Loading...
Nisqually Plaza Fireworks Stand 07/2021THIS FORM IS INTENDED FOR USE BY LOCAL AUTHORITIES HAVING JURISDICTION (AHJ) IN THE EVENT THEY DO NOT HAVE A PERMIT FORM SPECIFIC FOR RETAIL FIREWORKS SALES ATA CONSUMER FIREWORKS RETAIL SALES (CFRS) FACILITY. ITIS NOT MEANT TO BE REQUIRED IN ADDITION TO OR IN LIEU OF ANY LOCAL PERMITTING FORM ANDIOR PROCESS THATMAY EXIST WITH THE LOCAL AHJ. Directions: Provided the local jurisdiction has no permit form of their own, complete this permit application and submit it with the local AHJ portion of your Retail Fireworks Stand License to the jurisdiction in which you wish to run your CFRS facility. WASHINGTON STATE FIREWORKS RETAIL SALES PERMIT APPLICATION Applicant Information ❑ New/First Time Applicant ❑ Previous Permit Holder Name of Group, Organization, or Person (Last, First, Middle Initial) Issued the Firewarlts Retailer License FUNDS FOR KIM - Name of Permit Applicant (Last, First, Middle Initial) PO Box 5394; Spanaway, WA 98387 Permit Applicant Mailing Address (Complete Including Street, City, Stats, and ZIP Code) 253 279.1247 wcfireworks@icloud.com Phone Number E -Mail Address Local Business Number (if required) CFRS Facility Information ® Stand ❑ Tent Other. Size: 8 ' x20 ' Specify Square Feet/Dimensions 906 Algiers Drive NE; Yelm, WA 98597 CFRS Facility Address (Complete Including Street, City, State, and ZIP Code) Yelm Plaza LLC ( ) 22730110204 Name of Property Owner or Authorized Representative Phone Number Parcel Number for Stand Location Fireworks Suppiier Information List all of the licensed fireworks wholesalers who will be supplying this stand product Winco Fireworks Storage information ❑ On Site ❑ Off Site: Storage Address (Complete Including Street, City, State, and ZIP Code) © Sales Structure ❑ Detached Building ❑ Truck/Trailer ❑ Other: $ BCI CHECKLIST FOR SUBMISSION Check with the local AHJ for all applicable submission dates and deadlines: ❑ Application/Permit Fee ❑ Insurance Certificate ($1,000,000) ❑ Clean -Up Bond Fee (if applicable) ❑ Valid Washington State Fireworks Retailer License ❑ Property Owners Written Permission ❑ Detailed Site Plan ❑ Interior Plan (required for tents and "other" facilities) I hereby certify the information in this application is true and correct. I am aware of and agree to comply with all relevant provisions of law, rule, and any ordinance of the state of Washington and the city/county permitting this CFRS Facility. ar� � i LA _--i -L I 51"fu of PermittAppilt ant Printed me of Permit Applicant Date of Signature FIRE CODE AUTHORITY HAVING JURISDICTION ❑ APPROVED ❑ DENIED - — - Penult Number - Approved By Date of Approval SEE BACK OF THIS FORM FOR ANY RESTRICTIONS, CONDITIONS, OR NOTATIONS ON THIS PERMIT Signature of Permitting Official Printed Name and Tide Date of Signature THE FIREWORKS RETAILER LICENSE HOLDER (LICENSEE) SHALL RETAIN THIS PERMIT WITH THE ASSOCIATED FIREWORKS RETAILER LICENSE AND MAKE THEM BOTH AVAILABLE FOR INSPECTION AT ANY TIME THE STAND IS IN OPERATION 3000-420-013 (R 1118) A� " CERTIFICATE OF LIABILITY INSURANCE D'�`M""ID ' CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 3/22/2021 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 WANED, 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 Britton Gallagher One Cleveland Center, Floor 30 1375 East 9th Street CONTACT NAME: PHONEFAx 216-658-7100 tw:21155 658-7101 X COMMERCIAL GENERAL LIABILITY -ADDRESS: INSURERS AFFORDING COVERAGE NAIL# Cleveland OH 44114 INSURER A: Everest Indemnity Insurance Co. 10851 INSURED Winco Fireworks Utah LLC 710 Amidan Drive INSURER B INSURER c: CLAIMS-MADE OCCUR Ogden UT 84404 INSURER D: