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Home My WebLink AboutFW Permit AppENUM Harnett COUNTY lo� Mr-Ir"M 151 1 F i ;.A V 1 1711 12 11 a I $ I 13 12 NI NJ 11 j -4 11 17) 1 V W W 11 K 11.910 PLEASE TYPE OR PRINT APPLICANT INF( RMATION: (Note: The applicant is the person, group, corporation, association, or other entity sponsoring, holding or primarily responsible for the event or enterprise for which this permit is requested.) Name: East Coast Pyrotechnics Telephone: 803-789-5733home Address: P 0 Box 209 803-789-5733 work Catawba, SC 29704 For a corporate applicant, indicate the name and address of the registered agent for service of process: Name: Joel Mame" / jw1QeastwwtPm=m President or CEO: Tom Thompson Indicate whether the applicant is or will be insured with respect to the discharge of fireworks/pyrotechnics: YES XX NO If covered, specify the source, amount, and coverage period of the insurance: source: Britton -Gallagher & Assoc Amount: $ 5,000,000-00 t j i V4, ell 1ARMEI-ft"' A'� kJ C OMPLIANCEE, t E OFR CER DA I E: Harnett COUNTY ►WWWJWMMMrF PYROTECHNICS TECHNICIAN INFORMATION: (Note: This is to be completed by the individual who will shoot and/or discharge the fireworks or pyrotechnics.) Name: Chris Prince Telephone: (919) 324-5096 home Address: 306 Womble Drive (919) 324-W96 work Lillington, NC 27546 Bureau of Alcohol, Tobacco and Firearms permit/license type and no.: 1 -SC -091-51-6E-00223 Specify Pyrotechnicians' training and experience: NC Licensed Operator #1927, over 7 years experience. Past displays Indicate whether the technician is or will be insured with respect to the discharge of fireworks/pyrotechnics: YES XX NO If covered, specify the source, amount, and coverage period of the insurance: Some: Britton -Gallagher & Assoc Amount: $ 5,000,000-00 Coverage Period: 3/30/17 to 3/30/18 Harnett COUNry DISPLAY INFO RM6TION: (Note: Indicate who provided this information:) Applicant: XX Technician: Roth: Indicate the type of display event: Carnival: Exhibition: Fair. Public Celebration- Other: � )< Proposed day and time of the event: `^5 15 Day: 12/29/17 Time: -t' 0 _ AM /UM Proposed location or site: -Barclay Villa (see attached) Specify the type and quantity of the fireworks/pyrotechnics to be used and the sequence of the discharge/shooting: (1) 2 1/2" Caliber Multi -Shot Cakes 90 - 3" Caliber Shells 45 - 4" Caliber Shells I 7 - 5" Caliber Finale Shells I 40 - 3" Caliber Finale Shells I Estimated duration of the display: 10 to 12 minutes Specify any safety precautions to be taken: Follow all NFPA 1123, North Carolina and Harnett County guide lines. All technicians will have all Personal Protection gear (ear plugs, safety glasses, proper cotton clothing, etc) PUBLIC SAFETY INFORMATION: The display will occur within the following fire district: Coats Location of the nearest fire station- CoatsFireDepartment Name and location of the nearest medical facility: Name: Central Harnett Hospital Location: Lillington, NC ■ FIRE DEPART COMNENITS: (Note: To be completed by local fire department representing the district in which the discharge will take place,) Recommendation: Approve: Chief s Signature: M FINAL APPROVAL: APPROVED - re g0j�11 L , #-. . Fire (Deputy) Marshal Signature: M + 3. Fireworks Permit No. JI—AM Disapprove: Date: / Date: /-L-/ '-/ //) • E 1 DaTst ! CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 1211 7 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDEIL 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 1 RERt81, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If than cortlifIcaft holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION FS WAIVED, s to the terms and condidons of the policy, caftip policies may require an endorsement, A stolemaInt on this cartIfIcats does not confer fti to to the ceriliflosts holder In lieu of such anti men s , PRODUCER Britten Gallagher EACH OCCURRENCE One Cleveland Center, Floor 30 1376 East 8th Stmt � Cleveland OH 44114 INSURERIS) AFFORDING COVERAGE _ _ _ NIC Y —M—W-0 dRA:lylaxum ndamwty_tioawnY---......