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HomeMy WebLinkAboutFIR2024-00045 - FIR Inspections - 1/2/2025 �► INSPECTION CARD Mason County I' 615 W. Alder St. Building 8, Shelton, WA 98584 360-427-9670 ext 352 www.masoncountywa.gov PERMIT# FIR2024-00045 PROJECT ADDRESS 10 E ALDERBROOK DR UNION, WA 98592 PARCEL# 322335000014 PROJECT DESCRIPTION FIREWORK DISPLAY-ALDERBROOK OWNER NORTH FORTY LODGING ADDRESS PO BOX 609 PHONE CONTRACTOR ADDRESS PHONE CONTRACTOR LICENSE LENDER INSPECTION INSP DATE Comments INSPECTION INSP DATE Comments Fireworks Inspection R Mason County R Mason County - Division of Community Development 615 W. Alder St. I Building 8 Shelton, WA 98584 360-427-9670 ext 352 www.masoncountywa.gov FIR2024-00045 FIREWORKS DISPLAY (PYROTECHNIC LICENSE REQUIRED) PROJECT DESCRIPTION: FIREWORK DISPLAY-ALDERBROOK ISSUED: 12/16/2024 SITE ADDRESS: 10 E ALDERBROOK DR UNION EXPIRES: 06/14/2025 PARCEL: 322335000014 APPLICANT: WOLVERINE WEST LLC OWNER: NORTH FORTY LODGING PO BOX 628 PO BOX 609 CHEHALIS, WA 98532 UNION,WA 98592 1.206.459.0917 FEES: Paid Due Fireworks Display Permit $250.00 $0.00 Totals : $250.00 $0.00 REQUIRED INSPECTIONS Fireworks Inspection . __.._ __ .. ....__ .. .. . _ .. .. .. CONDITIONS (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. * (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. Printed by:Annie Wilson on:12/16/2024 01:09 PM Page 1 of 3 Mason County Mason County - Division of Community Development 615 W. Alder St. 1 Building 8 Shelton, WA 98584 360-427-9670 ext 352 www.masoncountywa.gov FIREWORKS DISPLAY (PYROTECHNIC LICENSE REQUIRED) FIR2024-00045 STORAGE 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 International Fire Code and the and local ordinances. * (8) No cooking is permitted in a retail fireworks stand or in a temporary fireworks storage structure. * (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. * 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. * (5)Storage of fireworks authorized by a retail license and permit is legal only during the periods specified in this section. * (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. * (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. * (4)No open flames nor any type of open flame equipment shall be allowed in any temporary fireworks storage structure. * (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. * 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. Printed by:Annie Wilson on:12/16/2024 01:09 PM Page 2 of 3 Mason County e Mason County - Division of Community Development 615 W.Alder St. Building 8 Shelton, WA 98584 360-427-9670 ext 352 www.masoncountywa.gov FIREWORKS DISPLAY (PYROTECHNIC LICENSE REQUIRED) FIR2024-00045 (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. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of Laws and Ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of�any other state/local law regulating construction or the performance of construction. Issued By: I"f r YV1 i I I�til'1 Contractor or Authorized Agent: �s Q ,` Date: h4 Printed by:Annie Wilson on:12/16/2024 01:09 PM Page 3 of 3 -ram a"max cobtirA MASON COUNTY (360)427-9670 Shelton ext.352 DEPARTMENT OF COMMUNITY DEVELOPMENT (360)275-4467 Belfairext.352 BUILDING• PLANNING• FIRE MARSHAL (360)482-5269 Elma ext.352 Y Mason County Bldg. 111, 426 West Cedar Street 'RS' PO Box 279, Shelton, WA 98584 www.co.mason.wa.us FIR20 _-�Op � 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: Owner: Alderbrook Resort&Spa Mailing Address: 7101 E WA-106 City: Union State: WA Zip: 98592 Phone#: 360.303.8274 Email: eric.sund@alderbrookresort.com Sponsor Information: Name: Alderbrook Resort&Spa Address: 7101 E WA-106 City: Union State: WA Zip: 98592 Phone#: 360.303.8274 Email: eric.sundWaiderbrookresort.com Washington State Fireworks License Information (Copy Required): License Number: P-04311 Date of Issuance 1/31/24 Xpyrotechnic Operator License ❑ Fireworks Stand License Bond or Certificate of Insurance (Copy of Certificate/Bond Required): Provider: The