HomeMy WebLinkAboutFIR2009-00066 Final Fireworks Stand - FIR Permit / Conditions - 12/29/2009 ' 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
lip, Shelton,WA 98584
FIRE PROTECTION PERMIT FIR2009-00066
APPLICANT: JOHN MILLER RECEIVED: 12/21/2009
CONTRACTOR: LICENSE: EXP: ISSUED: 12/28/2009
SITE ADDRESS: 22950 NE STATE ROUTE 3 BELFAIR EXPIRES: 6/28/2010
PARCEL NUMBER: 123325000044
LEGAL DESCRIPTION: SAM B. THELER'S HOME& GAR TRS TR 19-B
PROJECT DESCRIPTION: FIREWORKS STAND FOR NEW YEARS
System Information
Type of Use: STND
Fire District: 2 Sprinkler Heads: Audible Switches: Pull Stations:
Hood& Duct t: Flow Switches: Visual Devices: Door Releases:
Dry Chemical?: Pressure Switches:: Smoke Detectors: Duct Detectors:
Wet Chemical?: 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
FIR2009-00066 Please refer to the following pages for conditions of this permit. 1 of 6
Dec 24 09 01:26p Team Innovative Services 360-697-2551 p.1
12/24/2009 09:13 FAX 360 427 7798 MASON CO PERMIT CM 001
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Conditions Associated With 3:57.26pv]
Case#: Fmoog-NO66
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1 270 Fire Ma'rstia]CommeOW,
Corsut x fire works can only be sold on the following dates and times-
Decemb=27 th to 31 A flom 12 poon to 11 PM.
X
Only Wtshba&! to File Marsh pproved Class C common fire works may be sold.
X
A fircWor stand sball no!t be located more than 150 feet from an approved access road-Shall be at lease 100
fee.from a rbothcr fireworks stand or separated by a road,street or highway at least 30 feet wide•Sball not
010 ser than allowed by thz attached table to other structures or exposures cr be located closer than 100 feet
hewn any flammable liqui.6 or gas dispensing device,or 300 feet from stay fla,ttrrnable liquid or gas bulk storage
or dispensing facility.
x
The r<nir:itrnnm arces aratmd Sreworls stands as specifiicd in dire table shall be kept free from dtY grass,brush or
combusjblc debris.Ibis;arca shall be marked and 11299cd.
X
Mitor vchicl 'or trailers may not be Wked within 20 feel of tine fireworks stand e7ccept when delivering,
lottdulg or uuPall
firdworks-
Nu,makingallawcd within the Srewcrlcs stand or flagged off area.Signs stating no smoking within
1 GO feet in letters at least 2 inchen bigh and in contrasting color shall be posted conspicuously on all sides of the
stlucture.
X
All bat tery -,htTed equiptncnt;electrical equipment and cards shall be UL certified and listed and use din
in
accordance with that listang.Extension cords sball be of an industrial grade type and:sball be protected from
physic;d damage -S
X e i
All heating devices shall be UL listcd.Only heating devices with sealed type elements shall be used i.e.oil
filled car wet d for type.Open flame or clement heating devices are prolubitcd.
X
Genenimrs s 11 be located a rruui�tn of 20 feet*OM fire works stand-Fuel storage is limited to 5 gallons.
A minima inch.o"ae isle shall be taint uumd inside the full length of the sty.Customers nre not allowed
inside the fireworits stal}dL There shall be a rnimmutri of 2 exits at least 28 inches in width located at apposite
ends of the stand.These exits sball remain unlocked and uaobstrucwd during hours of operation of when the
stand is occupied. Sleeping inside a fu,works stand is prohlbited,l'be location of the nearest phone shall
bepos red in arks stand.All nts of the stand shall be informed as to the location of dtis phone.
The lu t rgency plitoue number,911,and the address of the fireworks stmtd shall be conspicuously posted
The 14112��ency
iusidc the,stand.
beR,shall be of 2 approved 2 112 gallon pressurized water fire extinguishers located adjacent to
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Page2of3
Dec 24 09 01:27p Team Innovative Services 360-697-2551 p.2
12/24/2009 09:13 FAX 360 427 7798 MASON CO PERMIT CTR Z 002 � k
12/23/2009
3:57:26PM L
Conditions Associated With
Case#= iFUU009-00066
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Cooking.Opel)flame or any l pc of en flame oquip►nen[is prohibited in a fircv+orka stand.
