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HomeMy WebLinkAboutFIR2011-00015 Final Fireworks Stand - FIR Permit / Conditions - 6/30/2011 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 FIR2011-00015 APPLICANT: THUNDER FIREWORKS RECEIVED: 4/19/2011 CONTRACTOR: LICENSE: EXP: ISSUED: 5/4/2011 SITE ADDRESS: 23501 NE STATE ROUTE 3 BELFAIR EXPIRES: 11/4/2011 PARCEL NUMBER: 123294300120 LEGAL DESCRIPTION: PCL 3 OF BLA#04-45 PTN SW SE S 1/124 S 30/2 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 Dry Chemical?: N Pressure Switches:: Smoke Detectors: Duct Detectors: 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 FIR2011-00015 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 6th from 9 AM to 12 noon X Only Washinn ton State Fire Marshal approved class C common fire works may be sold. X oti,/ 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 storage or dispensing facility. X Otii/ 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 be marked 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. X4: � 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 contrasting color shall be posted conspicuously on all sides of the structure. 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 colors shall be posted conspicuosly on all sides of the structure. X -/ui 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 type and shall be protected from physical damage. X -4s-,/ 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 tea., -- Generators shall be located a minimum of 20 feet from any fire works stand. Fuel storage is limited to 5 gallons. X l�t� 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 shall remain unlocked and unobstructed during hours of operation or when stand is occupied. X Sleeping inside a fireworks stand is prohibited. FIR2011-00015 Please refer to the following pages for conditions of this permit. Page 4 of 7 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 X_-- Cooking, open 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 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 to the public. X ,Grp 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 o�Driver's license or photo ID showing date of birth issued by a public or private school, state, federal or foreign government is acceptable. 3.) Valid Permit Must be on-site. X g4,z 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 AGENT: S �/� DATE: FIR2011-00015 Please refer to the following pages for conditions of this permit. Page 5 of 7 �0,,0GT0*,, FIRE PROTECTION BURFIAU FIREWORKS LICENSING PROGRAM PO Box 42600 ❑O ■ WASHINGTON STATE PATROL Olympia`JVA 98504-2600 �� ��`•A.,NAL»��`` (360)596-3914 FAX: (360)596-3934 APPLICATION FOR RETAIL FIREWORKS STAND PERMIT town, r county in which DATE OF TO Governingbody of city, to 0 Y tY fireworks stand will be located. APPLICATION Applicant Name Address,City,State Sponsor(If other than applicant) Address,City,State Location of proposed fireworks stand [Enclose drawing of stand location] i Z Manner and place of storage prior,during,and after sales dates L df State-Licensed Fireworks Supplier - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - FIREWO-D IN. STAND PERMIT For the Fireworks Sales Year of- (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 as the local governing authority, the named person, firm or organization is hereby authorized to sell U.N. 0336 1.4G Consumer fireworks at the location designated herein between the following date and times: Sales for July 41h Sales for December 31sc From: From: To: To: Sponsor Location /s/ /s/ Signature of Official Granting Permit Signature of Applicant Title Agency Date Permit Number Licensee Name License Number 3000-420-013 (R 3/09) III I i IlillI ! ' II � I � I I I � IIIIIII ii { 11111I_I�_ I - I I li ► 1i111 � i 111 ili ' I � ! I t ! I I I .� I I I ! I. I I I I I i ! III j I + ► � j' Ii ' I I I jl ! li - 1I ILII l -- i ! I I I ! �, j l ► i t I _- � I I II � ' I1�; 1111 � 11I1 ! i - 11 i FFr i I I , ► t i !_� i t I FE Illli r ! IIl ! I - I Lt.. m-� 1 1 � I I � I � I l i-�! ► l j I l i ' i 1 , f v10i8c Ir i o M JIIWB is I ! ! 1 ! I ! I i II ! it ' ii � ! 