Partners Group, Ltd. Insured: Wolverine West LLC Certified Holder: Alderbrook Resort&Spa Location of Stand/Display: Site Address: 7101 E WA-106,Union,WA 98592 Directions to Site: see attached Parcel Number: (twelve digit number) - -Fired from dock Legal Property Owner n/a "Please see reverse side to complete your application" 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 see attached aerial Applicants Affidavit I certify that the information provided herein is accurate and that compliance with all County, State and Federal laws pertaining to the sales or discharge of fireworks shall be Digitally signed 1,Rodney F.Hash maintained. Rodney F. H a s h o emailodney olveri,o=Wolverine Wes LLC, ou,email=rod@wolverinewest.com,-US Signed Dale-2024.12.70 14:4754-08'00' Date 12/10/2024 li© APPLICATION PART I -1-—L DATE OF APPLICATION JJJr FOR PUBLIC FIREWORKS DISPLAY PERMIT 12/10/24 TO: Governing body of city, town, or county in which display is to be conducted. APPLICANT NAME ADDRESS PHONE Wolverine West Fireworks PO Box 628 -Chehalis,WA 98532 206.459.0917 SPONSOR ADDRESS PHONE Alderbrook Resort&Spa 7101 E WA-106, Union WA 98592 360.898.2252 PYROTECHNIC OPERATOR NAME ADDRESS LICENSE# Aaron Webb PO Box 1120,Tenino,WA 98589 P-04311 NAME OF ASSISTANTS: at least one required) NAME ADDRESS AGE Nicholas Wolfe-Webb 7013 Timberlake Dr.SE, Lacey,WA 98503 P-04513 NAME ADDRESS AGE I EXACT LOCATION OF PROPOSED DISPLAY LOCATION From the dock in front of Alderbrook Resort, 7101 E WA-106, Union WA 98592 DATE 12/31/2024 TIME midnight NUMBER AND KINDS OF FIREWORKS TO BE DISPLAYED Not to exceed; [25] 2.5" shells - [25] 3" shells- [8] 4" shells- [81 multi-shot cakes Call Aaron Webb to schedule an inspection 360.790.3409 or pyroaaron@comcast.net MANNER& PLACE OF STORAGE PRIOR TO DISPLAY Subject to approval of Local Fire Authority) In our approved magazines _- -SIGNATU E OF APPLICANT FINANCIAL RESPONSIBILITY BONDING OR INSURANCE COMPANY (Mark One) The Partners Group Bond or certificate of insurance attached ADDRESS ❑ Bond or certificate of insurance on file with State Fire Marshal 1111 Lake Washington Blvd N.Suite 400 Bond or certificate of insurance shall provide minimum coverage of Renton,WA 98056 $50,000/$1,000,000 bodily injury liability for each person and event, respectively,and$25,000 property damage PART II PERMIT PERMIT# DATE: In accordance with the provisions of RCW 70.77 and applicable local ordinances, this permit is granted to conduct a fireworks display as per the above application. NAME: (Full name of person,firm,or corporation granted permit) RESTRICTIONS: Permit not valid without verification of (Signature of Official granting permit) the appropriate State Fireworks License (Title) LICENSE NUMBER: (Instructions on reverse side) 3000-420-050(R 02/05) Distribution: WHITE (A): Local Fire Authority; YELLOW(B): Permitee r j ,4cc o� CERTIFICATE OF LIABILITY INSURANCE 78/6/20(MM/DDfYYYY) 24 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 The Partners Group Ltd PHONE Janet Nau -- Fax 1111 Lake Washington Blvd N. xtl:425-455-5640 _ Arc No):425-455-6727 Suite 400 ADORResS: 'nau t r .com Renton WA 98056 INSURER(S)AFFORDING COVERAGE NAIC a INSURER A:Everest Indemnity Insurance Cc 10851 INSURED 15539 INSURER B:Everest Denali Insurance Company 16044 Wolverine West, LLC Wolverine West Fireworks INSURER c:Arch Specialty Insurance Company 21199 PO Box 628 INSURER D: Chehalis WA 98532 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 1251277431 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY Y S18GL02100241 2/1/2024 2/1/2025 EACH OCCURRENCE $1,000,000 _ X DAMAGETO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $500,000 _ CLAIMS-MADE I—R]OCCUR MED EXP(Any one person) $Excluded _ PERSONAL&ADV INJURY $1,000,000 GENERALAGGREGATE $2,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 POLICY X PRO- LOC S B AUTOMOBILE LIABILITY SI8CA00276241 2/1I2024 2/1/2025 COMBINED SINGLE LIMIT Ea accident S1,000,000 X ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident C UMBRELLA