HomeMy WebLinkAboutFIR2013-00018 Final Fireworks Stand - FIR Permit / Conditions - 6/27/2013 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
111
to
FIRE PROTECTION PERMIT FIR2013-00018
APPLICANT: JOHNATHAN MILLER RECEIVED: 5/23/2013
CONTRACTOR: LICENSE: EXP: ISSUED: 5/31/2013
SITE ADDRESS: 22950 NE STATE ROUTE 3 BELFAIR EXPIRES: 11/30/2013
PARCEL NUMBER: 123325000044
LEGAL DESCRIPTION: SAM B. THELER'S HOME &GAR TRS TR 19-6
PROJECT DESCRIPTION: FIREWORKS STAND
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 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?: Third Floor;:
Total: $100.00 $100.00
FIR2013-00018 Please refer to the following pages for conditions of this permit. Page 1 of 7
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.
X
-k2.) Valid Permit M -site.
X
vor
FIR2013-00018 Please refer to the following pages for conditions of this permit. Page 3 of 7
3.) 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
July 6th from A o 12 noon
X
Only Washin o e Fire Marshal approved class C common fire works may be sold.
X
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 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 bp4ocated 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 g facility.
X !7
The minimum areas 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 be d flagged.
X orll� -
Motor vehic s iFers may not be parked within 20 feet of the fire works stand except when delivering, loading or unloading fireworks.
X
Fireworks shAuot 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 on sting color shall be posted conspicuously on all sides of the structure.
X
No smoking 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 contrastin of r II be posted conspicuosly on all sides of the structure.
X
All battery pow ed equipment, electrical equipement and cords shall be UL listed and used in accordance with that listing. Extension cords shall be of an
industrial gr de and shall be protected from physical damage.
X
All heating de es 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 el en heating devices are prohibited.
X
Generators be located a minimum of 20 feet from any fire works stand. Fuel storage is limited to 5 gallons.
X
A minimum 24 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 exits a remain unlocked and unobstructed during hours of operation or when stand is occupied.
X
Sleeping insid a fireworks stand is prohibited.
FIR2013-00018 Please refer to the following pages for conditions of this permit. Page 4 of 7
X
The location f 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 emergeNy phone number, 911, and the address of the fireworks stand shall be conspicuously posted inside the stand.
X
There shal e a inimum of 2 approved 2 1/2 gallon pressurized water fire extinguishers located adjacent to each exit door.
X
Cooking p ame or any type of open flame equipment is prohibited in a fireworks stand.
X
Fireworks ds shall be locked when unoccupied and not open for business if fireworks are storged in the stand during these times. Fireworks stand
shall not b ocked when occupied. Fireworks maybe removed or transferred to a temporary storage structure or location approved as part of the license
and per
X
Fireworks may 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 on person 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 o en the ublic.
X
It is illega 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 ip4es 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 o 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 becom ull 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 comm ced f continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied.
Proof of continuatio work is by Raea of a progress i ction.The owner or the agent on the owners behalf, represents that the information provided is accurate and grants
employees of M on County access to t above es property and structure for review
/and inspection.
OWNER ORA ENT: N. DATE:
FIR2013-00018 Please refer to the following pages for conditions of this permit. Page 5 of 7
-n ic
N CONCRETE MECHANICAL MANUFACTURED HOME F
O Date By
Footings!Setbacks Gas Piping Ribbons m
OInterior Date By interior-Date By Date By
00 Exterior Date By Exterior-Date v By Set-up O
00 Point Load!Isolated Footings INSULATION Date By Z
BG 1 SLAB INSULATION -----------
Date By Data By FIRE DEPARTMENT
Foundation Walls Floors Date By D
Date By
Date By DECKS Z
FRAMING Walls Date e:
Date By Data By PROPANE TANKS
PLUMBING vault Date N,
Date By OTHER
Groundwork Attic
Type.
