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HomeMy WebLinkAboutFIR2014-00014 Final Fireworks Stand - FIR Permit / Conditions - 6/28/2014 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 a IrP4 FIRE PROTECTION PERMIT FIR2014-00014 APPLICANT: BOOMTOWN PRODUCTIONS LLC RECEIVED: 6/9/2014 CONTRACTOR: LICENSE: EXP: ISSUED: 6/23/2014 SITE ADDRESS: 22950 NE STATE ROUTE 3 BELFAIR EXPIRES: 12/23/2014 PARCEL NUMBER: 123325000044 LEGAL DESCRIPTION: SAM B. THELER'S HOME & GAR TRS TR 19-B 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?: Pressure Switches:: Smoke Detectors: Duct Detectors: Dry Chemical?: Zones: Heat Detectors: Wet Chemical?: Sprinkler?: Standpipe?: 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 FIR2014-00014 Please refer to the following pages for conditions of this permit. Page 1 of 8 1.) Valid P i us on-site. x 2.) The folio ' g materials may not be burned: Garbabge, dead animals, asphalt, petroleum products, paints, tubber products, plastics, paper, cardboard, treated wood, contruction/demolition debris, metal or any substance (other than natural vegetation)that normally releases toxic emissions, dense smoke or obnoxious odors when burned. X 3.) All ust originate from the property on which the burning is to occur. X FIR2014-00014 Please refer to the following pages for conditions of this permit. Page 3 of 8 4.) Sales: WAC 212-17-21505 Retailers of fireworks-General provisions. Fireworks may be sold from 12:00 noon to 11:00 PM on June 28 through 9:00 PM on July 5. Fireworks may not be sold between the hours of 11:00 PM Jea'y June 28 through July 3. Fireworks may not be sold from 12:00 midnight to July 4 through 9:00 AM on July 5. e sold from 12:00 noon to 11:00 PM on each day from the 27th of December through the 31 st of December of each year. G consumer fireworks,obtained from state-licensed wholesalers, not otherwise prohibited by chapter 70.77 RCW or local ordinance, and roducts incidental but related to these products, may be sold in retail fireworks stands. locations: WAC 212-17-21509 Retailers of fireworks-location. (1)Activities or uses subject to this rule shall not be limited in location except where such activities or uses are prohibited or controlled by local development regulation, traffic safety or road construction standards. (2)Temporary retail fireworks stands shall not be located more than 150 feet from a private way, fire department access road, public road, street or highway as measured by an approved route around the exterior of the stand. The minimum requirements for private way shall be determined by the local authority having jurisdiction, but shall not exceed the requirements of locally adopted street, road and access standards. (3)Any two retail fireworks stands shall be at least 100 feet apart or shall be separated by a road, street or highway not less than 30 feet in width. (4) Retail fireworks stands shall be located as required by table 212-17-21509 in this section and attached to the permit.The minimum required area surrounding the stand shall be marked or flagged, except that flagging and marking shall not block a sidewalk or pedestrian pathway. Flagging need not exceed twenty feet in any direction. (5) Retail fireworks stands shall not be located closer than 100 feet from any motor fuel dispensing station, retail propane dispensing station,flammable liquid storage, or combnustible liquid storage. Retail fireworks stands shall not be located closer than 300 feet from any bulk storage of flammable or com s ' le liquid or gas, including bulk plant dispensing areas. X Surro4EW&C2112-17-215111 area arond fireworks stands: Retailers of fireworks-areas around the retail fireworks stand. (1)The minimum areas around the retail fireworks stand specified in WAC212-17-21509 shall be kept free of accumulation of dry grass, dry brush and combustible debris. No parking shall be permitted within this minimum area. (2) No motor vehicle or trailer my be parked within twenty feet of a retail fireworks stand except when delivering , loading or unloading fireworks. (3) Fireworks shall not be discharged within 100 feet of a retail fireworks stand. Signs reading"NO FIREWORKS DISCHARGE WITHIN 100 FEET'in letters at least 2 inches high, with the principal