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HomeMy WebLinkAboutFIR2012-00038 Final Fireworks Stand - FIR Permit / Conditions - 12/28/2012 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 i� FIRE PROTECTION PERMIT FIR2012-00038 APPLICANT: JOHNATHAN MILLER RECEIVED: 12/4/2012 CONTRACTOR: LICENSE: EXP: ISSUED: 12/21/2012 SITE ADDRESS: 22950 NE STATE ROUTE 3 BELFAIR EXPIRES: 6/21/2013 PARCEL NUMBER: 123325000044 LEGAL DESCRIPTION: SAM B. THELER'S HOME & GAR TRS TR 19-B PROJECT DESCRIPTION: FIREWORKS STAND (DEC. 27-31) GENERAL INFORMATION System Information Type of Use: STND Fire District: 2 Sprinkler Heads: Audible Switches: Pull Stations: Hood& Duct?: N Flow Switches: - Visual Devices: Door Releases: Dry Chemical?: N Pressure Switches:: Smoke Detectors: Duct Detectors: 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 FIR2012-00038 Please refer to the following pages for conditions of this permit. Page 1 of 6 1.) Consumer fire works may be sold only on the following days and times. June 28th from 12 noon to 11 PM -rµ sr SON _ I 0% June 29th to July 5th from 9 AM to 11 PM DEC-• a� 31 P July om to 12 noon X Only W shington State Fire Marshal approved class C common fire works may be sold. X A fire work nd 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 or di p si facility. X The mini m as around a fire works stand, as specified in the attached table, shall be kept free from dry grass, brush,or combustible debris.This area shall e�a and flagged. X Motor vehicl ra rs may not be parked within 20 feet of the fire works stand except when delivering, loading or unloading fireworks. X -Fireworks sha 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 c afira5ti g color shall be posted`conspicuously on all sides of the structure. X No smoking berallowed within the fireworks stand or flagged off area. Signs-stating " No Smoking Witin 100 feet"in letters at least 2 inches high and .in contrastin s all be posted conspicuosly on all sides of the structure. X All battery pow equipment, electrical equipement and cords shall be UL listed and used in accordance with that listing. Extension cards shall be of an industrial grade t d shall be protected from physical damage. X All heating dev' 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 elem Ite ling devices are prohibited. X Generators�W�cated a minimum of 20 feet from any fire works stand. Fuel storage is limited to 5 gallons. X A minimum 2 ' ch 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 exi at main unlocked and unobstructed during hours of operation or when stand is occupied. X Sleeping i ' e a fireworks stand is prohibited. FIR2012-00038 Please refer to the following pages for conditions of this permit. Page 3 of 6 X The location 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 lo=g_a_P4-m-[num ber, 911, and the address of the fireworks stand shall be conspicuously posted inside the stand. X Tf 2 approved 2 1/2 gallon pressurized water fire extinguishers located adjacent to each exit door. X Cooking, op, e or any type of open flame equipment is prohibited in a fireworks stand. X Fireworks 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 location approved as part of the license and permit. X Fireworks m y stored in a locked and secured retail fireworks stand, track, 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 one on 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 ubl IC_ X .'- 1t"is illegal Zwingly sell fireworks to persons under ttre'age.of 16. A sign stating "No Sales Of Fireworks to PersonscUnder 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. X . . 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 progres ' spectlon.The owner or the agent on the owners behalf,represents that the information provided is accurate and grants employees of Mason Coun the ab cribed property and structure for review and inspection. OWNER OR AGE : DATE: FIR2012-00038 Please refer to the following pages for conditions of this permit. Page 4 of 6 - ic CONCRETE MECHANICAL MANUFACTURED HOME F Date ay L Footings (Setbacks Ribbons M Gas Piping O Intenor Date By Interior-Date By Date By w L O Exter" Date By Exterior-Date By Set-up _ O 00 Point Load J isolated Footings INSULATION Date By Z BG!SLAB INSULATION -------- Date By Data By FIRE DEPARTMENT Foundation Walla Floors Date By D Date By Date By DECKS Z F RAM I NG walls Date By Date By Date By PROPANE TANKS PLUMBING vault Date By Date By OTHER Groundwork Attic Date By Type. Dale By Date By D.W.v DRYWALL Type. Int.Brace Wall Date By 'T1 Date By Date By X Water Line Aeration FINAL INSPECTION No Fire Se Date By Date By Data By N O o Pass or Request Inspect. o Type of insp. Fail Date Date Done By Comments co 0 1- 52 12 .2 712 Z v m � co N O 0 O 7 a o t M f, � O S N M O O O N f� fD 0 Mason County Fireworks Permit Application PO BOX 186 426 W Cedar St Permit# FIR ) Shelton WA 98584 (360) 427-9670 ext 273 Receipt # CK # Date Received .1 -j4J 1 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. r: Applicant Information Name: ' L i�L+ka h1 M i ( I e►2 Mailing Address: City: --�,e State: Zip: 3 Contact Number 0 Sponsor Information Name: v � �-fo w ,.-n �.