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HomeMy WebLinkAboutFIR2013-00014 Final Fire Works Stand - FIR Permit / Conditions - 6/27/2013 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inspection Line(360)427-7262 Mason County Bldg. 3 426 W. Cedar P.O. Box 279 Phone: (360)427-9670, ext. 352 Shelton, WA 98584 1� FIRE PROTECTION PERMIT FIR2013-00014 APPLICANT: NORTH MASON PEE WEES RECEIVED: 5/16/2013 CONTRACTOR: LICENSE: EXP: ISSUED: 6/4/2013 SITE ADDRESS: 23861 NE STATE ROUTE 3 BELFAIR EXPIRES: 12/4/2013 PARCEL NUMBER: 123294100091 LEGAL DESCRIPTION: PCL 2 OF BLA#04-37 PTN TR 9-A NE SE S 29/194 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?: Third Floor;: Total: $100.00 $100.00 FIR2013-00014 Please refer to the following pages for conditions of this permit. Page 1 of 6 F1.) 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 th from 9 AM to 12 noon X P 44- Only Wshington State Fire Marshal approved class C common fire works may be sold. 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 storag,9e 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��ll 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. X -C--J 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. X L� 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 cyn tasting 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 industrial grade type and shall be protected from physical damage. X 6� 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 LZ L-4 Ge rators shall be located a minimum of 20 feet from any fire works stand. Fuel storage is limited to 5 gallons. X J4 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. Xh ge,exits shall remain unlocked and unobstructed during hours of operation or when stand is occupied. Sleeping inside a fireworks stand is prohibited. FIR2013-00014 Please refer to the following pages for conditions of this permit. Page 3 of 6 1 X ul+ 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 f( There shall be a minimum of 2 approved 2 1/2 gallon pressurized water fire extinguishers located adjacent to each exit door. x j�(J Cooke, 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 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. f_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 standX &4 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 C 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. 2.) Ow I Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. X 3.) Valid Permit Must be on-site. X C-fJ 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: DATE: L) A—c-) FIR2013-00014 Please refer to the following pages for conditions of this permit. Page 4 of 6 -n Z �5 CONCRETE MECHANICAL MANUFACTURED HOME O N date By Footings l Setbacks Gas Piping Ribbons = W Intenor Date By Interior-Date By Date By 3 CExterior Date By Exterior-Date_ B Set-up N -14b Point Load I Isolated Footings INSULATION Date By O BG I SLAB INSULATION - Z Date By Data By FIRE DEPARTMENT Foundation Walls Floors Date By m m Date By Data By DECKS FRAMING Walls Date By R1 Date By Data By PROPANE TANKS � PLUMBING vault Date By Date By OTHER Groundwork Attic Date By Date By Type: Date By D.W.v DRYWALL Type- Inl.Brace Wall Date Fs; T Date By Date g y y FINAL INSPECTION c M Water Line Fire Seperation Date By Date By Date by W � O o Pass or Request Inspect. o Type of Insp. Fail Date Date Done By Comments �; 0 3 fQ _ M to O A O 7 a r: 0 N O N <D N (0 CD CA 0 Ac"#?" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) II/I/2013 3/5/2013 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 NAME:CONTACT 3280 Peachtree Road NE,Suite 800 PHONE FAX A/C No Ext: A/C No): Atlanta GA 30305 E-MAIL (404)460-3600 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Scottsdale Insurance Company 41297 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 COVERAGES CERTIFICATE NUMBER: 12219627 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR IN SR WVD POLICY NUMBER MMIDD/YYYY MM/DDIYYYY A GENERAL LIABILITY N N CPS1612503 II/l/2012 II/l/2013 EACH OCCURRENCE DAMAGE TO RENTED X MMERCIAL GENE BILITY PREMISES(Ea occurrence) $ 100 000 CLAIMS-MADE OCCUR MED EXP(Any oneperson) $ 5,000 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 F PROECT X LOC S J AUTOMOBILE LIABILITY NOT APPLICABLE (Ea accident) $ XXXXXXX ANY AUTO BODILY INJURY(Per person) $ XXXXXXX ALL OWNED SCHEDULED BODILY INJURY Per accident $ XXXXXXX AUTOS AUTOS PROPERTY DAMAGE $ XXXXXXX NON-OWNED HIRED AUTOS AUTOS $ XXXXXXX UMBRELLA LIAB OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX EXCESS LIAB CLAIMS-MADE AGGREGATE $ ){){){}{}{}(}{ DED RETENTION$ $ XXXXXXX WORKERS COMPENSATION NOT APPLICABLE AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ XXXXXXX OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ XXXXXXX If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ XXXXXXX DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Reid Realty located at 23861 NE Hwy 3 in Belfair,Wa(Loc.W WM6512)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. 