ct 426 W Cedar Permit # FIR St Shelton WA 98584 Receipt # (360) 427-9670 ext 273 CK # o7 Date Received J 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 STATERT 3 City: BELFAIR St e: WA I 98 8 Contact Number (360) 277-37-/8 V_ Sponsor Information Name: BELFAIR ASSEMBLY OF GOD 01:ELFAI State: WA s 3 Cit Mailing Addres' 23001 NE S ATE T 3 Cit - BELFAIR State: WA/ Zip: 98528 Contact Number 360 277 3778 Washington State Fire orks Information (Copy Required) I License No.: Date of WSPFL-0 48 02/09/2009 % Issue: ❑ Pyrotechnic Operator Lille [N 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: SAFEWAY #1571 23961 NE ST RT 3 BELFAIR, WA Directions to Site: Parcel Number: Legal Description: Legal Property Owner: SAFEWAY Please see the reverse side to complete your applic,,itioll • The following pertinent information MUST be provided on the site diagram below Locations and Setback distances fi•oni the back, sides and front of retail sales stands or designated display areas to: • Fire Hydrants • Property Lines Buildings • Parking a Combustibles • Public Roads and Right of Ways Fire Lanes 0 Private Roads and Right of Ways Trees/Brush m Landmarks 0 Utilities and Gas A Mortar separation distance • Designated.landing area **PLEASE SEE ATTACHED DIAGRAM V C _. _._........ F nts Affidavit that the information provided herein is accurate and that compliance with ty, State and Federal laws pertaining to the sales or discharge of fireworks maintained. , Signed FOR TYSON DEVRIES Date 0 6/0 4/0 9 _ FOR OFFICIAL USE ONLY BELOW THIS LINE A� Accepted By: Date: APPLICATION FOR RETAIL FIREWORKS STAND PERMIT WWH6552 TO: Governing body of city, town, or county in which DATE OF APRIL 28, fireworks stand will be located. I APPLICATION: 2009 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 storaue 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: 2009 (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 41h 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/ _�,1� i FOR TYSON DEVRIES Signature of Official Granting Permit Signature of Applicant Title: Agency: Date: Permit Number: Licensee Name: BELFAIR ASSEMBLY OF GOD License Number: 3000-420-013 (Rev.2/05) Washington State Patrol U� 9629 Fire Protection Bureau Office Of The State Fire Marshal Fireworks Stand License Washington State Fireworks License License is Non-TransferableandValidfor Only One Stand Licensee Information Belfair Assembly of God 2120 Milwaukee Way State Fire Marshal Signature Tacoma, WA 98421 License Number: WSPFL-00848 Detach this wallet card and cant'with you for verification of certification. Stand Information Washington State Patrol Contact Person: Tyson DeVries Fire Protection Bureau 9629 • 360 277-3778 Office Of The State Fire Marshal Phone Number • ( � ANNUAL FIREWORKS STAND LICENSE County: Mason Date of Expiration Date of Issue Licensee: Belfair Assembly of God Stand Number: SN-03724 January 31, 2010 February 9, 2009 ; Contact Person: Tyson Devries License Number: WSPFL-00848 l Stand Number: SN-03724 [Valid For One Stand] i Date of Expiration: January 31,2010 1 Location: Stand Location: i [Stand Lora on ro BeCompleted By Licensee] [Stand Location To Be Completed By Licensee] 1 ____ .-_ --- State Fire Marshal Signature Licensee Signature ACORD,M CERTIFICATE OF INSURANCE ISSUE /2D009E 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 PCL0223304725 11/01/2008 EACH OCCURRENCE $ 1,000,000 ®Commercial General Liability 11/01/2009 FIRE DAMAGE $ 100,000 ❑Claims Made ®occurrence MEDICAL EXPENSE $ El Owners'and Contractors'Protection 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 Per erson $ ❑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 em to ee $ EL DISEASE(Policy Limit $ EXCESS LIABILITY EACH OCCURRENCE $ ❑Occurrence ❑Claims Made AGGREGATE Is This certificate only applies to Re: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 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 ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Belfair Assembly of God Mason County Authorized Representative PO Box 186 426 W Cedar Shelton,WA 98584 Page 1 of 1 Certificate I D# HTW92L5P