_.—_- ----- _ OAMACOMMERGIAt 55 gw— INSURER S;RhM=fjjnffU[anQLQ-- East Copt Pyrotechnics Inc. INBURaec:Evnrest irldemnity_1 aUranoo..Co. P, O. Bax 209 Inewe-R D Everest National Insurence_i;4r[iDeny "- --- Catawba SC 28704 INSURER E, MEDEXP An pttaan INSURER F ; r+T.3'11:7T34: X34Ail91#72li:111.ir]'I'•I :. , 7 t=�I „r . THIS IS TO CERTIFY- MY THE POLICIES OF INSURANCE LIFT—ED BELOW-RAV5135EN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANOINO ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WMCH 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. I" ADDL EFf CYE LIMITS 1.TYPE OF INSURANCE OLICY NUMIER 114;6m C GENERAL LIASIUTY Y tS18ML000O8.171 3%3012017 3!3012018 EACH OCCURRENCE 51.000400 Xw� GENERALLIABILITY OAMACOMMERGIAt 55 gw— %500 000 !--I CLAIMS-MAM 1x. _.1 OCCUR MEDEXP An pttaan PERSONAL R ACV INJURY $1,000,000 $2,000,000 GENERALAGGREGATE PRODUCTS-COMPiOP AGG GEN%.. AGGREGATE LIMIT APPLIES PER' x2,000.000 _ _ ......_. _ POUCY X PRD• LDC ffi P AUTOMOSRELSaaiLlTY Y SI8CAOGOO5•171 313012017 3P301ZO18 (Eauddont) #1,400.000 _ BOCILY INJURY IPt(WW) i ANY AUTO a -- ALL OWN OHHOESDULED X ti1REDAUTOS HX AIEO 5 --- 5 BODILY INJURY tPtr aiC�nt! _-- ffi A—UMORELLA UAB X OCCUR Y EXC6020406 313012017 313012018 OCCURRENCE ..._ _ _ KOOO.ODO X EXCESS UAS CLAIMS -MADE _$ [EAGGREGAT-E $4.000.000 DEC RETENT ON B WORKERGCOMPENSAYION AND EMPLOYERS'UASILITY ANYPROPRiETORIPARTNERMXECUTIYE YIN A SCARP304378 9WQO17 $13412018 X p�. -- 9H`LLUT .. -.ER' (EL.EACHAGCI[}ENT 11,00010M -- CEPJMEMSEREXCLUDED? ❑ (Mmuietmy In NH) (N!A ! t ' -'-"-'- E -L. DISEAS E - EA EMPLOYEII S1.000,00D I 51 00D DOO Ryytts desube under OESG UPtION OF OPERA -"ONS b4 low i E.L. DISEASE -POLICY LIMIT i I t k r OESCRIPTIO# Of OPERATIONS t LOCATIONS t VEHICLES tAHHtett ACORD 191. AddMMAI Ramaft EthtduW If AYaro GPM Is 9WO) Additional insured extension of Covera a is provided by above referenced General Liability policy where required by written agreement. FIREWORKS DISPLAY DATE: DEI BER 29, 2017 ADDITIONAL INSURED: 1 COUNTY OF HARNETT 2) DESS and DEBORAH LANGDON 3} COY BROADWELL 4}DEE LANGOON 5) BARCLAY VILLA 300 • !... ROAD ANGIER NC 27501 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXMRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISION. AUTHORUPD REPRESENTATIVE UL ACORD Z5 (2010105) The ACORD name and loco am registered marks of ACORT �.rSEARCH .. l I HOME ABOUT US OSFM DIVISIONS DEPARTMENT OF INSURANCE CONTACT US EMPLOYMENT OSTM 24 NOTICE T'YR0TECHNIC 0CLNSE SNI ORMATSON tam has* marad seeks aibenmrta Sutbttso an 32s N. dallaWrV Stress natsipb, NC. Our realanit address COATACTS will not be 12n2 Mali Service Center, R®Iaiah, NC 23899-1292. Please Carl our main namber for �erauar�ee - 9Ia-der-own. �i TA F PPCTPERrY PEkMIT; ONLINE LOGIN PvR0T£(]-t1tC L;CFNSE APPLY/REUEW I 3q VYWOTECHNIC I IC: ASFS t ,59 PYROTECHNIC LIC=RSFS PROXIMAT E AUDIENrl I.ICFNSES VYk0TECHNIC: INSTRUCTOr,S/DELIVE RY AGENCIES MLIHICIFAL FrAPLOYEE LODF Uf`HC:ALS PIVAOTrCHNIC EVENT FMr1,.OYFE SPONSOR, VEnUE AND PAODUCI ION MANAGEMENT 'i Fire Safety Programs FIRE SAFETY PROGRAMS, w PYROTECWNIC LICENSE INFORMATION rotechnic License Information Current Pyrotechnic License Holders Selert Ucca ut Type of Interest License Type Licenst levet fa7 Pyrotechnic 1.36 GOperator 0 Pyrotechnic 1.46 0 Assistant 0 Pr uximete Audience Get List Get License Holder Information Pyrotechnic License Number Driver's License Number Search