stroke of not less than one ha;f inch, on contrasting background„ shall be conspicuously posted on all four sides of the stand. (4) No smoking shall be allowed within the retail fireworks stand or within the minimum flagged off area.Signs reading"NO SMOKING WITHIN 20 FEET" in letters at I t 2 inches high, with the principal stroke of not less than one half inch, on a contrasting background, shall be conspicuously posted on all four sides f the d. X Electrical sup and usage: WAC 212-17-21513 Retailers of fireworks stand use and construction. (1) Fireworks may be sold from: (a)A permanent structure which meets provisions of WAC 212-17-21505(3). (b)Temporary, stable structures made of wood, metal, fiberglass or other material. Any temporary fireworks retail stand greater than 400 square feet FIR2014-00014 Please refer to the following pages for conditions of this permit Page 4 of 8 shall meet the reo,uirments of a permanent structure, except tents or canopies as defined in the International Fire code retail stand greater than 4UU square feet shall meet the requirements of a permanent structure. (c)Tents , canopies, or structures utilizing temporary membrane material. All tents, canopies or temporary membrane materials structures shall be made from fire retardant material or treated with fire retardant as identified in the International Fire code. Any tent, canopy or temporary membrane material structure falling within the scope of the International Fire code shall comply with those requirements When those requirements are in conflict with other provisions of these rules, the more restrictive provisions shall apply. (2) Battery powered equipment, electrical equipment cords which are used in conjunction with a retail fireworks stand or a temporary storage structure or location must be listed by a recognized laboratory and used in accordance with that listing. If electrical power is supplied by an extension cord, the size of the cord, the length of the cord and the amperage and the voltage supplied shall be in compliance with the requirements of the National Electrical code, current edition. The cord shall be protected as necessary from drive-over and other physical damage. No additional permits from a city or county or state official having jurisdiction shall be required for these temporary uses except as specified in subsection(5)of this section. (3) All heating units shall be listed by a recognized testing laboratory and shall be used in accordance with the listing. Heating sources shall have"tip over" and temperature overheat protection. All heating devices shall have sealed type elements( i.e, oil filled or water filled radiator type). Open flame heating devices are prohibited. (4) Generators which use combustible fuel and which are at least twenty feet from the retail fireworks stand or the temporary fireworks storage structure shall be allowed. Generator fuel shall be limited to not more than five gallons and stored at least twenty feet from all stands. (5) Compliance with the National Electrical code, current edition, shall be required for all new, permanent electrical installations, including temporary power drops, subject to possible fees. (6) R i ales f fireworks and other products which are holiday related shall be from buildings used for no other purpose. X Storagea�ssociated with retail fireworks: WAC212-17-21517 Retailers of fireworks-Temporary fireworks storage associated with the retail fireworks stand operation. (1) Temporary fireworks storage is not permanent fireworks storage. Temporary fireworks is defined as storage associated with retail fireworks sales and may only be from June 13 through July 13 and from December 12 through January 10 of the following year. Permanent fireworks storage is associated with retail or wholesale fireworks acbvites when the period of time of storage is other than, or longer than that specified for temporary storage. Temporary fireworks storage shall be in accordance with this section. Permanent fireworks storage is subject to the Intemaitonal Fire Code and the local ordinances. (2) Delivery of fireworks to a location, or storage of fireworks in a facility, not authorized by the license and permit is prohibited. If the approved storage location is outside