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HomeMy WebLinkAboutFIR2012-00014 Final Fireworks Stand - FIR Permit / Conditions - 6/28/2012 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 FIR2O12-00014 APPLICANT: JOHNATHAN MILLER RECEIVED: 6/5/2012 CONTRACTOR: LICENSE: EXP: ISSUED: 6/6/2012 SITE ADDRESS: 22950 NE STATE ROUTE 3 BELFAIR EXPIRES: 12/6/2012 PARCEL NUMBER: 123325000044 LEGAL DESCRIPTION: SAM B. THELER'S HOME & GAR TRS TR 19-B PROJECT DESCRIPTION: FIREWORKS STAND...LOCATED ON THE CORNER OF ST RT 3 AND ROESSEL RD BELFAIR GENERAL INFORMATION System Information Type of Use: STND Sprinkler Heads: Audible Switches: Pull Stations: Fire District: 2 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 $100.00 Auto Fire Alarm?:N Third Floor;: Total: $100.00 $100.00 FIR2012-00014 Please refer to the following pages for conditions of this permit. Page 1 of 6 CASE NOTES FIR2012-00014 CONDITIONS FOR FIR2012-00014 FIR2012-00014 Please refer to the following pages for conditions of this permit. Page 2 of 6 1.} 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 Jule AM to 12 noon X Only tate Fire Marshal approved class C common fire works may be sold. X A fire work and 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 ispe 9L___ X The mini s around a fire works stand,as specified in the attached table,shall be kept free from dry grass, brush, or combustible debris.This area sh 11 bee gged. X Motor vehi I ay not be parked within 20 feet of the fire works stand except when delivering,loading or unloading fireworks. X Fireworks sh 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 ontrastin II be posted conspicuously on all sides of the structure. X No smoking s Mowed within the fireworks stand or flagged off area. Signs stating" No Smoking Witin 100 feet"in letters at least 2 inches high and in contras' colors be oersted conspicuosly on all sides of the structure. X All battery*po equipment,electrical equipement and cords shall be UL listed and used in accordance with that listing. Extension cords shalt be of an industriale a protected from physical damage. X All heating devi s 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 a ent * es are prohibited. X Generato sh be inimum of 20 feet from any fire works stand. Fuel storage is limited to 5 gallons. X A minimum 24 i 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 s remain unlocked and unobstructed during hours of operation or when stand is occupied. X _ Sleeping in ' e fireworks stand is prohibited. FIR2012-00014 Please refer to the following pages for conditions of this permit. Page 3 of 6 X The locati 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 eme one number,911, and the address of the fireworks stand shall be conspicuously posted inside the stand. X There shall inimum of 2 approved 2 1/2 gallon pressurized water fire extinguishers located adjacent to each exit door. X c Cooking,op a or works any type of open flame equipment is prohibited in a fireworks stand. X Fire st . s 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 iocation approved as part of the license and perm . X Fireworks y 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 o erson 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 responsib e e supervision of the fireworks stand and its operation. No person under tha age of 16 shall be allowed to occupy the fireworks stand when ope to the lic. X 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 1D is required and it is responsiblityof the seller to require proof Driv 's license or photo ID showing date of birth issued by a public or private school,state,federal or foreign government is acceptable. X _ 2.) Owner! 