Loading...
HomeMy WebLinkAboutFIR2010-00014 Final Fireworks Stand - FIR Permit / Conditions - 6/28/2010 r 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 FIR2010-00014 • APPLICANT: JOHN MILLER CONTRACTOR: FIREWORKS SUPERMARKET 360.620.1732 LICENSE:WSPFL-01428 EXP: RECEIVED: 6/1/2010 SITE ADDRESS: 22950 NE STATE ROUTE 3 BELFAIR ISSUED: 6/15/2010 PARCEL NUMBER: 123325000044 EXPIRES: 12/15/2010 LEGAL DESCRIPTION: SAM B. THELER'S HOME & GAR TRS TR 19-B PROJECT DESCRIPTION: FIREWORKS STAND- NEXT TO BELFAIR ELEMENTARY SCHOOL 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 Wet Chemical?: N Zones: Heat Detectors: 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 $100.00 87-7 - 23y 1 10 '7 FI R2010-00014 Please refer to the following pages for conditions of this permit 1 -ef-6- ` .. .._..._ ...—, ••••••••,•• •• n) v,i u is ivnV1fY11114%jap 131IU III Ile$. June 28th from 12 noon to 11 PM June 291h to July 5th from 9 AM to 11 PM o w ` July 6th from 9 AM to 12 noon N N O o X my Washington State Fire Marshal approved class C common fire works may be sold. ��/-- ,. �--oop, A fire works stand shall not be located more than 150 feet from an approved access road. Shall beat least 100 feet from another fire works stand or °' � SOVarMed hV-q MRd irfLM nr h! hwq Rt 1 R!';n fPof in xx,;r*h �_`ha.!1�n! �n lr }a�anv nlrt�c-fh=n�nr__crl l��r 3F,a�!lor4rl!f�5,1—:n.t►�,�r . - , exposures or be located closer than 100 feet from an flammable liquid or ' w.���"��"�'"'� "' "" 9 Y q gas dispensing device, or 300 feet from any Flammable I'Illiquid or as bulk � storage or dispensing facility. X a - A The minimum areas around a fire works stand,as specified in the attached table. shall be kept fraa from riry rtrace hnieh ,,,,.�,.,,,,,,.;,.,,,J L_;_ TL' �l -•e a ---r_•__„j,., .... ,,,.,u�.,�ne veut,a, i 1na - m � U a Motor isles or trailers may not be parked within 20 feet of the fire works stand except when delivering,loading or unloading fireworks. X 0 Fireworks shall not be discharged within 300 feel of any fireworks stand.A sign stating"No Fireworks discharge within 300 feet"in letters at least 2 inches ae high and i ntrasting color shall be posted conspicuously on all sides of the structure. X z o No sn.4ing 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 contrast colors shall be posted conspicuosly on ail sides of the structure. b x X v� H 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 C industrial grade type and shall be protected from physical damage, y X x All heating evic�shallbe UL fisted. Only heating devices with sealed type elements shag be used,i.e.oil filled or water filled radiator type.Open flame 0 or open element heating devices are prohibited. " X M Generator IZ ll be located a minimum of 20 feet from any fire works stand.Fuel storage is limited to 5 gallons. X M A minimum 4 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. o These exits shall remain unlocked and unobstructed during hours of operation or when stand is occupied. X 19 Sleeping Ins[ e a fireworks stand is prohibited. o N X c �' � w N CO - FIR2010-00014 "PI§ase referto the fallowing pages for conditions of this p6m it 06/28/2010 12:04 FAX 360 427 7798 MASON CO PERMIT CTR Z 005 X CO NCRx_TE MECHANICAL MANUFACTURED HOME r- Da r FoaAinBs Setheod� Gas P4pin9 By ORaZ. M GInteriorCata: IBy InWor-Date By Dipla Sy L O Werlor Daly By Exterior-Data B up Q IN5LUMON = Point toad)d Isolated Footing p'at� By z BG FSL,kB ItaSIJ'LATImFI note By Data By- FIRE DEPARTMENT Foundatim Wall s Floors Date By Date _ 13y Data ey DECKS FRAMING warns Date By Clate By. Dania By PROPANE TANKS PLUMBING Vault Data By Date By OTHER Ground"rk Attic DOW By Dale By Type- Data lBy O.v+r_v DRYWALL Type: Int Braca Wall •� [late s v We 13y � 3 Data ByN Water Lim Fire Sgmration CD �N�4L INSPECTION O C a8tp By Data By. Dais By O O oPass or request Inspect. s Type of Insp. Fail Date "e � Done By Comments m o U3 0 a � a rt in rt i I I cn 0 cn i ` 4 Mason County Fireworks Permit Application PO BOX 186 426 W Cedar St Permit# FIR --« I Shelton WA 98584 Receipt # 10— 1075 (360) 427-9670 ext 273 CK # Date Received -l I O 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: �o!