X
Ted
Fin:wor}s stands shall be Locked when unoccupied and not open for business if firewor bar moved or
n the stand
_lies.ttrr=z.Fisezva�rk3 stands not
not be locked.when occupied.Fireworks may
transfers ad to a fernpoiar:c storage c or location approved as Part of the license and penmt
Fineworics may a stored in a locked and secured retai]firework stud,tru=1S
col)taines.ar feaster that[s aticast
20 feet ft'om the fireworks stand during business hours,or in a locked or secure metal or wood garage,sued.
barn or ether access building tit' t least 20 feet from the fireworks stand.
X
At lead one per90it 18 yYs of age or older sYralt be on duty in the fireworks stand when fireworks are being sold
to-the public.Such person shall be responsible for die supervision of the r=warks nand an it's option_No
works stand when it is open to the public.
alto d to occupy y the fiie
person iuuler the a e '6 shah be �P
f FiTcwor-Ls to
X
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it:s illegal to wingty sell fireworrks to gcr$ons under'the age of 16.A S*U stating"ha1Sb a O o the
Persons Under the Age Of 16"in letters at least 2 inches high and in wntrasting posted
is
aired and it is the respuas�lity of the seller to require proof of age.Driver's
front of-the
_noel.A hato m req
fro e s P foreign
license or photo 1D showing a date of birth is by a public or private school.state,fede or
geverntnent is ac tab
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____��p Footings i Setbacks Date By �
Ribbons --_ m!
Gas Piping X
C Interior Date By Interior-Date By Date By
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Cry Exterior Date BY Exterior-Date _ By
Sat-up 0
rn INSULATION =
CD Point Load/Isolated Footings [late By Z
BG I SLAB INSULATION -----
Date � By Data By FIRE DEPARTMENT
Foundation Walls Floors Date By
Date BY Data By DECKS
FRAMING Walls Date By
Date By Data By PROPANE TANKS
PLUMBING vault Date By
Date By OTHER
Groundwork Attic
Type.
Date By Date By Date By
o.W.V DRYWALL Type:
Date By Y 55 Int.Brace Wall Date B
N Date By FINAL INSPECTION N
M Water Line Fire Separation C
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Date By Data By Date By
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o Pass or Request Inspect. c
Type of Insp. Fail Date Date Hone By Comments
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Mason County
!Now= Fireworks Permit Application
PO BOX 186 Permit#FIR` � � -(XX�CQ Le 426 W Cedar St
�... Shelton WA 98584
#
Receipt t
(360) 427-9670 ext 273 �'f -I�! i
CK # Ci yj,rJK
Date Received i
A Permit for the Retail Seles or Public display of fireworks is required. A completed
applica,.Jon with required documentation and fees shall be submitted for Fire Marshal
review. A permit will be lissued upon satisfactory site inspection by the Fire Marshal.
Applicant Wormatlon
Name:
Mailing Address:
City: ea se State: �o� Z1P:
Contact Number 3 60 � p _ r� 3 Z `
Spolaor informattela
NarnE:: _ Ftretoorks-z
Mailing Address:
City: State: ir)►A- Zip: b 4
Contact Number -- L
Washington State.Fir bworks License-information (Copy Required)
Licen;,e No.: W S P FL_ 01 g Z Date of
ct 30 ,ZOOy
Issue:
[] Pyrot+)chnic Operator license R�r Fireworks Stand License
Bond or Certificate of Insurance
(COPY Of cef ificate/Bond equited)
Provider:
Insured: F P7 M
Certifiod Holder. � `<
FDrections
on of stand/display
s.' _Z4 S(0 N t f{ tc !Z t ,,,c.