12219627 AUTHORIZED REPRESENTATIVE North Mason Pee Wees Reid Realty Mason County PO BOX 186 426 W Cedar Shelton WA 98584 ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD © 9 13- 10 ACOAD CORP TION.All rights reserved _ RECEIVED MAY 16 200 426 W. CEDAR ST. 11 _Fi 6 Z01 -poo i`4 Washington State Patrol \"' w 0\( 14394 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 n North Mason Pee Wees 2120 Milwaukee Way State Fire Marshal Sipn to ' Tacoma, WA 98421 License Number: WSPFL-00506 Detach this wall ard; nd with you for verification&ceitification. Stand Information Washington State Patrol 14394 Fire Protection Bureau Contact Person: Brett Bergdahl Office Of The State Fire Marshal Phone Number: (360) 710-2121 ANNUAL FIREWORKS STAND LICENSE County: Mason Date of Expiration Date of Issue Licensee: Nort Wees Stand Number: SN-07355 January 31, 2014 January 17, 2013 Contact Person: Br Bgai ;vx License Number: W Stand Number: S .; id For One Stand] Date of Expiration: Jan i Location: _ Stand Location: [ land Location ompletedByLicensee] [Stand Location To Be Completed By Licensee] 3000-420-012(R 9/05) State Fire Marsh ature Licensee Signature + ' Mason County ' Fireworks Permit Application PO BOX 186 Permit# FIR 2D13- D�l 426 W Cedar St P L4 Shelton WA 98584 RECEIVED (360) 427-9670 ext 273 Receipt # 512 01 -,415 MAY 16 200 CK # 426 W. CEDAF3 ST. Date Received \5-/(p. �p 13 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: Ida City: �e Omm Sta Lj-A Zip: 8 2. Contact Number (3c�y) �75, (�10�1 . Ent Sponsor Infor at' Name: -� Mailing ddress: ',,_D) 1 E I'y)p� - � V �Ei,�� I� ►Z . City: A l l State- Zip: ci�3GZ� Contact Number (34 ) -15 - LaIo9 Washington State Fireworks License Information (Copy Required) License No.: Date of _ 0 ,7 �� -. �j CD Issue: .JA r) 17 2.01 ❑ Pyrotechnic Operator License Fireworks Stand License Bond or Certificate of Insurance (Copy of Certificate/Bond Required) Provider: p LLC, Insured: n �V Tnc� Certified Holder: Sn ca—, C40 .E] Location of stand/display Address: -� SCc _ A I I, Directions to Site: + e_4-3 -gyp O ?IV Af-4 n Parcel Number: Legal Description: C-L a -4 o 3 `Tt2.q'-�Q nE 5 S Legal Property Owner: L * * Please see the reverse side to complete your application The followingPertinent information MUST be provided on the site diagram below Locations and Setback distances from the back, sides and front of retail sales stands or-- sip deated 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 I n e 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 V�, Date FOR OFFICIAL USE ONLY BELOW THIS LINE Accepted By: Date: APPLICATION -��2.ZO 13•DOc� `-� FOR RETAIL FIREWORKS STAND PERMIT WWM6512 TO: Governing body of city,town, or county in which DATE OF MAR. 1, 2013 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: BRETT BERGDAHL 2120 MILWAUKEE WAY, TACOMA„ WA 98421 Location of proposed fireworks stand: [Enclose drawing of stand location] !!& INE HWY 3, BELFAIR WA VACANT LOT 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: 2013 (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 4a' Sales For December 31s' From: From: To: To: Sponsor: NORTH MASON PEE WEES Location: VACANT LOTX; S' 14E HWY 3, BELFAIR WA /s/ /s/ FOR BRETT BERGDAHL Signature of Official Granting, Permit Signature of Applicant Title: Agency: Date: Permit Number: Licensee Name: NORTH MASON PEE WEES License Number: 00506 3000-420.013(Rev.2/05) - SITE DIAGRAM Date Updated: 2 ! 0 Location #: W W Location Name: P-';C/�O( Ordinance Of: �1�. (� �( ►'� f Site Address: Structure Size: �~ 3 CITY �b STATE/ZIP -vv Structure Faces: Parcel: Show all setback groin structures gas, fire lanes, public and pr'vate roads, ru er ty Dries trees and ian-Irnarks J h k n is `Jv CHANGES a 38� ht SUBMIT CHANGES FOR APPROVAL PRIOR TO PERFORMING WORK L� `je� Gtt �c_1•.c cl �41r-A r\44:r'.r -ro c- re-r,-N ti vi Notes • MASON COUNTY FIRE MARSHAL III 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 28th from 12 noon to 11PM • June 29t'—July 5th from 9AM to 11PM • July 6`h from 9AM to 12 noon • December 27th—31"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' 5' 20' 20' 5' Front of Stand 20' 20' 20' 20' 20' 20' _ 46 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 & Usa2e • 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. op I 23z � yIL)C)C) T fit [ � r opy 2- THESE PLANS MUST BE ON THE JJi3 SITE FOR INSPECTION. APPROVED MASON C,OUI/STY FIRE AR§HAL DATE 2 Z_Lo BY c.J SUBJECT TO FIELD INSPECTION ALL APPLICASL CODES QH.ALL APPLY. ERRORS AND/OR O+AISS10NS ON PLANS ARE SOLE NF. SPONSIBILITY OF OWNER/CONTRACTOR. COPPEC- TIONS REOUIRED FROM FIELD INSPFCTION SH.4Lt BE AT OWNER/CONTRACTOR'S EXPENSE. THIS AP- PROVAL DOES NOT GRANT TO ANY PERSON r;-tr RIGHT TO VIOLATE ANY CITY Or STA,Tr : .•y���: ! '