1I1 ill IIII ! il � I t i l l I It I w 1 MASON COUNTY FIRE MARSHAL !ice Mason County Bldg.III 426 W Cedar St PO BOX 186 Shelton,WA 98584 (360)427-9670 Ext 273 CODE ENFORCEMENT FIRE INSPECTIONS FIRE INVESTIGATION PUBLIC EDUCATION STANDARDS FOR THE OPERATION OF RETAIL FIREWORKS STANDS Sales Consumer fire works may be sold only on the following days and times. • June 28"' from 12 noon to 11PM • June 29th—July 5th from 9AM to 11PM • July 6th from 9AM to 12 noon • December 27 h—31st from 12 noon to 11PM Approved Fireworks Only Washington State Fire Marshal approved Class C common fireworks may be sold. Fireworks Stand Location • A fireworks stand shall not be located more than 150' from an approved access road, • Shall be at least 100' from another fireworks stand or separated by a road, street or highway at least 30' in width, • Shall not be located any closer than allowed by the table below to other structures or exposures, • Or be located closer than 100' from any flammable liquid or gas dispensing device, or 300' from any flammable liquid or gas bulk storage or dispensing facility. Retail Fireworks Stands—Minimum Clearances Buildings Combustibles Property Line Parking Motor Vehicle Motor Vehicle Traffic, Traffic, Public Road Private Way Back of Stand 20' 20' 5' 20' 20' 5' Side of Stand 20 20' S 20' 20' 5' Front of Stand 20' 20' 20' 20' 20' 20' Surrounding Area around Fireworks Stands • The minimum areas around fireworks stands, as specified above, shall be kept free from dry grass, brush or combustible debris. This area shall be marked and flagged. • Motor vehicles or trailers may not be parked within 20' of the fireworks stand except when delivering, loading or unloading fireworks. • Fireworks shall not be discharged within 300' of any fireworks stand. A sign stating No Fireworks Discharge Within 300' in letters at least 2"high and in contrasting color shall be posted conspicuously on all sides of the structure. • No smoking shall be allowed within the fireworks stand or flagged off area. Signs stating No Smoking Within 100' in letters at least 2"high and in contrasting color shall be posted conspicuously on all sides of the structure. Electrical Supply &Usage • All battery powered equipment, electrical equipment and cords shall be UL listed and used in accordance with that listing. Extension cords shall be of an industrial grade type and shall be protected from physical damage. • 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. • Generators shall be located a minimum of 20' from any fireworks stand. Fuel storage is limited to 5 gallons. Fireworks Stand Operations • A minimum 24"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"in width located at opposite ends of the stand. These exits shall remain unlocked and unobstructed during hours of operation or when stand is occupied. • Sleeping inside a fireworks stand is prohibited. • 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. • There shall be a minimum of 2 (two) approved 2 1/2 gallon pressurized water fire extinguishers located adjacent to each exit door. • Cooking, open flame or any type of open flame equipment is prohibited in a fireworks stand. • Fireworks stands shall be locked when unoccupied and not open for business if fireworks are stored in the stand during these times. Fireworks stands shall not be locked when occupied. Fireworks may be removed or transferred to a temporary storage structure or location approved as part of the license and permit. • Fireworks may be stored in a locked and secured retail fireworks stand, truck, container, or trailer that is at least 20' from the fireworks stand during business hours, or in a locked or secured metal or wooden garage, shed,barn or other accessory building that is a least 20' from the fireworks stand. • At least one person 18yrs 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 the age of 16 shall be allowed to occupy the fireworks stand when it is open to the public. • It is illegal 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"high and in contrasting color shall be posted on the front of the stand. A photo ID is required and it is the responsibility of the seller to require proof of age. Driver's License or Photo ID showing a date of birth issued by a public or private school, state, federal or foreign government is acceptable. APPROV ED IS AL MASON COUNTY F DATE =� �/ 13 T T FIELE N A�� ��"c,a� CODES ` VSOLER,RS THESE PLANS MUST BE aDfc« o""bStO"S °" O N THE JOB SITE 0. SPOMb101Ut, Of OW"ERICF. CORNEC• f10Mb IIEt�W ® To GTOSC THi` FOR INSPECTION. ovm wrta TwE0V-►.1 O00�T o"ANvERso� �►.tE,ANY AAT£ 'LAItaS:.