�►ti 1�1 i ll� Mailing Address: I S i 5-T.0 NW F l,,'re City: S � State: Lo A Zip: 9 4>3 eo Contact Number (360) 20 -i _7 3 2 Sponsor Information Name: 1=�'re�.9o�-!cg Mailing Address: I SI rat W H 1 tz City: � � C-{ State: -w A Zip: `1 a38d Contact Number .3(.o ) & 2O _ 1 -7 3 2 Washington State Fireworks License.Information (Copy Required) License No.: WS P FL —0 / `l28 Date of Issue: y�jy� 0 ❑ Pyrotechnic Operator License Q' Fireworks Stand License Bond or Certificate of Insurance (Copy of Certificate/Bond Required) Provider: �cc,►.r,�u �hs,�►-�, Insured: E F-M P c Lc Certified Holder: Location of stand/display Address: 2 2 R Sp N E S+a.4-c- IQ o u.-I`e 3 Ig L am ; Directions to Site. C,0 o ; N c- S+0-4c. P-o 1- e 3 �,I,- u^A- N E. Qo e s Se I R-A PA c4 4- -W 13.c I Parcel Number: 2 33 2 5- c000 - yH Legal Description: Sa,,,, 6 , -��1trs R m` d (21a �s M /q 3 Legal Property Owner. C-F-M Pt-ape ts LC G * * Please see the reverse side to complete your application The Mowing 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 • Designated landing 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: The folioPertinent informsdoa MUST be provided on toe site diagram below Locations and Setback distances from tho back,sides and front of retail sales stands or desi I display arm,to: • Fue Hydrants N/A • Property Lanes ►�`-- - • Buildings ✓ • PaAing ✓ Combustibles iV/A • Public Roads and Right of Ways ✓ • File Lanes '' Private Roads and Right of Ways • Trr�es /Brush • Landmarks • Utilities and Gas wA- Mortar separation distance • D_ c i,�ri dod landing area j JJ wje w ? 7 v 10 Wp—1 cants Affidavit 1 cerOV that the information provided herein is accurate and that compliance with all Count}l. S l laws ee a to the sales or discharge of fireworks shall be m ntained _ Signed Date - 2D C) _ FOR OFFICIAL USE ONLY BELOW'PHIS LINE Accepted By. Date: 2009-12-14 15:30 3604277798 Page 377 +,SN\NOTONJlRfF FIRE PROTECTION BUREAU FIREWORKS LICENSING PROGRAM PO Box 42600 ■ Olympia WA 98504-2600 WNSHINGTON STATE PATROL +fr'�R�N�C>•�R�\4W (360)596-3914 FAX: (360)596-3934 uO APPLICATION FOR RETAIL FIREWORKS STAND PERMIT TO Governing body of city, town, or county in which DATE OF fireworks stand will be located. APPLICATION $/ZyZj Z� Applicant Name Address,City,State e 9�38b Sponsor(If other than applicant) Address,City,State h It' Location of proposed fireworks stand [Enclose drawing of stand location] E 2'1 Sb N E S+-A;te V-o14-- 3 !?-L14-"'- Manner and place of storage prior,during,and after sales dates kJ -0 6-c- 04 l-r-- State-Licensed Fireworks Supplier LL v`4 c✓ T�w W o/" - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - FIREWORKS 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 4th Sales for December 31St From: From: To: To: Sponsor Location Signature of Official Granting Permit Signature of Applicant Title Agency Date Permit Number Licensee Name License Number 3000.420.013(R 3/09) FIREWORKS LICENSE AGREEMENT This agreement is made between Joe Solif, as licensor and Firework Supermarket as licensee for the said purpose of allowing retail sales of Consumer Fireworks from the following location: 22950 NE STATE ROUTE 3 BELFAIR Parcel tax ID#123325000044 The licensor represents that it owns, or controls the use of the lot as listed above and agrees to grant licensee the right to operate a retail firework stand on the premises for the period of June 22,2010 through July 8,2010 for a license fee of$60"0 due later than July 15"', 2010. 