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HomeMy WebLinkAboutFIR2010-00007 Final Firework - FIR Permit / Conditions - 6/28/2010 I 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 FIR2010-00007 APPLICANT: ROBERT SUMARA CONTRACTOR: LICENSE: EXP: RECEIVED: 4/19/2010 SITE ADDRESS: 23331 NE STATE ROUTE 3 BELFAIR ISSUED: 5/4/2010 PARCEL NUMBER: 123325000014 EXPIRES: 11/4/2010 LEGAL DESCRIPTION: SAM B. THELER'S HOME & GAR TRS TR 6 S 1/2 OF PROJECT DESCRIPTION: FIREWORK PERMIT GENERALNF MATT System Information Type of Use: STND Fire District: 2 Sprinkler Heads: Audible Switches: Pull Stations: Hood & Duct?: N Flow Switches: Visual Devices: Door Releases: 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 S100.00 Auto Fire Alarm?:N Third Floor;: Total: $100.00 $100.00 FIR2010-00007 Please refer to the following pages for conditions of this permit. 1 of 7 r 1.) Owner/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. 1 X "__ 2.) Valid Permit Must be on-site. X_t�1/� FIR2010-00007 Please refer to the following pages for conditions of this permit. 3 of 7 3.)� Consumer fire works may be sold only on the following days and times: f June 28th from 12 noon to 11 PM June 29th thru July 5th from 9 AM to 11 PM July 6th from 9AM to 12 noon X Only Wash' ton State Fire Marshal Approved class C common fireworks may be sold. X ,fy� 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 fireworks stand or separated by a road, street or Hwy at least 30 feet wide. Shall not be located any closer than allowed by the table attached to this permit( Retail Fireworks Stand- Minimum clearances) 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 or dispensing facility. X The minimum areas around a fireworks stand as specified in the attached table shall be kept free from dry grass, brush or combustible debris, this area shall be clea y marked or flagged. X Motor vehicles or trailers may no be parked witin 20 feet of the fireworks stand except when delivering, loading or unloading fireworks. X 1irr� Fireworks shall not be discharged within 300 feet of any fireworks stand. A sign stating No fireworks discharge witin 300 feet in letters at least 2 inches high and in coptrasting color shall be posted conspicuously on all four sides of the structure. X No smoking shall be allowed within the fireworks stand or flagged off area. Signs stating No smoking within 100 feet in letters 2 inches high in contrasting color shall be ed conspicuously on all four sides of the structure. X � All battery powered equipment, electrical equipment and cords shall be UL listed and used in accordance with the listing. Extension cords shall be of an industrial grade pe 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 types. Open flame or open element heating devices are prohibitied. X G� Generators shall be located a minimum of 20 feet from any fireworks stand. Fuel storage is limited to 5 gallons. X 4' ---- 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 remain unlocked and unobstructed during hours of operation or when stand is occupied. X Sleeping in the stand is prohibited. The location of the nearest phone shall be posted in the fireworks stand. All occupants of the stand shall be informed FIR2010-00007 Please refer to the following pages for conditions of this permit. 4 of 7 ' 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 / X an d. There shall b minimum of 2 approved 2 1/2 gallon pressurized water fire extinguishers located adjacent to each exit door. X- 7�a Cooking, open flame or any type of open flame equipment is prohibited in a fireworks stand. X Fireworks stand shall be locked when unoccupied and not open for business if fireworks is stored in the stand during these times. Fireworks stand shall not be locked when occupied. Fireworks maybe removed or transferred to a temp. storage structure or location approved as part of the license and permit. i X Fireworks maybe stored in a locked and secured retail fireworks stand, truck, container, or trailer that is at least 20 feet from the stand during business hours, or in a locked or secured metal or wooden garage, shed, barn or other accessory building that is at least 20 feet from the fireworks stand. X At least one person 18 years of age or older shall be on duty in the fireworks stand when fireworks are being sold to the public. Such person shall be responcible 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 t Xhen i i the public. 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 the resposiblity of the seller to require proof of X age. Drivers or phot ID showing date of birth issued by a public or private school, state, federal or foreign government is acceptable. 