�.�.-ter _Th� 2 ! 1Z3 0012 (D T � � z� I -- r--.o ��� llvasx)n County Fireworks Permit Application PO BOX 186 426 W Cedar St Permit # FIR Shelton WA 98584 (360) 427-9670 ext 273 Receipt # CK # Date Received (q 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: Mailing Address: City. State: d .9- Zip: ' Contact Number, Sponsor Information Name: Mailing Address: 7 �( City: State: Zip: Contact Number Washington State Fireworks License Information (Copy Required) License No..- Date of El Pyrotechnic Pyrotechnic Operator License Fireworks Stand License Bond or Certificate of Insurance (Copy of Certificate/Bond Required) Provider: Insured: ' Certified Holder. ti Location of stand/display Address: 5, Directions to Site- Parcel Number: 1.2r) Legal Description: Legal Property Owner: * * Please see the reverse side to complete your application y � 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 landin area 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 Date Datej,�// FOR OFFICIAL USE ONLY BELOW THIS LINE Accepted By: Date: or 1 r ® DATE(MMIDDIYYYY) A�a CERTIFICATE OF LIABILITY INSURANCE 04/11/2011 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 1-425-454-3386 CONTACT Joanne Manion NAME: Arthur J. Gallagher Risk Management Services, Inc. PHONE 425-454-3386 FAX 425-451-3716 No.ExtI* Alc No E-MAIL P.O. Box 367 ADDRESS: Bellevue, WA 98009-0367 INSURERS AFFORDING COVERAGE NAIC# INSURER A: James River Insurance Co. INSURED INSURER B: Thunder Fireworks, Inc. INSURER C 5207 187th Street E. INSURER D: INSURER E Tacoma, WA 98446 INSURER F COVERAGES CERTIFICATE NUMBER: 20652681 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MMIDD/YYYY A GENERAL LIABILITY 000457200 11/15/1 11/15/11 EACH OCCURRENCE $ 1,000,000 DAMAGEO ED % COMMERCIAL GENERAL LIABILITY PREMISES E.occurrence $ 50,000 CLAIMS-MADE FTI OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident A UMBRELLAUAB N OCCUR 000457220 11/15/1 11/15/11 EACH OCCURRENCE $ 91000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 9,000,000 DED RETENTION$0 $ WORKERS COMPENSATION WC STATU- OTH- ER AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Location: 23501 NE State Route 3, Belfair, WA 98528 Mason County and all its employees; Robert Sumara and all his employees; Judy Scott; MJ Scott Enterprises, LLC are included as additional insureds but only as respects the operation of the named insured per policy terms and conditions - policy form EG2032US 0109. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Mason County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P. 0. Box J AUTHORIZED REPRESENTATIVE li Shelton, WA 98581 /—,W USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD jmanion 20652681 Washington State Patrol 12443 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 Robert S. Sumara Post Office Box 417 State Fire M rshal gt�a e Allyn, WA 98524 License Number: WSPFL-00448 Detach this w 11 ar and carry with you for verifi ion if certification. Stand Information Washington State Patrol 12443 Contact Person: Robert S. Sumara Fire Protection Bureau Phone Number: (360) 427-1087 Office Of The State Fire Marshal ANNUAL FIREWORKS STAND LICENSE County: Mason Date of Expiration Date of Issue Licensee: Robert S.Suriiara Stand Number: SN-05863 January 31, 2012 April 1, 2011 Contact Person: Robert S.'Sumara License Number: WSPFL-00448 Stand Number: SIB-05863 E [Valid For One Stand] Date of Expiration: January 31,'2012 .r Location: ' Stand Location: [ land Locatiai To-Be Completed By Licensee) [Stand Location To Be Completed By Licensee] �� ,� 3000-420-012(R 9/05) State Fire Marsh6i i ature Licensee Signature i 40 i