7S4 1 �— The licensee shall pay all cost involved in the erection, operation and maintenance of the stand, and shall guarantee that the premises shall be returned to the original condition after removal of the stand. The licensee will provide liability insurance coverage and provide to the licensor, before occupancy. The insurance shall name the licensor as an additional insured, and licensee will hold the licensor harmless from any claims arising from the maintenance or operation of the structure. The licensee shall pay for and obtain licenses and permits required by law and post any performance bonds which might be required. The licensee shall guarantee that the stand is operated in a business like manner and adhere to all local state regulations. If the property is sold, ingress/egress changed, or location impacted due to construction or the like,then this license is subject to revocation and refund of any payments made. LICENSOR: LICENSEE: � r Joe Solif-Owner Firework Supermarket Representative Phone 360.440.4873 Phone:360.620.1732 i ACORDri CERTIFICATE OF LIABILITY INSURANCE DATE( oD,YYYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION David Connolly Insurance Agency Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE y y HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 9393 Bayshore Dr ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Silverdale,WA 98383 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: National Fire&Marine Ins.Company Aurora Fireworks LLC INSURER B: 29399 Beach Dr NE INSURER C POulsbo,WA 98370 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. MSR ADDIL POLICY NUS POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERALIJABAM 72LPS-012423 5/1/2010 5/1/2011 EACH OCCURRENCE $ 1,000,000.00 X COMMERCIAL GENERAL LIABILITY PREMISES Ea omoenoe $ 100,000.00 CLAIMS MADE a A OCCUR MED EXIP one n) s 5,000.00 PERSONAL&ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE s 2,000 000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMROP AGG $ 1,000,WO.00 POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANv AUTO (Ea acciden1) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (P-pe—) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Par acd&M) PROPERTY DAMAGE $ (Pr acddant) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG S EXCESSAIMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ S DEDUCTIBLE S RETENTION S $ WORKERS COMPENSATION AND WCSTLWTS ATU- FIR EMPLOYERS'LIABRJTY ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERA*MBER EXCLUDED? EL DISEASE-EA EMPLOYEE S It yyees.describe under SPECIAL PROVISIONS bebw E.L.DISEASE-POLICY LIMIT S OTHER DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate holder& Mason County, Property Owner Joe Solif are listed as an additional insured for the fireworks stand at 22950 NE State Route 3 Belfair, WA 98528. CERTIFICATE HOLDER CANCELLATION Fireworks Supermarket SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 15156 NW Hite Center Rd DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Seabeck,WA 98380 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. AUTHORIZED REPRESENTATIVE .nI ACORD 25(2001/08) ©ACORD CORPORATION 1988 JANICE LYNN VENTURA FIREWORKS SUPERMARKET 12023 DAPHNE LN NW APT A302 SILVERDALE WA 98383-8786 004090 DETACH BEFORE POSTING ...._-..._- -------- '---.._ _..--------'----- -'-------__.._--.