INSURER E: INSURER F - MED EXP (Any one n) $ CnVFRAGFS CERTIFICATE NUMBER: 1SMIA102113 RI=lIISION 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. ILTR AODLTYPE OF INSURANCE M SUER POLICY NUMBER pyo EFF M Y EXP LIMITS LTRfort " A GENERAL LIABILITY S18ML02067-202 12/31/2020 12/31/2021 EACH OCCURRENCE $1,0()0,000 X COMMERCIAL GENERAL LIABILITY REMISES fFa AMA O 7�V F �ce$ 5W.000 CLAIMS-MADE OCCUR MED EXP (Any one n) $ PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ Z000,000 $ POLICY PRO- X LOC AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT acpde BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS AUTO ED [PerPRO)DAMAGE $ $ UMBRELLA LIABOCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DELI I I RETENTION $ $ WORKERS COMPENSATION _ VC: STATUOTH- AND EMPLOYERS LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTNE EL. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A EL. DISEASE- EA EMPLOYEE $ EL. DISEASE- POLICY LIMIT s If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) "For premise liability — this certtl'Icate reflects coverage for the dates and location noted below only.— "*For product liability — this certiFicate reflects coverage for product purchased from the above referenced named insured only" Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement. Dates of Coverage for 4th of July Season: 06/28/21 through 07/04/21 Stand Location: 906 Algiers Drive Yelm, WA 98597 Stand Operator: Funds for Kids Landowner: Yelm Plaza, LLC Additional Insured: The City of Yelm and all its employees; West Coast Fireworks; Yelm Plaza, LLC; Funds for Kids; Seven One Seven Ind. LLC 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. City of Yelm P.O. Box 479 AUTHORIZED REPRESENTATIVE Yelm WA 98597 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD CITY OF YELM COMMERCIAL BUILDING PERMIT APPLICATION FORM Project AddressP06 Yelm Ave East Parcel #:22730110204 Zoning; Comercail Current use:Grocery Store/ FProposed Use:Consumer Fire ❑ New Construction ❑ Re -Model / Re -Roof / Tenant Improvement ❑ Plumbing 0 Mechanical 0 Fire Prevent/Suppress/Alarm © Other Project Description/Scope of Work -Retail sales of 1.4 G Consumer Fireworks Class C Project Value: NA Building Area (sq. ft) Parking GarageN/A Vt Floor1600' 2nd FloorN/A P FloorN/A Building Height N/A Are there any environmentally sensitive areas located on the parcel? no If yes, a completed environmental checklist must accompany permit application. BUILDING OWNER/TENANT NAME: elm Plaza LLCGreat Wall Propertise Inc. ADDRESS EMAIL NA CITY t STAT'E18tA-21P98032 TELEPHONE 1-425-982-0049 ARCHITECT/ENGINEERNA LICENSE # ADDRESS EMAIL CITY STATE ZIP TELEPHONE GENERAL CONTRACTOR NA TELEPHONE ADDRESS EMAIL CITY STATE ZIP FAX CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE # PLUMBING CONTRACTORNA _TELEPHONE ADDRESS EMAIL CITY STATE ZIP FAX CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE # MECHANICAL CONTRACTOR NA TELEPHONE ADDRESS EMAIL CITY STATE ZIP FAX CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE # Copy of City Mitigation documentation (TFC). I hereby certify that the above information is correct and that the construction on, and the occupancy and the use of the above described property will be in accordance with the laws, rules and regulations of the State of Washington and the City of Yelm. { L4 Applicant's Sign t e Date Owner/ Contract Owner's Agent/ Contractor's Agent/ Tenant (Please circle one.) All permits are non -transferable and will expire if work authorized by such permit Is not begun within 180 days of issuance, or if work is suspended or abandoned for a period of 180 days 105 Yelbn