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 ust be o -site. X J This permit becomes nufrand 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 pro ress ins ctio .Th o ner or the agent on the owners behalf,represents that the information provided is accurate and grants employees of Mason County acre he ab a ib ro rty ructure for review and inspection. OWNER OR AGENT: DATE: ��'� "�� Z_ FIR2012-00014 Please refer to the following pages for conditions of this permit Page 4 of 6 r ► Mason' County Fireworks Oermit Ap'plieation °N 0 5 21012. MBANW PO BOX 186 Y. Permit#FIl� '� 426 IN Cedar St Shelton WA 98584 Receipt # (360)427-9670 ext 27 CK # Date Received 2,61 Z A Permit for the Retail Sales or Public display of firleworks 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: 5 , N w wtc , Ce City: t State: w Zip: q 7 37-0 Contact Number 3i e za-C?3Z Sponsor Information Name: oo ,,� Mailing Address: �x w oi-, ,� e- . City: S State: U A---- Zip: 1 Contact Number -Lo- 1-1 32 Washington State.Fireworks License Inform Lion {copy Required) License No.: Date of i W 5? F L. -- c) 2-O'2-7 issue: --I -9) 12-Z Z EQ Pyrotechnic Operator License [-Tireworks Stand License Bond or Certificate of Insurance (Copy of Certificate 1 Bond Required) Provider: _ a e�s u G)Yv Insured: u a 90 e y-t+0 wvt Pro�(kcfib�S. LLC. Certified Holder S Location of standldisplay I'o1 Address: 2-2-9 5.0 0 E_ -3 Directions to Site: •C.aY�« J4 ,v E- S +_ V4 3 eL -CfL.,v tJ tE zo esSe Nc-�.- `1v Parcel Number. `2 Legal Description: S m 9 . -tln7e,Ie ` S. Y 4-,S TP- t 9-9 Legal Property Owner: * * Please see the reverse side to complete your applicaiian Washington State Patrol 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 Boomtown Productions 15156 Northwest Hite Center Road State Fire Marsh l Sign Seabeck,WA 98380 License Number: WSPFL-02027 Detach this wallet far n' tray with you for verification of ce ification, Stand Information Washington State Patrol Contact Person: John Miller 13814 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: BoonlloCr11, c.r yetions Stand Number: SN-06868 _ January 31, 2013 April 9,2012 Contact Person: Toht�t Miller ii License Number: W�F' L© fl7 Stand Number SI40&5 8' �`ilq id For One Stand] Date of Stand Location: 2-2 1�O N to i c fie` Location:2ZJStt tqc S� rQL TC 3 B EL At i / t3+ 31a: _ ..--J j,r ltrt¢LOL•l lion (:)'1a11Q LOGtltturr xu ve w[npceteu s�V tJlt^eriaee� 3000.420-012 jR 910.51 State Fire Mars, (, i ature Licensee Si¢nature ACC11MVCERTIFICATE OF LIABILITY; INSURANCE ar;ozo," ' TM CERTIFICATE is ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPOM T"E CERTIFICATE BOLDER.THIS = CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR',ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOE$ NOT CONsmwE A CONTRALCT BETWEEN THE ISSUWG INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCED,AND THE CERTIFICATE HOLDER. j , IMPORTANT: it the certtRcate hotaer is an ADORIONAL INSURED.the p Acy(ies) be endorsed a SWROGATON tS WAIVED.sect to VIA term and condIlIkum of the potty,cMsin poticies n*y require an endorsement A stalenient on this oetslftimle does nat co fer rights to the wNficate holder in IGww of such wxlomemengs(. FAX rltooumt DOW CMX y insurance Agency Inc 093 8aydx"Dr E-MA L S&efdale,WA SSW lUm = AFFOROeriCDveRAAE MALL/ MANAGER A-NAII OW Fre$Mwr *kls.C IT401Y Aumm Fireworks LLC 29M Beach Dr NE Poulstyo,WA 95M o_ i resins: COVERAGES CERTIFICATE NUMBER: 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 ISSUM OR MAY PERTAIN, THE WSURAMCE AFFOROED BY THE POLICIES DESCRIEEO HEREIN IS SUBJECT TO ALL TIE TERNS, EXCLUSIONS AND CONDITIONS OF SUCH POLWAS.