the jurisdiction issuing the permit, the authority issuing the permit shall notify the appropriate authorities of the jurisdiction in which the storage is to be Icoated. (3) A temporary fireworks storage facitlity or a temporary fireworks storage location shall be authorized as a part of a license and permit if it meets the requirements specified herein. (4) No open flames nor any type of open flame equipment shall be allowed in any temporary fireworks storage structure. (5) Storage of fireworks authorized by a retail license and permit is legel only during the periods specified in this section. (6) Fireworks may be stored: (a) In a locked or secured retail fireworks stand;or (b) In a locked or secured truck, container, trailer, other vehicle or anything similar which is not less than 20 feet from the retail fireworks stand during hours of retail sales;or (c) In a locked or secured truck, container, trailer, other vehicle or anything similar which is not less than 20 feet from an inhabited building where the term "inhabited building" is defined as in the International Fire Code. or (d) In a magazine which meets the minimum standards of a type 4 as prescribed by the International Fire code, and which is not less than 10 feet from an inhabited building where inhabited building" is defined as in the International Fire code: or (e) In a locked or secured metal or wooden garage, shed, barn or other accessory building, or anything similar which is not less than: 20 feet from an inhabited building for storage of fireworks for one or two retail stands, or 30 feet from an inhabited building for storage of fireworks for three or more stands. The term " inhabited building is defined as in the International Fire code. FIR2014-00014 Please refer to the following pages for conditions of this permit. Page 5 of 8 (7)The local authority having juisdiction may reduce the minimum separation required of this section provided that satety of lire and property is not diminished. (8) No Cooking is permitted in a retail fireworks stand or in a temporary fireworks storage structure. (9)Temporary fireworks storage structures may be inspected prior to use and other inspections may occur on other days as warranted. There shall be no additional charge for all such inspections. ' X OWNER 1 BUILDER acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below. I declare that I am the owner, owners legal representative, or contractor. I further declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary parties, including any easement holder or parties of interest regarding this project. The owner or authorized agent represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for review and inspection.This permittapplication becomes null &void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a perioo 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION.INACTIVITY OF THIS PERM CATION OF 180 DAYS L INVALIDATE THE APPLICATION. 6�' --L-2, Signat re Date dl�ll 0'r" ,J r C C OWNER - REPRESENTATIVE - CONTRACTOR Print Name (circle one to Indicate) FIR2014-00014 Please refer to the following pages for conditions of this permit. Page 6 of 8 -n W CONCRETE MECHANICAL MANUFACTURED HOME O N Data By O C? footings /setbacks Ribbons Gas piping CInterior Date By Interior-Date By Date By 0 00 Exterior Date By Exterior-Date By Sot-up L INSULATION Point Load/Isolated Footings Date By Date By Data SLAB INSULATION By FIRE DEPARTMENT 0 Foundation Walla Floors Date By 0 Date By Data By DECKS 0 FRAMING Walls Date By Date By Data By PROPANE TANKS z PLUMBING vault Date By. ._ Date By r OTHER n Groundwork Attic Date By Date By Type: .��..�— �.— Date By D.W.v DRYWALL Type: Int Brace Wall Date By 0 Date By pate By y FINAL INSPECTION c o Water Line Fin separation ;, Date By Date By Date By uo O o Pass or Request Inspect. o Type of Insp. Fail Date Date Done By Comments o f m m ce y O n O 3 a r: 0 3 N O N N 3 v cn cu 0 I 00 RECEIVED JUN o 9 z01�1 #18.54 MASON COUNTY1�p� (360)427-9670 Shelton ext.352 DEPARTMENT OF COMMUNITY DOMWA&W (360) 275-4467 Belfair ext. 352 BUILDING• PLANNING. FIRE MARSHAL (360)482-5269 Eima ext. 352 Mason County Bldg. 111, 426 West Cedar Street PO Box 279, Shelton, WA 98584 www.co.mason.wa.us PM HHL FIRZo MA �-�� MARSHAL Mason County Fireworks Permit Application Incomplete applications will not be accepted A permit for 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: D Owner: 1 t R-oO Tl oAj S LLJMAjfll*M— 41 Mailing Address: City: gG�State: i1 f{Zip: C Phone#: : Gb() . (n ) Email: r �- 3-6) ag Sponsor Information: Name: O�rYI'1(kw.