Avenue West (360) 4584885 PO Boat 479 (860) 458-8144 FAX Yelm, WA 98597 www.ciyelm.wa.us City of Ye lm Date Received By File No. 1a Community Development Department Y L COA MERCIAL BUILDING wpSH,N�TQff PERMIT APPLICATION APPLICATION EXPIRES 180 DAYS AFTER DATE OF SUBMITTAL. TO EXPEDITE PROCESSING, PLEASE VERIFY ALL DOCUMENTATION FOR ACCURACY. ALL CONTRACTORS ARE REQUIRED TO PROVIDE A COPY OF THEIR CONTRACTOR'S REGISTRATION CARD AND PROOF OF A CURRENT CITY OF YELM BUSINESS LICENSE. IN ORDER TO PROVIDE PROMPT AND EFFICIENT SERVICE, WE NEED THE FOLLOWING DOCUMENTS SUBMITTED WITH PERMIT APPLICATIONS: ID Identification and description of the work to be covered by the permit for which application is being made. Description of the land on which the proposed work is to be done by legal description, street address or similar description that will readily identify and definitely locate the proposed building or work. e Description of the use or occupancy for which the proposed work is intended. Five complete sets of plans, diagrams, computations and specifications. (See attached list for specifics.) Stated valuation of any new building or structures or any addition, remodeling or alteration to an existing building. Signature of the applicant, or the applicant's authorized agent. Energy calculations. Civil plans and specifications, if applicable. ® Any additional data and information as may be required by the building official. Copy of mitigation agreement with school district, if applicable. THE FOLLOWING ITEMS ARE NEEDED WHEN SUBMITTING AN APPLICATION FOR A SIGN PERMIT: • The name, address and signature of the owner of the sign. The street address or location of the property on which the sign is to be located and the name and address of the owner of that property. The type of sign or sign structure. A site plan showing the proposed location of the sign relative to the boundary lines of the property where it will be situated, the locations and square footage areas of all existing signs on the same premises, and the location of all abutting public rights-of-way, building and other structures on the premises. Specifications and scale drawings showing the materials, designs, dimensions, structural supports, and electrical components of the proposed sign. 105 Yelm Avenue West (360) 458-3835 PO Bos 479 (360) 458-2144 PAX Yelm, WA 98597 worm ei yelm wa.us What inspections should be expected? Each project requires a different set of inspections. Typically, they might include: A. Footings, setbacks and foundation walls — when forms and rebar are in place before concrete is poured. B. Rough electrical, plumbing and mechanical — after structure is closed -in (windows, roof, etc.) but before these systems are covered by insulation or drywall. (Electrical permits are issued through Labor and Industries (L&I); electrical inspections are also performed by L&I.) C. Framing — after framing is complete and all wiring, plumbing and ductwork is complete. D. Energy Code — insulation, windows, sealing, and vent fans are inspected. E. Sheetrock Nailing — before tape and texture. F. Fire Systems - Tests G. Final — after all work is finished before the dwelling is occupied. This inspection includes decks, steps, attic insulation, appliances, posting of address and the like. If any inspection cannot be approved, a written Correction Notice will be left by the inspector. After any required corrections are made, you must call and schedule a re -inspection. How do I schedule an inspection? Call the Yelm Building Department at 360-458-8407 to schedule an inspection with Gary Carlson, the City of Yelm's Building Official. (24-hour notice