Date By Date By Date By
D.W.v DRYWALL Type
Int.Brace Wall Date By
Date By Date By FINAL INSPECTION N
y O
� Water Line Fire Seperatlon �
Date By Date By Date By W
O
o Pass or Request Inspect. o
Type of Insp. Fail Date Date Done By Comments
0
f
to
v
y
O
0 —
O
7
a
o'
N
O
S
N
fD
N
(fl
(D
0)
O
v
AC"RL> CERTIFICATE OF LIABILITY INSURANCE DATE(MMMDIYYM
3/26/2013
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
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
David Connolly Insurance Agency Inc. PHONE FAX---
A/C,
9393 Bayshore Dr No):ADDRESS:
Silverdale,WA 98383
INSURER AFFORDING COVERAGE NAIC 0
INSURER A:National Fire 8 Marine Ins.Company
INSURED
INSURER 8:
Halo Fireworks LLC INSURERC:
15156 NW Hute Gunter Rd INSURER0:
Seabeck,WA 98380 INSURER E.
INSURER F:
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 ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE POLICY EFF POLICY EXP
POLICY NUMBER LIMITS
GENERAL LIAINLITYX 72LPS-017262 4/112013 4/1/2014 EACH OCCURRENCE $ 1,OW,000.00
X COMMERCIAL GENERAL LIABILITY PREMISES Me occurrence $ 100,000.00
A CLAIMS-MADE 1XI OCCUR MED EXP(Any one person) $ 55,000.00
PERSONAL 8 ADV INJURY $ 1,000,000.00
GENERAL AGGREGATE $ 2 OOD 000.00
GEN.L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000.00
X POLICY PRO JECTLOC $
AUTOMOBILE LIABILITY COMBINED SINGE LIMIT
Ea accident
ANY AUTO BODILY INJURY(Per person) $
ALL OS OWNED �OEDULED BODILY INJURY(Per scc7der� $
AUTHIRED AUTOS AUTOS
NON-OWNED PROPEL DAMAGE $
UMBRELLA LIAS OCCUR EACH OCCURRENCE $
EXCESS LLAS HCLAIMS-MADE AGGREGATE $
DED 1 1 RETENTION $
WORKERS COMPENSATION YIN WC STATU- OTH
ILITY T R -
AND EMPLOYERS'LIABY 1 I
ANY PROPRIETORIPARTNERIECECUTNE E.L.EACH ACCIDENT $
OFFICERIMEMBEREXCLUDED? ❑ N/A ----- -- --
Mandatory In" E.L.DISEASE-EA EMPLOYEE 5
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,I more space Is required)
Boomtown Production LLC, Mason County, Property Owner Joe Solif are listed as Additional Insured, for the fireworks stand at
22950 State Route 3 Belfair, WA 98528
CERTIFICATE HOLDER CANCELLATION
Boomtown Production LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
15156 NW Hite Center Rd THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Seabeck, WA 98380 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
C 1988-2010 ACORD CORPORATION. All eights reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
FIREWORKS LICENSE AGREEMENT
This agreement is made between Joe Solif,as licensor and Boomtown Productions. LLC
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 20,2013 through July 8,2013 for a license fee of$1000.00 due no later
than July 15a',2013.
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:
Solif-Owner hnath 4ifler/Boomtown Productions,LLC
Phone 360.440.4873 Phone* .620.1732
h..•-,�. ��...rem ,. �-. � .y .'' �__ � ��r(:� _ - _ i\:
f• bR_ = BUSINESS LICENSE r yy cyn
STATE OF -
WASHINGTON
Unified Business ID #: 603 174 712
Domestic Limited Liability Company Business ID #: 1
Location: 1
BOOMTOWN PRODUCTIONS, LLC ;
15156 NW HITE CENTER RD
SEABECK WA 98380 9283 '�,
r�
TAX REGISTRATION
I�
fa
,
:r(
r�
•X
'_�.
J
Y
r�
r:\
1'
r--\-
This document lists the registrations, endorsements,and licenses authorized for the business `
named above.By accepting this document,the licensee certifies the information on the application
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 Revenue
Mason County
Fireworks Permit Application
PO BOX 186 Permit# FIR ' ��3�D
WV
426 W Cedar St P i r�
Shelton WA 98584
(360)427-9670 ext 273 Receipt #
CK
Date Received5 U
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
j Name:
Mailing Address:
city: S State: Wi - Zip: 9 g38p
Contact Number 20 -36U ( 1'732
Sponsor Information
Name: 9 u D,..-fv wr, P'r tkv-fs LLL
Mailing Address: t S-)s7,o N W H,4-
City: State: 'w A— Zip: qg 3
Contact Number bo 6zv- 17 3 Z
Washington State.Fireworks License.Information (copy Required)
License No.: Date of
W S P t=- L_ O 2-0 27 issue: 3125/Z o 13
❑ Pyrotechnic Operator License Fireworks Stand License
Bond or Certificate of Insurance
(Copy of Certificate/Bond Required)
Provider: vyv.o►5 ►�S k �,��, ,.a l I
Insured: �..,fi,,,,,, p�-r� �,�,►s Lc. /-ta a� C'o �itle
Certified Holder: f� o�• -tv w h p►-�dl h`o,.s. L��
Location of standldisplay
Address: 2 2- q N TZ S+X,)f iQ1) V4 C_ 3 �c lam,►.