^� 1� + �1 ' Address: City: State: Zip: Phone #: Email: Washington State Fireworks License Information (Copy Required): License Number: � A,l G y Date of lssuance M4\!RC V+ ❑ Pyrotechnic Operator License �ireworks Stand License Bond or Certificate of Insurance (Copy of Certificate/Bond Required): Provider: DavLO jAr5utzt,i.fC r- tj _y iAic Insured: "A Le. - 9- Certified Holder: Q!!)Qvvn'aw nl P ooyctl a-A' L C Location of Stand/Display: Site Address: 7 2.�50 6J[- s'T t��. 2091C ����; { �� Directions to Site: �! )C?" -.ro UP UAitz t.Zfw)6;-V7tL Parcel Number: (twelve digit number) Legal Property Owner "Please see reverse side to complete your application** r gON CpL7 P FIREWORKS STAND SITE PLAN SITE DIAGRAM DATE UPDATED: 41-20 -Z©/!j LOCATION NAME: L3ELFA/2 7F�rt�12- PARCEL NUMBER: 33 7_.5-0000 VY ORDINANCE OF: Sa-Y?'TIIWAI %oizw LlCT yr SITE ADDRESS: 7'7 -O NC S"rA7C Ralf] LSTRUCTURE TYPE: W44P CITY& STATE: BEIr-All STUCTURE SIZE: ' CROSS STREETS: STD Icovrt 3 & 96 Po6 ssic-R0 STRUCTURE FACES: W ES r aw c�7y- � a _ ... ,ram } ti.1 • t� t ;oll;_i_ �1 GTI GG ��CA- f1 5 MASON COUNTY (360)427-9670 Shelton ext.352 DEPARTMENT OF COMMUNITY DEVELOPMENT (360) 275-4467 Belfair ext. 352 BUILDING• PLANNING • FIRE MARSHAL (360) 482-5269 Elma ext. 352 _ Mason County Bldg. 111, 426 West Cedar Street 1Rs� PO Box 279, Shelton, WA 98584 www.co.mason.wa.us STANDARDS FOR THE OPERATION OF RETAIL FIREWORKS STANDS '5ALES: WAC 212-17-21505 Retailers of fireworks—General provisions. • Fireworks may be sold from 12:00 noon to 11:00 p.m. on June 28 through 9:00 p.m. on July 5. Fireworks may not be sold between the hours of 11:00 pm. and 9-00 a.m. from June 28 through July 3. Fireworks may not be sold from 12:00 midnight on July 4 through 9:00 a.m. on July 5. • Fireworks may be sold from 12:00 noon to 11:00 p.m. on each day from the 27th of December through the 31 st of December of each year. • Licensees shall familiarize all persons working in a retail fireworks stand with the provisions of these rules. • Failure to comply at any time with the provisions of this rule or any other applicable regulation shall constitute a violation of chapter 70.77 RCW and may result in the temporary suspension or immediate revocation of the license or permit, closure of the fireworks sales or storage structure, the seizure and/or forfeiture of some or all of the fireworks, and other criminal penalties as specified by law. APPROVED FIREWORKS: • Only Division 1.4G consumer fireworks, obtained from state-licensed wholesalers, not otherwise prohibited by chapter 70.77 RCW or local ordinance, and holiday related products incidental but related to these products, may be sold in retail fireworks stands. IREWORKS STAND LOCATIONS: WAC 212-17-21509 Retailers of fireworks-Location. (1) Activities or uses subject to this rule shall not be limited in location except where such activities or uses are prohibited or controlled by local development regulation, traffic safety or road construction standards. (2) Temporary retail fireworks stands shall not be located more than one hundred fifty feet from a private way, fire department access road, public road, street or highway as measured by an approved route around the exterior of the stand. The minimum requirements for a private way DCommunity Development\FaE MARSHAUFireworls Permit application.doc t a shall be determined by the local authority having jurisdiction,but shall not exceed the requirements of locally adopted street, road and access standards. (3)Any two retail fireworks stands shall be at least one hundred feet apart or shall be separated by a road, street or highway not less than thirty feet in width. (4)Retail fireworks stands shall be located as required by Table 212-17-21509 in this section. The minimum required area surrounding the stand shall be marked or flagged, except that flagging and marking shall not block a sidewalk or pedestrian pathway. Flagging need not exceed twenty feet in any direction. Retail Fireworks Stands -Minimum Clearances MOTOR MOTOR VEHICLE VEHICLE TRAFFIC TRAFFIC Combustibl Property Parki PUBLIC PRIVATE Buildings es Line ng ROAD* ROAD* 13ACKOF STAND 20 FT. 20 FT. 5 FT. 20 20 FT. 5 FT. FT. SIDE OF STAND 20 FT. 20 FT. 5 FT. 20 20 FT. 5 FT. FT. FRONT OF STAND 40 FT. 40 FT. 20 FT. 20 20 FT. 20 FT. FT. 20 FT.