required) FEES The following permit fees, if applicable, are due at the time of permit issuance: Sewer permit Plan Review fee Building permit Plumbing permit Mechanical permit Sewer hook-up Water meter Water hook-up Traffic Facilitation Charge Open Space Proof of payment of School Mitigation 105 Yelm Avenue West (360) 458-3835 PO Box 479 (360) 458-3144 FAX Yelm, WA 98597 rvwu;.ci yelm.wa.us CITY OF YELM REQUIREMENTS FOR COMMERCIAL PLANS SUBMITTAL Cover Sheet Must Include the Following: Address of Building Owner of Building and Phone Number Architect and Phone Number Contractor and Phone Number Building Use Legal Description Zone Code (Seismic, Wind, Snow, Live Load and Dead Load) Occupancy Group Construction Type Building Area Plans Must Also Include the Following: Five (5) Full Sets of 24" x 36" Plans — one of these may be a Y2 -scale set — which include Prints must be drawn and stamped by an Engineer or Architect* Foundation plan and details Structural plan and details Area separation walls/Rated corridor details Elevations Number of stories Building height Roof drainage Mechanical drawings Electrical drawings Plumbing drawings Exits Fire alarm or sprinkler systems, if required NRED (Non Residential Energy Code) Two (2) Sets of Specifications Structural Calculations, if Separate. CD of one (1) of all of the above (pdf or of format) * With the approval of the Building Official, small non-structural projects need not have a stamp. 105 Yelm Avenue Weat (360) 458-3835 PO Box 479 (360) 458-3144 PAX Yelm, WA 98597 www.d yelrn.wa.us OF r,,~ A `,6 y � 0 k 6 j I, .p +rtrw �rN V wrw.w► . 7r .�. rV o a b o D L. 5 � r r� M :�1 O C`J r, • 1s "ti "� ■ 1 ME WIFE IN WEEM16 0 IM IRWIN m ME WE Lamm n IMEEU INN IMMIN IN 0 ■n o INN MIME rk;of IN o a . k 2 0 c O k $ iz U) , m N c N . A CL LU 2 ■ 2 2 o qhe � Q Q LU co co w © ■ ■ ak �0 �$ c$ k k� � $ C4 2 LO k k N N CL Ix k Q \ § LL LL & § C CL C? e . U- U. 2 k 0 S � � § CCL o 2 � §� � § k f 1 CL 0 z 0s 2 @ 2 -0 & E $ Lu B .......... ........ IS - �,ZtN -7 T_! IN. Registered No. ;,.V'tankIfzC-'u'ed Date FA444.01 6/2212007 (253) NN ti S ZO �AMNKS PARTY RENTAL 771OWaller'gd.E. TamrM WA 98443- rtai The anid'as dssciibad bsl! hzva fbS i a,,-, wo -tat the applica-don aF SSi -Sh Chaun'C'ej �,772'z done arip Colif-or MiqrIce d7e C-' the ztata C', Cai"'fornia -arld Ru! and Res"kations 01 ullsc St n" Lh I az! Fire F-larshal -is- :i—oNJ N,rC,eC;C'f_ SC2' C ­n Zecs La- -d KiW I klx� 61) a h. a a zti C es -d a S C b a C., ra ovv a re 1 n a -n a 0 M a a m, a E s i b c :.r nn P. t -e d a re s are d arc ON n-pproved by the 5t8 Te 7 !Ps-ShSi fOr SUCK LIS9. FA-444.____� ade i-,,Ome o-7 lan-a-casistan- 'fab- rfc Ferrari 502 01 XN N: M Torn Raridles C) 7 1:srrjs, of.Pr due'don Supar c5e; Des --:-�pt,- (2) 40':x_2(Y-canopyhip ends-FaiM 5M16nsfucent white vinyl. Ferrari 502 is certified to meet It. 1� NFPA-701 stwubrcLs, 66507E -,"aim FIREWORKS TENT LEASE AGREEMENT THIS LEASE AGREEMENT ("Lease Agreement"), made this Z ti day of Ic 2020 between Yelm Plaza LLC, hereinafter designated the "Land Owner" and 9even One Seven Ind. LLC., a Washington limited liability corporation, hereinafter designated the "Lessee." WITNESSES: That the said Land Owner does by these presents lease to Lessee the following: 1. PREMISES: 906 Algiers Drive North West, ( 906 Yelm Ave East) As per the diagram marked Exhibit "A". 2. TERM: June 15th to July 15th for the year of 2021 3. RENT: 4. SECURITY AND DAMAGE DEPOSIT: Waived. 5.SUBLET: Lessee shall not assign this Lease Agreement or any part hereof without the prior written consent of Land Owner. 