Directions to Site: , -4 u L S tam Qok. 3 &J&,.L
N E 122 s sue.I al 1J e x-h i-o !(ic 11Su V- EIc._-4t.K
Parcel Number.. 1 2, 3 s 2 5-- 25' - tro o o qy
Legal Description: Sir., 13 -7-tie.i.:v 1-tri-, .. ,� 7)2-
Legal Property Owner:
* * Please see the reverse side to complete your application
f
1
I
LIE aftd // 96LL Rip 09C OE St 6l Zi-s00Z
=41pMd=V
nm sir.&o'Mg WO-asa Imo-doa -
u!e}u!mu New
S410 aajtit}o aBletlos!p 30 sales(n�
o}oum is - noo He
t�eaus!ldwop 484t Pue 2#ee si u! LoJd uo4MWojtu OLD Iona Ci m 1
IIAePOV s UBO!IddV
F
893E r .�Q.. .• `i
NaOM ONIW80383d OPIPPMUOPUZO&S TD • 3u v-i •Sgo pm sar 1mri •
IVA08ddt/ JOA ONVHO limns $*Muq)t1 • aamovo I�SLLIg Sd`tI�- i
I Pue SPgo)i�PAUJ ! a wfw a sanarj att3 •
.FOCI
so sPucjs voIies Hepajo Pio4 P'ma sap eq zip moij wmalsV j=qpS Pw suoq=o'I
MASON COUNTY FIRE MARSHAL
J � Mason County Bldg.III 426 W Cedar St
PO BOX 186 Shelton,WA 98584
(360)427-9670 Ext.273
CODE ENFORCEMENT FIRE INSPECTIONS FIRE INVESTIGATION PUBLIC EDUCATION
STANDARDS FOR THE OPERATION OF RETAIL FIREWORKS STANDS
Sales
Consumer fire works may be sold only on the following days and times.
• June 28th from 12 noon to 11PM
• June 29th—July 5th from 9AM to 11PM
• July 6th from 9AM to 12 noon
• December 27a —31"from 12 noon to 11PM
Approved Fireworks
Only Washington State Fire Marshal approved Class C common fireworks may be sold.
Fireworks Stand Location
• A fireworks stand shall not be located more than 150' from an approved access road,
• Shall beat least 100' from another fireworks stand or separated by a road, street or highway at least
30' in width,
• Shall not be located any closer than allowed by the table below to other structures or exposures,
• Or be located closer than 100' from any flammable liquid or gas dispensing device, or 300' from any
flammable liquid or gas bulk storage or dispensing facility.
Retail Fireworks Stands—Minimum Clearances
Buildings Combustibles Property Line Parking Motor Vehicle Motor Vehicle
Traffic, Traffic,
Public Road Private Way
Back of Stand 20' 20' 5' 20' 20' 5'
Side of Stand 20' 20' 5' 20' 20' 5'
Front of Stand 20' 20' 20' 20' 20' 20'
Surrounding Area around Fireworks Stands
• The minimum areas around fireworks stands, as specified above, shall be kept free from dry grass,
brush or combustible debris. This area shall be marked and flagged.
• Motor vehicles or trailers may not be parked within 20' of the fireworks stand except when
delivering, loading or unloading fireworks.
• Fireworks shall not be discharged within 300' of any fireworks stand. A sign stating No Fireworks
Discharge Within 300' in letters at least 2"high and in contrasting color shall be posted
conspicuously on all sides of the structure.
• No smoking shall be allowed within the fireworks stand or flagged off area. Signs stating No
Smoking Within 100' in letters at least 2"high and in contrasting color shall be posted
conspicuously on all sides of the structure.