** 20 FT.** NOTE: Clearance distances are not cumulative *Measured from the outer edge of the nearest traffic lane. **If stand is equipped with 135 fusible links which will automatically close all sales doors in case of fire,or is equipped with a wire-mesh screen with openings of not more than one inch which covers not less than 900/a of all sales openings. (5)Retail fireworks stands shall not be located closer than one hundred feet from any motor vehicle dispensing station,retail propane dispensing station, flammable liquid storage, or combustible liquid storage. Retail fireworks stands shall not be located closer than three hundred feet from any bulk storage of flammable or combustible liquid or gas, including bulk plant dispensing areas. EXCEPTION: 1.Fuel for generators as allowed by WAC 2 12-1 7-2 1 5 1 3(4). 2.Fuel within the tanks of motor vehicles. CTRROUNDING AREA AROUND FIREWORKS STANDS: WAC 212-17-21511 Retailers of fireworks-Area around the retail firework stand. (1) The minimum areas around the retail fireworks stand specified in WAC 212-17-21509 shall be kept free of accumulation of dry grass, dry brush and combustible debris. No parking shall be permitted within this minimum area, (:\Community Development\FIRE MARSHAL\Fireworks Permit application.doc (2)No motor vehicle or trailer may be parked within twenty feet of a retail fireworks stand except when delivering, loading or unloading fireworks. (3) Fireworks shall not be discharged within one hundred feet of a retail fireworks stand. Signs reading "No FIREWORKS DISCHARGE WrrH1N 100 FEET" in letters at least two inches high, with a principal stroke of not less than one-half inch, on contrasting background, shall be conspicuously posted on all four sides of the stand. (4)No smoking shall be allowed within the retail fireworks stand or within the minimum flagged off area. Signs reading "NO SMOKING WITHIN 20 FEET" in letters at least two inches high, with principal stroke of not less than one-half inch, on a contrasting background, shall be conspicuously posted on all four sides of the stand. LECTRICAL SUPPLY & USAGE: WAC 212-17-21513 Retailers of fireworks-Stand use and construction. (1)Fireworks may be sold from: (a)A permanent structure which meets provisions of WAC 212-17-21505(3). (b) Temporary, stable structures made from wood, metal, fiberglass or other material. Any temporary fireworks retail stand greater than four hundred square feet shall meet the requirements of a permanent structure, except tents or canopies as defined in the International Fire Code retail stand greater than four hundred square feet shall meet the requirements of a permanent structure, (c) Tents, canopies, or structures utilizing temporary membrane material. All tents, canopies or Temporary membrane materials structures shall be made from fire retardant material or treated with a fire retardant as identified in the International Fire Code. Any tent, canopy or temporary membrane material structure falling within the scope of the International Fire Code shall comply with those requirements. When those requirements are in conflict with other provisions of these rules,the more restrictive provisions shall apply. (2) Battery powered equipment, electrical equipment and electrical cords which are used in conjunction with a retail fireworks stand or a temporary storage structure or location must be listed by a recognized laboratory and used in accordance with that listing. If electrical power is supplied by an extension cord, the size of the cord, the length of the cord and the amperage and the voltage supplied shall be in compliance with the requirements of the National Electrical Code, current edition. The cord shall be protected as necessary from "drive-over" and other physical damage.No additional permits from a city or county or state official having jurisdiction shall be required for these temporary uses except