LIAB OCCUR UXP105131601 2/l/2024 2/1/2025 EACH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE S4,000,DW DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN ER - ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) The following are included as Additional Insured on General Liability as their interest may appear as respects operations performed by or on behalf of the Named Insured per form ECG 20592 0509 Additional Insured-Designated Person or Organization attached: Alderbrook Resort&Spa,Mason County&its employees ATIMA are Additional Insured as respects the 11/29/24, 12/31/24 Aerial Fireworks Displays located at Alderbrook Resort&Spa,7101 E State Highway 106,Union,WA 98592. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, Alderbrook Resort& Spa 7101 E State Highway 106 AUTHORIZED REPRESENTATIVE Union WA 98592 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD f j POLICY NUMBER: S18GLO2100231 COMMERCIAL GENERAL LIABILITY ECG 20 592 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons Or Organization(s) ANY PERSON OR LEGAL ENTITY IN WHICH YOU HAVE A WRITTEN CONTRACT, AGREEMENT, OR PERMIT WHICH REQUIRES THAT YOU NAME THE CONTRACTING PARTY AS AN ADDITIONAL INSURED. Alderbrook Resort&Spa, Mason County& its employees ATIMA are Additional Insured as respects the 11/29/24, 12/31/24 Aerial Fireworks Displays located at Alderbrook Resort& Spa 7101 E State Highway 106, Union,WA 98592. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to C. The Limits of Insurance afforded to an additional include as an additional insured the person(s) or insured shall be the lesser of the following: organization(s) shown in the Schedule, but only 1. The Limits of Insurance required by the written with respect to liability for "bodily injury", "property agreement between the parties; or damage" or "personal and advertising injury" but only to the extent caused, in whole or in part, by 2. The Limits of Insurance provided by this Cov- your acts or omissions or the acts or omissions of erage Part. those acting on your behalf: D. With respect to the insurance afforded to an addi- 1. In the performance of your ongoing operations, tional insured, the following additional exclusion or applies: 2. In connection with your premises owned by or This insurance does not apply to "bodily injury", rented to you. "property damage" or"personal and advertising in- B. The insurance afforded to an additional insured Jury" arising out of any act or omission of an addi- shall only include the insurance required by the tional insured or any of its employees. terms of the written agreement and shall not be broader than the coverage provided within the terms of the Coverage Part. ECG 20 592 05 09 Copyright, Everest Reinsurance Company 2009 Page 1 of 1 ❑ Includes copyrighted material of Insurance Services Office, Inc., used with its permission. Alderbrook Resort OLV WO A� a w . t i di' s•' WE6T 1990 a` agery ate: /S 01 at'''47:3 to *23. 70401°,ei, R `` Washington State Patrol Fire Protection Bureau G23746 Office of the State Fire Marshal �x General Display Fireworks License �f RAR9NAl`S��� Licensee Data Operational Data Wolverine West, LLC In State Agent, Rio ney F. Hash Post Office Box 62$ Phone Number: (206) 459-0917 Chehalis, WA 98532 Email Address: rodtc w6iverinewest.com License Number: C-04138 Date of lssue:Fe&4 ry 21, 2024 Date of piralion:January 31, 2025 3000 4zo oa,E10r State Fire Marshal Licensee Signature Washington State Patrol Fire Protection Bureau 11224P Office of the State Fire Marshal Pyrotechnic Operator License �F'�'ARtMAL" d� Licensee Data " Rodney F. Hash Phone Number:(206) 459-0917 Post Office Box 628 Email Address:rod@wolvbrinewest.com Chehalis, WA 98532 t Date of Issue: February 21, 2024 License Number: P-04255 Date of Expiration:January 31, 2025 State Fire Marshal Licensee Signature 3000-420-043(10118) licensee WaN Mount Card ate_ Pyrotechnic Operator License Washington State Patrol It 326P Fire Peofec-tion Boreau jallwary A4 on, VVj3b StIsto F ft mark nsee SWWOM