Electrical Supply& Usage
• All battery powered equipment, electrical equipment and cords shall be UL listed and used in
accordance with that listing. Extension cords shall be of an industrial grade type and shall be
protected from physical damage.
• 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 type. Open flame or open element heating devices are
prohibited.
0 Generators shall be located a minimum of 20' from any fireworks stand. Fuel storage is limited to 5
gallons.
Fireworks Stand Operations
• A minimum 24"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 in width located at opposite ends of the stand.
These exits shall remain unlocked and unobstructed during hours of operation or when stand is
occupied.
• Sleeping inside a fireworks stand is prohibited.
• The location 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 emergency phone number, 911, and the address of the fireworks stand shall be
conspicuously posted inside the stand.
• There shall be a minimum of 2 (two) approved 2 1/2 gallon pressurized water fire extinguishers
located adjacent to each exit door.
• Cooking, open flame or any type of open flame equipment is prohibited in a fireworks stand.
• Fireworks stands shall be locked when unoccupied and not open for business if fireworks are stored
in the stand during these times. Fireworks stands shall not be locked when occupied. Fireworks
may be removed or transferred to a temporary storage structure or location approved as part of the
license and permit.
• Fireworks may be stored in a locked and secured retail fireworks stand,truck, container, or trailer
that is at least 20' from the fireworks stand during business hours, or in a locked or secured metal or
wooden garage, shed,barn or other accessory building that is a least 20' from the fireworks stand.
• At least one person 18yrs 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 the age of 16 shall be allowed to occupy the fireworks stand
when it is open to the public.
• It is illegal to knowingly sell fireworks to persons under the age of 16. A sign stating"No Sale Of
Fireworks to Persons Under the Age Of 16"in letters at least 2"high and in contrasting color shall
be posted on the front of the stand. A photo ID is required and it is the responsibility of the seller to
require proof of age. Driver's License or Photo ID showing a date of birth issued by a public or
private school, state, federal or foreign government is acceptable.
FILL
I Zo /3 - Ooo l � �, ;Jp
�-j .� . Y
THESE PLANS MUST BE
ON THE 10:3 SITE
FOR INSPECTION.
APPROVED �
MASON��OU�TY FIRE RS't-IAL
DATE-! ZY% BY
SUBJECT TO FIELD INSPECTION
ALL APPLICASL CODES RHALL APPLY. ERRORS
AND/OR OMISSIONS ON PLANS ARE SOLE RE-
SPONSIBILITY OF OWNER/CONTRACTOR. CORREC-
TIONS REQUIRED FROM FIELD INSPECTION SI•IALL
RE AT OWNER/CONTRACTOR'S EXPENSE. THIS AP-
PROVAI. DOES NOT GRANT TO ANY PERSON THE -
RIGHT TO VIOLATE ANY CITY OR STATE LAWS.
Washington State Patrol 14970
� 4 9 7 O
Fire Protection Bureau
Office Of The State Fire Marshal Fireworks Stand License
Washington State Fireworks License
License is Not:-Transferable and Valid for Only One Stand
Licensee Information
Boomtown Productions, L. L. C.
15156 Northwest Hite Center Road State Fir Mu�r 11a1 (lgnarf�cevi
Seabeck, WA 98380 License Number: WSPFL-02027 setach this ,"Ai i itany with you for
verificationfication.
Stand Information Washington State Patrol 0
Fire Protection Bureau
Contact Person: Johnathan Miller Office Of The State Fire Marshal
Phone Number: (360) 620-1732
ANNUAL FIREWORKS-STANDR LICENSE
County: Mason Date of Expiration Date of Issue I Licensee: Boo gti• 03 tions,L.L.C.
Stand Number: SN-07726 January 31, 2014 March 25, 2013 I Contact Person: Jo X
I License Number: w D ;'
I Stand Number: S id For One Stand]
Date of Expiration: Jan•�d"'
Stand Location: 2.2.q 5 I� E. S`�'a-'e- R-�t,. e 3 Qel�' il^ LjA-- Location: Sb NL t i4
[ tand L catio=niplettBy
Lic s
[Stand Location To Be Completed By Lic nseej I
3000 420.012(R 9/05) State Fire ars ature Licensee Signature