____-___ __ p� MASTER LICENSE SERVICE PO Box 9034.Olympia, WA 98507-9034•(360)664-1400 y�rsy° REGISTRATIONS AND LICENSES STATE OF WASHINGTON Unified Business ID #: 602 795 967 i Sole Proprietorship Business ID #: 1 Location: 1 I JANICE LYNN VENTURA FIREWORKS SUPERMARKET 12023 DAPHNE LN NW APT A302 SILVERDALE WA 98383 8786 TAX REGISTRATION } REGISTERED TRADE NAMES: jI FIREWORKS SUPERMARKET i i tg I I f u 1 I i The licensee named above has been issued the business registrations or l Ncenses listed.By accepting this document the licensee certifies the information provided on the application for these licenses was complete,true,and accurate to the best of his or her knowledge, and that business will be conducted in compliance with all applicable Washington state,county,and city regulations. Director,Department of Licensing Washington State Patrol 1 1 4 1 4 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 Fireworks Supermarket 15156 Northwest Hite Center Road State Fire Marshal Signature Seabeck, WA 98380 License Number: WSPFL-01428 Detach this wallet card and carry with you for verification of certification. Stand Information Washington State Patrol 11414 Contact Person: John Miller Fire Protection Bureau Office Of The State Fire Marshal Phone Number: (360) 620-1732 ANNUAL FIREWORKS STAND LICENSE County: Mason Date of Expiration Date of Issue Licensee: Fireworks Supermarket Stand Number: SN-05108 January 31, 2011 April 14, 2010 Contact Person: John Miller License Number: WSPFL-01428 Stand Number: SN-05108 [Valid For One Stand] Date of Expiration: January 31 2011 Stand Location: 2215b IN E-S+z,4c_AUAc 3 Location: 2 T01Sb NE-S" R{r�►c 3 [Stand L cat' n To Be Completed ByLiLicensee] [Stand Location To Be Completed By Licensee] vW 3000-420-012 (R 9/05) State Fire Marshal Signature Licensee Signature MASON COUNTY a� Department of Community Development FIRE PROTECTION SYSTEMS INSPECTION CARD* PO BOX 186, 426 W Cedar ST, Shelton WA 98584 General Questions: (360) 427-9670 ext 352 Inspection Requests: (360) 427-7262 Permit Number FIR2010-00014 Date 06/15/2010 Issued By Project FIREWORKS STAND- NEXT TO BELFAIR ELEMENTARY SCHOOL Site Address 22950 NE STATE ROUTE 3 BELFAIR Applicant JOHN MILLER Contractor FIREWORKS SUPERMARKET License Number WSPFL-01428 Con. Phone 360.620.1732 Expiration Date 01/31/2011 Primary Code 2006 IFC Wet Chem N Sprinkler N Use STND Dry Chem N Standpipe N Hod and Duct N Public Works Access /Driveway Other Health Dept Septic Well Planning Dept Site Inspection Fire Marshal Fire Apparatus Access Fire Sprinkler Auto Fire Alarm Hood and Duct Other Final Building Dept Building Official: Community Development Designee Concrete Setbacks Slab Footing Perimeter Ret. Wall / Bulkhead Footing Interior Footing Decks/Porches Foundation Stem Walls Other Rough-In Groundwork Plumbing Plumbing Groundwork Mechanical Other Groundwork Gas Pipe Gas Piping Framing Mechanical Insulation Slab Ceiling Floor Vaulted Ceiling Walls Vapor Barrier Other Wallboard Nailing Interior Wall Brace Panels Fire walls Other Final Building Manuf. Home Setbacks Setup Concrete Foot/ Runners Final Other APPROVED PLANS MUST BE ONSITE FOR ALL INSPECTIONS *THIS STRUCTURE MAY NOT BE USED FOR OCCUPANCY UNTTL ALL APPLICABLE FINAL INSPECTIONS ARE COMPLETED DO NOT PROCEED BEYOND EACH STAGE OR COVER WORK UNTIL APPROVALS ARE GIVEN. POST THIS CARD IN A CONSPICUOUS PLACE ON THE FRONT OF THE PREMISES CONVENIENT FOR MAKING REQUIRED ENTRIES. ALL PERMITS EXPIRE 180 DAYS AFTER PERMIT ISSUANCE OR 180 DAYS AFTER LAST INSPECTION ACTIVITY IS PERFORMED. OWNER/AGENT IS RESPONSIBLE FOR CALLING FOR ALL INSPECTIONS PRIOR TO CALLING FOR FINAL INSPECTION,ALL.CONDITIONS OF THE PERMIT MUST BE MET.