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. PAM sum TrME OF NefMAYCt UWTS GENERALUAsaarY X 72LPS-015414 5IIj2C12 Sttt2013 EA 6occu� S 1:000.000.00 X eAL oEessx uAeam ,ram�i�iT s 100�.000.00 A ` CL4&ISMAOE X OCCUR aED xP on. S 5,000M =PERSONAL A Aw%JURY s 1,000,000.00 C 9CM AGGREGATE s 2.000-000,OD GEKL AGGREGATEUNIT PPP ES PER PROOUCTS•COMPIOP AGO s 1.000,OW.00 X POLICY n� n LOC f YITOENAN a tlAaalTY CCW91EO SINGLE LMT f t ANY AUrO i epO1LY iNJt1RY{Per pereaay I S ( ALL OYMED AUTOS i somy ftmRY(Pont mecda d S 9QiEOUL U AUTOS PROPERTY alrteAQE s ►IFISDALROB D'er acodmN NON•O ium AUTUJ f s O=Ik EACH OC(XMtRENCE S � r3AtiBifADE j � AO(;REGATE f DEDUCTIBLE j 6 i RETE+rtlD�l s � s YrORIt!!M COtM1iAATIOM WC STATtb Af1e ""@J v VIA TORY AtfYPIIOPR�TtibPAPt1R CVTfyE E.L.EACH ACCIDENT S DFNCFRAEMf�E7tCY.tJOE09 C M 1,.� -- pAndow in Am E.L DISEASE-EA S _ j'DEiCAPT'IONOF PERATWNSbtLw� El.DM"E-POLCYLAW S f I ' I � OF OPl�A710Ne!LocAl+oles rvewleleB µilrh ACOw Ni,Addra+d l6rw�Au lehetlda N�•P+�e��C+d=M Mason County and Boomtown Fireworks are listed as an additional insured. CERTIFICATE HOLDER CANCEL TION JOB Sold SWXILO AWY OF THE ABOVE DESCRIBED POUFS BE CANIMUE•D BEFORE 25W3 NE State Route 3 THE EV*tATMN SATE THEREOF, ROTTCE WILL aE ORJVEREO W Betfair,WA 98528 ACcoRUA�CIE WIN TINE POLICY PROVISIONS. AVTIedtltJtD AteV! � Gam"' 0198E-2009 ACORD CORPORATION. All rights mserved. ACORD 25(2889/119) TIN ACORD name and logo are fegIstsrod marks of ACORD FIREWORKS LICENSE AGREEMENT i This agreement is made between Joe Solif, as licensor and Boomtown Productions, LLC as licensee for the said purpose of allowing retail ales of Consumer Fireworks from the following location: 22950 NE STATE RO E 3 BELFAIR Parcel tax 1D#123323 00044 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 20,2012 through July 8,2012 fo�a license fee of S1000.00 due no later than July 15111,2012. I The licensee shall pay all cost involved in the ere ion,operation and maintenance of the stand,and shall guarantee that the premises shall a returned to the original condition after removal of the stand. The licensee will provide liability insurance coveitl',age and provide to the licensor, before occupancy. The insurance shall name the lieensurlas an additional insured;and licensee will hold the licensor harmless from any claims a ising 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. I If the property is sold,ingresslegess changed,or�eation impacted due to construction or the like,then this license is subject to revocation d refund of any payments made. LICENSOR: L�CENSEE: i � I Joe Solif-Owner Joh ill Boomtown Productions,LLC Phone 360A40,4873 Ph t 60.620.1732 1 s - l BUSINESS LICENSE TIIW3Q w` STATE OF WASHINGTON s3 " Unified Business ID #: 603 174 712 . Domestic Limited Liability Company Business ID #: I Location: 1 { kt ' t BOOMTOWN PRODUCTIONS, LLC 1, ��- 15156 NW HITE CENTER RD SEABECK WA 98380 9283 [' P its TAX REGISTRATION ` s s 7ILI �4 Ak t' This document lists the registrations,endorsements,and licenses authorized for he business named above.By accepting this document,the licensee certifies the information on th application was complete,true,and accurate to the best of his or her know[ed�e,and that bus ness will be e conducted in compliance with all applicable Washington state,county,and city r uladons.. Director,Department of R