as specified in subsection(5) of this section. (3)All heating units shall be listed by a recognized testing laboratory and shall be used in accordance with the listing. Heating sources shall have "tip-over" and temperature overheat protection.All heating devices shall have sealed type elements (i.e., oil filled or water filled radiator type). Open flame heating devices are prohibited. (4) Generators which use combustible fuel and which are at least twenty feet from the retail fireworks stand or the temporary fireworks storage structure shall be allowed. Generator fuel shall be limited to not more than five gallons and stored at least twenty feet from all stands. (5) Compliance with the National Electrical Code, current edition, shall be required for all new,permanent electrical installations,including temporary power drops, subject to possible permit fees. (6) Retail sales of fireworks and other products which are holiday related shall be from buildings used for no other purpose. 1ACommunity Development\FIRE MARSHALTireworks Permit application.doc TORAGE ASSOCIATED WITH RETAIL FIREWORKS: WAC 212-17-21517 Retailers of fireworks—Temporary fireworks storage associated with the retail fireworks stand operation. (1)Temporary fireworks storage is not permanent fireworks storage. Temporary fireworks storage is defined' as storage associated with retail fireworks sales and may only be from June 13 through July 31 and from December 12 through January 10 of the following year. Permanent fireworks storage is associated with retail or wholesale fireworks activities when the period of time of storage is other than, or longer than that specified for temporary storage. Temporary fireworks storage shall be in accordance with this section. Permanent fireworks storage is subject to the Intemational Fire Code and the and local ordinances. (2) Delivery of fireworks to a location, or storage of fireworks in a facility, not authorized by the license and permit is prohibited. If the approved storage location is outside the jurisdiction issuing the permit,the authority issuing the permit shall notify the appropriate authorities of the jurisdiction in which the storage is to be located. (3)A temporary fireworks storage facility or a temporary fireworks storage location shall be authorized as a part of a license and permit if it meets the requirements specified herein. (4)No open flames nor any type of open flame equipment shall be allowed in any temporary fireworks storage structure. (5) Storage of fireworks authorized by a retail license and permit is legal only during the periods specified in this section. (6)Fireworks may be stored: (a) In a locked or secured retail fireworks stand; or (b) In a locked or secured truck, container, trailer, other vehicle or anything similar which is not less than twenty feet from the retail fireworks stand during hours of retail sales; or (c) In a locked or secured truck, container,trailer, other vehicle or anything similar which is not less than twenty feet from an inhabited building where the term "inhabited building" is defined as in the International Fire Code; or (d) In a magazine which meets the minimum standards of Type 4 as prescribed by the International Fire Code, and which is not less than ten feet from an inhabited building where the term "inhabited building" is defined as in the International Fire Code; or (e) In a locked or secured metal or wooden garage, shed,barn or other accessory building, or anything similar which is not less than: 20 feet from an inhabited building for storage of fireworks for one or two retail stands; or 30 feet from an inhabited building for storage of fireworks for three or more stands. The term "inhabited building" is defined as in the International Fire Code. (7) The local authority having jurisdiction may reduce the minimum separation requirements of this section provided that safety of life and property is not diminished. (8)No cooking is permitted in a retail fireworks stand or in a temporary fireworks storage structure. (9) Temporary fireworks storage structures may be inspected prior to use and other inspections may occur on other days as warranted. There shall be no additional charge for all such inspections. IACommunity Development\=MARSHAUFueworks