to Sifie: corms v ryF s+.dr eOM
Parcel Number.: ' �J �.As,- veoo Next- {�, rr'.f`'�•, € I<rv.s�(� �
3 .. q
Legal Description: yrt (� 7h e I cr S /-(e,,,�z Z- r,a 7`s TQ
Legal Property Owner: ,E F/y P,-O
* * Flease see the reverse side to Complete your application
2009-12-14 15:29 360 427 7798 Page 2
P,qAC6Z- * �Z33Z�'a0bo
The:follo pertinent information MUST be provided on the site diagrambelow
Locations and Setback distances from the back,sides and front of retail sales stands or
designatect display areas to: j
- Fine Hydrants N/A • Property Lines
• Buildings ✓ • Parking ✓
C inbustibles "IA . Public Roads and Right of Ways
• Fue Lanes '' Private Roads and Right of Ways
Tmes /Brush ✓ Landmarks
Utilities and Gas wh-
�5�= a Mortar separation distance
• Designated landing area
r C I IAII
to 4,
€ s:
£ a t 7
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APPItcants Affidavit
1 certify that the information provided herein is accurate and that compliance with
all Count % S de l laws pea 0 to the sales or discharge of fireworks
shall be m ntained
Signed Date z
FOR OFFIG7A,L USE ONLY BELOW THIS LINE
Accepted By: Date:
2009-12-14 15:30 360 427 7798 Paqe 317
12/10/2009 17:28 FAX IM001/001
Commercial Certificate of Insurance A R M e R s
Agent David M Connolly Ins Agency
Name 9393 Bayshore DR
& Silverdale,WA 98383 issue Dated/DD/YY) 12/113/09
Address 360-692-6439 T ils certificate Is issued as a matter of Information only and confers no rights
upon the certificate holder.This certificate does not amend extend or alter the
St. 79 Dist. 13 Agent 315 coverage afforded by the policies shown below.
Companies Providing Coverage;
Insured Company A. Trucknsura Ince Exchange
. Aurora Fireworks LLC totter
Name . 29399 Beach Dr NE eoomparry B Farmers Insurance Exchange
um
d Aress Poulsbo,WA 98370 E=p•ny C Mid-Century Insurance Company
=-y D National Fire&Marine Ins Company
Coverages
This is to cwtll� that the policies of insurance listed below have been Issued to the insured named above for the policy period indicated.Notwithstanding
2requirement,term or condition of any contractor other document with respect to which this certificate maybe rued or may pertain,the Insurance
rded by the policies described herein Is subject to all the terms,exclusions and condltlons of such policies.Limits shown may have been reduced by
PAW claims. _
Co. Type of Insurance Policy Number-�-Policy��ti� Pity p Atli ---'Policy Limits
wmto
K General Liabiky Cenetal AWWM $2,000.000
Commercial General Products-Complops
Liability
Aggregate $ EXCL
Personal&
D K -Owmence Version
72LPS010910 05ro1/09 05101/10 Advertising Injury s I,000,000
Contractual-Incidental Each Occurrence $ 1,000,000
pnly Ftre Damage
foe)
Owners&Contractors Prat, (Any one $ 100.000medical
(Any one
Automobile Liability Combined Single
All Owned Commercial UMIt 5
Autos Bodily Injury
Scheduled Autos (Pe'p—M) S
Hired Autos Bodily Inj er try $
Non-Owned Autos
Garage Liability I Property Damage $
Garage Aggregate S
Umbrella Liability Umit $
Workers'Compensadon Statutory---
and Each Accident g
Disease.Cmch Employee $
Employers'Liability Disease-Policy Limit t
Description of Operadons/VehiclWRestrlctlons/Speclal items: - ---- --- ��
EFM Propertied LLC and Mason County are listed as additional insureds for locations 22950 WE State Route 3 9elfair,WA 98528.
Certificate Holder Cancellation
. Fireworks Supermarket ShouW a of the above described policies be canoalled before the expiration date
Name thereof a issuing company will endeavor to mull 30 days written notice to the
& M holder named to the left,but failure to mall such n l Impose no
Address obit or liability of any kind upon the company,I is or representatives.
I
me"
so 2492 +g+ Copy Distribution:Service Center Copy an Agent's Copy H-0e
Washington State Patrol 10569
Fire Protection Bureau
Office Of The State Fire Marshal Fireworks Stand License
Washington State Fireworks License License is Non-Transferable and Validfor Only One Stand
Licensee Information
Fireworks Supermarket '-.'A040(
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 10569
Contact Person: John Miller Fire Protection Bureau
Phone Number: (360) 620-1732 Office Of The State Fire Marshal
ANNUAL FIREWORKS STAND LICENSE
County: Mason Date of Expiration Date of Issue Licensee: Fireworks Supermarket
Stand Number: SN-04495 January 31, 2010 October 30, 2009 Contact Person: John Miller
License Number: WSPFL-01428
Stand Number: SN-04495 [Valid For One Stand]
Date of Expiration: January 31,2010
Stand Location: ZZ9 qO N� STATE: RO ME 3 13E 1�Al2- VJa 9 V5L8 Location:
- [Stand Loc lion To Be ed icens
[Stand Location To Be Completed�-By Licensee)
3000-420-012 (R 9/05) PARCcsL 41-- IZ33ZS(X3pp4y State Pire Nfarshal Signature icensee Signature