{�.c fi �S C Lt_ Mailing Address: i 5 ism N w V k City: State: zip: Contact Number Washington State Fireworks License.Information (Copy Required) License No.: S Date of W C,- (� 20 2' Issue: 15 I Z v i 2- ❑ Pyrotechnic Operator License Ll�Fireworks Stand License Bond or Certificate of Insurance (Copy of Certificate/Bond Required) Provider: -a r�.. ►--�r_ v� c� (a ,1M ( ►2Su Z-e'OC�, Insured: � ��N - Cert�fted Holder: � �..� S Location of stand/display Address: "1-'d 4,e3 � Directions to Site: r"o La �j ►.. r2� s p i2�1 ,.,cam-�- ��. KAe r+I Parcel Number t Z 3 0 v 00 y Legal Description: S 3 . I; Legal Property Owner: F ,* C * * Please see the reverse side to complete your application a The following pertinent information MUST be rovided on the site diagram below Locations and Setback distances from the back,sides and front of retail sales stands or deal ted di la areas to: • Fire Hydrants • Property Lines • Buildings • Parking • Combustibles • Public Roads and Right of Ways • Fire Lanes • Trees/Brush Private Roads and Right of Ways Utilities and Gas • Landmarks • • Mortar separation distance • Desi ated landin area S �1� [-Applicants Affidavit --- s I certify that the information provided herein is accurate and that compliance with all County, State and Federal laws pertainin o the sales or discharge of fireworks shall be maint�ed~, Signed Date �- -- - / Z FOR OFFICL4L USE ONLY BELOW THIS LINE Accepted By: Date: F SIAlE r 4y BUSINESS LICENSE r - I�_i f, STATE OF f WASHINGTON �. Unified Business ID #: 603 174 712 f Domestic Limited Liability Company Business ID #: 1 Location: 1 f BOOMTOWN PRODUCTIONS, LLC (' 15156 NW HITE CENTER RD i SEABECK WA 98380 9283 q � TAX REGISTRATION f. r i nil t� f. 1 This document lists the registrations, endorsements, and licenses authorized for the business rL named above.By accepting this document,the licensee certifies the information on the applicationt 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 Re nu J :=- —1.r-' --mr�nrr-- '- ;, -:►n— ten— - - , li. o � CERTIFICATE OF LIABILITY INSURANCE 4/10(201 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 REPRESENTATNE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: M the osrtlAate holder is an ADDITIONAL INSURED,the po"Ies)must be endorsed. I SUBROGATION IS WANED.sebjeet to the terns and coniftwe of the pocky,certain policies may require an endorsement. A state" id on this cediflcate does not confer rights to the certilimte holder In lieu of such endore nent(s). PRGaUcel CIMCFACT NAME: DoW Connolly Insurance Agency Inc. PHONE 9393 SWIft re Dr EJAAL Silverdale,WA 98383 NAM CUSTOMM ID AFFGRana oorEltAOE NAIc r A Nadonel FIFA a Marine lns.Company Aurora F"rewrorks LLC s 29M Beach Dr NE Poulabo,WA 95370 e: rISIUAER s COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF 04SURANCE 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 TERNS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMMS. Tree OF NMMANN R TV 1 LIYns X 72LPS-015414 5i112012 9112013 EAcm occL%wmm 1.000.000.00 X COMMERCIAL GENERAL LuearY $ 100,000.00 A CLAws+AAOE XD OCCUR MED EXP a. s 5,000.00 PERSONAL a ADV MULIRY $ 1,000,000.00 GENERAL AGGREGATE f 000.00 OWL AGGREGATE Leer APPLES PER PRODUCTS-COMPIOP AGG f 1,0KOW.00 X POLICY n,ACT n Loc f AYr01110011 UAeRItY COM NED SINGLE LMTANY f (Ea=d4W) AUTO 1 COOLY tumY(PW ww") �'.f ALL OV*ED AUTOS e001LY INJURY rPer ecnAelt) f SCHEDULED AUTOS PROPERTY DAMAGE f WIEOAUTOS (per s tlAf OCCUR EACH OCCURRENCE f CLAM/sfAAeE AGGREGATE f D®uCTME f RETENTION f f WOMMM OLI�Ten V/C STAT AID UOALM ANY EXCLUDED? C<nTVE Y N t A E.L.EACH ACCIDENT f OFFIL pN�rtlely Nlp E.L DISEASE•EA EMPLOY f MdnoDtudw ip M OF O SPATKM btlow EL LVAEASE-POLICY L"T f i DEaCItlPr10N OF OPMATIONa J LOCATIONS I VENIUM(Audi ACORD NI,AddlMend RwA*A rthtdde.0 mom Veu Is reouh+a) Mason County and Boomtown Fireworks are listed as an additional insured. CERTIFICATE HOLDER CANCELLATION Joe SOIif 1111OULD ANY OF TIE ABOVE DESCRIBED POLICIES BE CANCIELLED DEFORE 25603 NE State Route 3 THE EXMATIDN DATE THEREOF. NOTICE WILL BE DELIVERED IN Setfair,WA 98528 ACCORDANCE WITH THE POLICY PROVISIONS. AUTNORTIaDREPIlEftMTATN! �� ®ISU-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD Washington State Patrol 13 814 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 Boomtown Productions "v 15156 Northwest Hite Center Road State Fire Marsh l Sign t Seabeck, WA 98380 License Number: WSPFL-02027 Detach this wallet ar nd any with you for verification of Aification. Stand Information I Washington State Patrol Fire Protection Bureau 13 814 Contact Person: John Miller I Phone Number: (360) 620-1732 I Office Of The State Fire Marshal ANNUAL FIREWORKS STAND LICENSE County: Mason Date of Expiration Date of Issue Licensee: Boomtown Productions Stand Number: SN-06868 January 31, 2013 April 9, 2012 Contact Person: Joh iiler 1 License Number: W FL-02© Stand Number: S 0686 id For One Stand] Date of E�^:-^•: _. . _i: _._�,�d :� 2 5 C) N S tc 2` tT� t,, I Location:2Z.ySd NE Sr rw,.'ie3 13C�1�IWH- 'Stand Location:' �� 3 t3 ELFA�a_ _ _ t anal, cation Urn istana LOCattun i u De t-urnpteteu Dy jacert,5ec/ 3000-420-012(R 9/05) State Fire Mars 1 i azure Licensee Sionature