6. LESSEE'S OBLIGATIONS: Lessee shall: (a) Assume full liability for any and all claims, damages or causes of action arising during the term of this Lease Agreement caused by Lessee, it's agents, contractors, sub -contractors, guests and invitees, and hold Land Owner harmless there from. (b) Provide Land Owner with evidence of liability insurance effective for the Term in an amount of not less the ten million dollars ($10,000,000.00) with a rider listing Land Owner as an additional insured. Lessee will provide documentation to Land Owner showing the insurance coverage is active prior to the commencement of any use of the Premises for the term of the Lease. (c) Properly dispose of all rubbish, garbage and waste generated by Lessee, its agents, contractors, sub -contractors, guests and invitees, in a clean and sanitary manner. (d) Not restrict the flow of traffic (pedestrian / vehicular). (e) Comply with any and all laws, rules, regulations and requirements imposed upon it by any governmental agency governing the Lessee's proposed use of the Premises and post any required performance bonds with the local government.. Any permits or licenses required of the undersigned Lessee shall be obtained by the Lessee prior to the commencement of the Term of this agreement. LEASE AGREEMENT —PAGE 1 costs. It is agreed that the venue of any legal action brought under the terms of this agreement shall be Pierce County, State of Washington. 13. NOTICES: (a) Notices to Land Owner shall be delivered, personally or by certified mail, postage prepaid, addressed to Land Owner at: Yelm Plaza LLC 18230 East Valley Hwy Suite 108 Kent WA 98032 (b) Notices to Licensees shall be delivered, personally or by certified mail, postage prepaid, addressed to Licensees at: Seven One Seven Ind. LLC DBA West Coast Fireworks PO Box 5394 Spanaway, WA 98387 Phone: 253.2791247 14, EXECUTION: This instrument is signed in multiple identical copies, any one of which will suffice for legal purposes as an original. IN SIGNING THIS INSTRUMENT EACH PARTY ACKNOWLEDGES AND REPRESENTS TO THE OTHER SIGNERS: (a) That the person signing has read the instrument in its entirety. (b) That the person signing this document has authority to do so and to bind his/her principal, understands that this instrument constitutes and important and binding legal contract, which fixes and determines certain legal and obligations of the persons signing it. (c) That no provision of this document can be changes by reference to any oral representations or agreements. IN WITNESS WHEREOF, the Lessee and Land Owner have each hereunto signed this instrument in duplicate the day and year first above written. LAND OWNER: By: Witness LEASE AGREEMENT — PAGE 3 LESSEE: i y: �.H,MG1'9H�r4'F Washi A,Patrol flii a Protection Bureau yamia"' 211he Stfire Marshal CONSUMER FIREWORKS RETAIL SALES (CFRS) FACILITY LICENSE <44tand Number: SN -14243 - PSf1AL� [:Is Licensee Data L.Jerational Data. Funds for Kidz ASH ■ . w Ir^I' Wholesaler: Winco Fireworks Utah. LLQ. P.O. Box 5394 County of Oiler tion: Thurston Spana`~vay, , WA 98387 Gperateor: Licensee License Number: WSPFL-02938 Stand Operated By: Charity Utter back Phone Number: (253] 279-1247 Date of Issue:April 23, 2021 gate of Expiration. January 31 2022 Consumer Fireworks Retailer Llco ai's issued after May are ONLY valid for New Years Sales 622263 Thin license is h107 valid without a permit from a local fire code officiallauthOnty h iving j% isdictior, This license allows for or :.ration of a sin�i:F locx:,zn'S[aI J for retail sales to the puhlic-�f state legal consumer frev;orw.s purcrssed oniy from a licensed fireworks :vh.alesaler. Tri€5 LICE14SE PORTION ACCOMPANIES YOU LOCAL PERMIT APPLICATION