Permit application.doc WAC 212-17-21519 Retailers of fireworks—Cleanup. (1) At the end of the legal selling period, all fireworks must remain in the retail fireworks stand, temporary storage location authorized by the retail permit or another location approved by the local authority having jurisdiction or his or her designee until returned to the suppliers from which they were obtained, or until transferred to an approved location. (2) Cities and counties may require a clean-up bond, not to exceed five hundred dollars, as a condition of the permit, to ensure the removal of all structures and debris from the site. (3) In order to obtain return of a clean-up bond, cleanup of debris associated with the retail fireworks activity and the removal of all temporary structures authorized by the license and permit shall be completed no later than 11:59 p.m., July 15 for the Fourth of July selling period or no later than 11:59 p.m., January 10 for the New Year's selling season. (4) Failure of the licensee to comply with subsection (3) of this section shall constitute forfeiture of the clean-up bond and the licensee shall be liable for any clean-up costs incurred by the city or county which exceed the amount of the bond. l Community DevelopmentTIRE MARSHAlTireworks Permit application.doc z �5� > Z 233 Zoo ono y6( nO(D IK APPROVED MASON COUNTY FIRE MARSHAL DATE G-/6 �` BY SUBJECT TO FI LA NS-EE-Ol r< ALL APPLICABL CODES RHAu APPL'. V Mv+ AND/OR OMISSIONS ON PLANS AAt ,OLt SPONSIBILITV OF OWR�ER:CE NfRACTO' OC o''A C TIONS REQUIRED FNSE. 1"'' r.P c%P BE AT OWNER/CONTRACIOR': CR:r(n PROVAL DOES NOI GRANT TG AN' P ' :- RIGHT TO VIOLATE ANY CIT*y OF STT,A ' 1 I The following pertinent information MUST be provided on the site diagram below Location and Setback distances from the back, sides and front of retail sales stands or designated display areas to: Fire Hydrants Property Lines Mortar separation distance Combustibles Parking Designated landing area Fire Lanes Public Roads and Right of Ways Trees/Brush Private Roads and Right of Ways Utilities Landmarks Applicants Affidavit I certify that the information provided herein is accurate and that compliance with all County, Stat d Federal la pertaining to the sales or discharge of fireworks shall be mainta' d. Signed Date Washington State Patrol a 6 0 7 9 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, L. L. C. 15156 Northwest Hite Center Road State Fire Mars a1*cen Seabeck, WA 98380 License Number: WSPFL-02027 Detach this wallth you for verifica . Stand Information Washington State Patrol 6 0 7 9 1 Fire Protection Bureau Contact Person: Johnathan Miller Office Of The State Fire Marshal Phone Number: (360) 620-1732 ANNUAL FIREWORKS STAND LICENSE County: Mason Date of Expiration Date of Issue Licensee: Boomtown Productions, L. L. C. Stand Number: SN-08504 January 31, 2015 March 6, 2014 contact Person: Johnathan Miller License Number: WSPFL-02027 Stand Number: SN-08504 [Valid For One Stand] n t7 ( i Date of Expiration: January 31; 015 7 c1 tiJ"O (j E S" d" iL 27 r tom% j t5 t l t—A l Location: ly !fie l{fit.L Stand Location' +V I �) Am—h- nd o aon To Be Coin leted censee[Stand Location To Be Completed By Licensee] � A a an,rr Licensee Sianature 1 DATE(MMtDDMYY) ACORN CERTIFICATE OF LIABILITY INSURANCE 4/10/2014 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). CONTACT PRODUCER NAME: _..._..._._ David Connolly Insurance Agency Inc. ANC,PRONE FAx 9393 Bayshore Dr EMAIL AD Silverdale,WA 98383 INSURERS AFFORDING COVERAGE NAIL 0 INSURER A,National Fire&Marine Ins.Company INSURED INSURER B: Halo Fireworks LLC INSURERC: 15156 NW Hite Center Rd INSURER0: Seabeck,WA 98380 INSURER E: INSURER F COVERAGE'S 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. �SR AODL BR POLICY EFF 06UCY EXP LIMITS LTR TYPE OF INSURANCE I POLICY NUMBER MM/DDNYYY M GENERAL LIABILITY X 72LPS-019608 4/1/2014 4/1/2015 EACH OCCURRENCE $ 1,000,000.00 DAMAGEX COMMERCIAL GENERAL LIABILITY PREMISESTO ENTED S 100,000.00 A CLAIMS-MADE XIS occuR MED EXP one $ 5,000.00 PERSONAL&ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE S 2,000,000.00 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000.00 POLICY PR6 LOC $ JFCTCOMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident BODILY INJURY(Per Person) S ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per awdent) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per e�benl I $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE $ _ DED RETENTION$ $ — LIMIT OTH-W WORKERS COMPENSATION CS LIMITER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORtPARTNF_RIEXECUTIVE N I A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED'? E.L.DISEASE-EA EMPLOYE $ (Mandatory In NH) II yyeess deacnbe under DESCRiPT10N OF OPERATIONS below E_L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD IM,AodWonal Remarks Schedule,If more sp"o Is r"ulmd) Boomtown Production LLC, Mason County, and property owner Joe Solif are listed as additional insured, for the fireworks stand at 22950 State Route 3 Belfair, WA 9K,28 CERTIFICATE HOLDER CANCELLATION Boomtown Producion, 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 /J (D1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Washington State Patrol 9 6 0 7 9 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, L. L. C. 15156 Northwest Hite Center Road State Fire Mars al *a - 'sSeabeck, WA 98380 License Number: WSPFL-02027 Detach th walleth you for verifica _ Stand Information Washington State Patrol Fire Protection Bureau16079 Contact Person: Johnathan Miller Office Of The State Fire Marshal Phone Number: (360) 620-1732 ANNUAL FIREWORKS STAND LICENSE County: Mason Date of Expiration Date of Issue Licensee: Boomtown Productions, L. L.C. Stand Number: SN-08504 January 31. 2015 March 6, 2014 Contact Person: Johnathan Miller ! License Number: WSPFL-02027 Stand Number: SN-08504 [Valid For One Stand] j Date of Expiration: January 31,2015 ? IL Q 1 Location: Stand Location: 2,4)St lv E - 4 z:�.. `` � 1�A t�' I r] Stand o otion To Be Completed y tcensee] [Stand Location To Be Completed By Licensee] �- :,� ri�Mnrsh s ature Licensee Signature FIRE PROTECTION BUREAU •,OyOtOMll�� FIREWORKS LICENSING PROGRAM PO Box 42600 %®V r,�STAIC PATROL Olympia WA 98504-2600 W�—�`� (360)596-3914 FAX: (360)596-3934 ? APPLICATION FOR RETAIL FIREWORKS STAND PERMIT TO Governing body of city,town, or county in which DATE OF fireworks stand will be located. I APPLICATION `/12-?f 1`1 Applicant Name Address,City,State Sponsor(If other than applicant) Address,City,State Location of proposed fireworks stand [Enclose drawing of stand location] a ?-9 93 N E sIA4,- 3 ui 1-1 'z",i (A,) Manner and place of storage prior,during,and after sales dates 'Pry-.t,0"" 4, �X 01ti St 7 t State-Licensed Fireworks Supplier cJ e, k'f'S F—"i•--e w o-*-P - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 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 /s/ /s/ Signature of Official Granting Permit Signature of Applicant Title Agency Date Permit Number Licensee Name License Number 3000-420-013 (R 3/09) i FIREWORKS LICENSE AGREEMENT This agreement is made between Joe Solis,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 113#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 20,2014 through July 8,2014 for a license fee of$1000.00 due no later than July 15',2014_ 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. LICENSO LICENSEE: Joe Solis-Owner J an Miller/Boomtown Productions,LLC Phone 360.440.4873 hone:360.620.1732 ' N to V r p • O li : w • N p � O . r BOOMTOWN PRODUCTIONS, LLC 15156 NW HITE CENTER RD • SEABECK WA 98380-9283 003255 DETACH BEFORE POSTING My - .: BUSINESS LICENSE STATE OF WASHINGTON r Unified Business ID #: 603 174 712 Domestic Limited Liability Company Business ID #: 1 Location: 1 �. Expires: 01-31-2015 i BOOMTOWN PRODUCTIONS, LLC 15156 NW HITE CENTER RD SEABECK WA 98380 9283 TAX REGISTRATION CITY LICENSES/REGISTRATIONS: f° 1 PORT ORCHARD GENERAL BUSINESS REGISTERED TRADE NAMES: 1 BOOMTOWN FIREWORKS OLD MILL DAYS OLD MILL DAYS AMERICANA n' w t ai h' kA>A a This document lists the registrations, endorsements, and licenses authorized for the business Y It, 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 ly%t conducted m comphancc with all applicable Washington state,county,and ctty regulafaons Director Department of Revenue 4.+ `�' ?`.�.—(a;"�`!'.Mr+._-�s�3� �cr..sc -`r_ . �.,."=..i-�v �,..L,,....•+ ,�;..;,��i�..,"u z-���`+,.,.>Awi a;,t;�...•rA:a�`�+w....rt..s�i,:,a"� _ `�"'� z"'{:.