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 anytime 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 orthe 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:/ec-4 /Lim��,, _ DATE: FIR2010-00007 Please refer to the following pages for conditions of this permit 5 of 7 II Mason County F!re!"+!L'ra ��i iiit hjJ plIcation PO BOX 186 426 W Cedar St Permit# FIR o'ZG/d-06007 Shelton WA 98584 (360) 427-9670 ext 273 Receipt # .S1 ".Zvid — 73s CK # Ccas1 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: / �-T ��- Mailing Address: z,.,�,,f City: ,) State: Zip: I Contact Number (?������� Sp7-4 nformation NaMailing Aess. ^' City: �,�.� State: Contact Number Zip: yr" _ Washington State Fireworks License Information (copy Required) License No.: Date of Issu ❑ Pyrotechnic Operator License Fireworks Stand License Bond or Certificate of Insurance (Copy of Certificate/Bond Required) Provider: _ Insured: Certified Holder: Location of standldisplay Address: 7 Directions to Site: Parcel Number.: Legal Description: Legal Property Owner: * * Please see the reverse side to complete your aPP lication 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 anding 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 FOR OFFICIAL USE ONLY BELOW THIS LINE Accepted By: Date: •� '_,.u16T0y J�,lt FIRE PROTECTION BUREAU FIREWORKS LICENSING PROGRAM PO Box 42600 Olympia WA 98504-2600 w"`"I"`UMW- APPLICATIONSTATE PATROL `49SMAL's (360)596-3914 FAX: (360)596-3934 FOR RETAIL FIREWORKS STAND PERMIT TO Governing body of city,town, or county in which DATE OF 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] Manner and place of storage prior,during,and after sa es dates State-Licensed Fireworks` upplier 1 ! - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - FIREWO�S STAND PERMIT For the Fireworks Sales Year of: x (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 4 h Sales for December 31St From: From: To: To: _... Sponsor Location /s/ /s/ Signature of Official Granting Permit Signatufe of App c,an Title Agency Date Permit Number Licensee Name License Number 3000-420-013 (R 3/09) WCf7U�.� i : [ , f I I 1 i I I I I ; I • I : i • � i I � i I i � �� i : i { ! I j ( ii _ i $�LF•p� i f� I , i I i i • i � I I i I i i 1 : : I� , ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 3 29 2010 PRODUCER Phone: 440-248-4711 Fax: 440-248-5406 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Britton-Gallagher and Associates, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6240 SOM Center Rd. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Cleveland OH 44139 INSURERS AFFORDING COVERAGE NAIC# INSURED _ WSURERA:Lexington Insurance Co Thunder Fireworks Inc. INSURERB:Granite State Insurance Co. 23809 5207 187th Street East Tacoma WA 98446 INSURER C:A}t1S-Suriplus Ins Company INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' POLICYEFFECTIVE POLICY EXPIRATION L POLICYNUMBER D T LIMITS A GENERAL LIABILITY 43925453-01 11/15/2009 11/15/2010 EACHOCCURRENCE $1 000 000 DAMAGEN X COMMERCIAL GENERAL LIABILITY PREMISES IEa occurence $5 Q 0 0 0 CLAIMSMADE IX I OCCUR MED EXP(Any one person) $ PERSONAL BADVINJURY $1 000 000 GENERAL AGGREGATE $2 0 0 0 0 0 0 GEN.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2 0 0 0 0 0 0 POLICY 7 JECT PRO—X LOC B AUTOMOBILE LIABILITY CA9 3 8 2 9 6 5 8 11/15/2 0 0 9 11/15/2 010 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $1,0 0 0,0 0 0 ALL OW NED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIREDAUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTYDAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHERTHAN EAACC $ AUTO ONLY: AGG $ CT EXCESSIUMBRELLA LIABILITY EAU710 6 5 0 11/15/2 0 0 9 11/15/2 010 EACH OCCURRENCE 1$9,000,000 }{ OCCUR CLAIMS MADE AGGREGATE $9 0 0 0 0 0 0 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC Y STATULIMIT- OTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERlEXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1$ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS OCATION: HOOD CANAL MASONIC CENTER 23331 NE STATE ROUTE 3 BEL FAIR WA 98528 DDITIONAL INSURED: MASON COUNTY AND ALL IT'S EMPLOYEES, ROBERT SUMARA, LEE ISOM, HOOD CANAL MASONIC CENTER. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER MASON COUNTY WILL ENDEAVOR TO MAIL30 DAYS WRITTEN NOTICE TO THE P.0 BOX J CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHELTON WA 98581 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE oo ACORD 25(2001/08) ©ACORD CORPORATION 1988