far Ll�nsa� Raider's Full Name: Christopher Robert Ptince Business Name: Fast Coast Pyrotechnics Government 10 lly: North Carolina Government ID Type: Driver License ID Number, **°6667 10 ckrlelas+a, License Number: 1927 Priot6 License Type: 1.30 Pyrotechnic License Levet: Operator License Status: Valid Expiration Date: 051[3120 19 Get a list of license holders by Last Name or ilusinewEmployer Last Nome Business/Employer Sdaron for List http:/l .ncdoi.com/OSFM/Fire_Safety_programs/Default.aspx?rieldi =Cod... 5115/2017 Types of License at T' wnit 51 -IMPORTER OF EXPLOMV pEtrc atiti tart€#i ii s € `) + r %ardisad d r , a 57 WIN tireFFLC; Gf arey, changes') 'Hit ase asptsmkw rimwd Amw draft a — - mvilifiidtuv6smausti, d and- osot of orilt4wives to swift the id f ay alae t Aarliti, tr€ttraaae # by xi CFR Pert S CAS's' € A T * �i i F ti�i �s B iC MMAW-9 A Pa ed or s-oratted "the t �v)s1s a ` ` " orwaded to beeal ' ,shite it *4 s _ . tied of dao st BOX , L; t at i -1 d '(FrA) or a r amie pami dfaclitd hercATAW6A. SO 29704. yofAb ortiffirat i edto the liomut ar a� i , §l r rtff�i �tsz=e twtd `""f��pe cd C,�e€wt '� L` #�frtti�i - ria irufzt,rc� l�€id€rati'T`€t1 eirirrtr i ia91i i ale IT ? lxi k"da. Mtn q P i f'ac*;.°sats§ase €a�a vec is iat €meiraaa€rs ,s e saaatt sae; s: ae lctatsasYatsa €r. '(sk i=. :a sir Eca sa km—t4 (3C109'K wit Federal Fitittattivet 11ornae (t=FL) t tstafm t- °ce Information rederat btRiocives Licensing Center (FEE,) °loth=t`mc T@ - hotw Nuirtbm (877)283-3352 A I. 11mutta a: W 'A.at€.9Dv 7441 Neecdy, Road Fax Number OW) 6164401 rot t Peddle (27 C'Et .55 54(io(,tr. Licenfices or potn$ittaes my doring the itom of thea curtest€ iscen p $at S rcrsime t6tr it ts;aaioess or s�,irsaticst;s to a new twat€rest at which they ira oo d ri a tatrby to ctErry on such tiers€a m jai Worutlorie, The €tcens or licemiticc as r,loned ra grVC auMf"tion afters. nrw Immio a of th, bminssor operaliont ¢foe less than i(i day°e prior to woil rete mat with tits U-6of, Federal Explosives losives Lictr s ng Center. The lictose or pertnit will be valid fix the rvaaaainder orthe tette# of the or Mesal €icce re or pertat¢t, (Tear CE ef, rFI.C, sec , It the Remsec car Iwistaftfee is acret tpuali eth ref", the request for amearded t remme r pmuit to the C a ns at Industry Otirrafietis f€tt- dettlal in iterordance #title § SM") Right of Smit iteta (27 (71,7? 535.59+), (a) C'elthin perscans other nixie €he ficemec or p satfittec may scoure the right to carry' on the sorne explosive mateteds tsusittm are w tations a# Etre severs adder shown (fit, and for the remainder of tire form of, n carr at liecow or pennil Vitae it tsa rat tag dei. (t } `t 1tr surwai ing sgaouss o€ child, or meati(, administralm, ger other legal reps aeotat ve € f a itmeasorl liceaseft or p rrnt(€ems; and () A rectivef €tr truralec, in bankruptcy, ro an rotiatince Iry herroftt of ereditors (b) bit order to erre life eight pr,tOdtoi by this scolim, the l - 'on rt# persons cams'#m ing the busi#acas or ohoratious dealt f€rt#gist£ the ficerm cw= permit for for Haat hamate m of op erationt, for cndor rt?e#es of Sarahy sire st.-rc to heti Chief, HILL', withr a Tla € aya fresh; telt: Ime on whic.,s tt$t puccevaor befin s to carry € rl the boginess or opiaations- p "Dreamier# ora reveres side) t.a$t T tett ap�t$ty€ i.tetae#rttit ([,) tesfer stilette `itf�€i t i,icens `dlemitt eoar. EAST COAST PYROTECHNICS IN ¢ t t t # tium acres Name- t ( t j1<tratas ii' twit Flri caber. 5 7•S t t d 3.icat=3tcrkrttt 7'yp�d t„t t p t ti.€aa4iasar 5, 2049 h t @aisa ?Carte Neat Valid for the ate Or Me, Disp-miii,rai of Faiat„nc i V'c t Federal Explosives License/Permit Bur gait ofAlcohol,Totm :caa, i°ircitmis eat Explosives - C. Chapter *, � � r F1 y1k iterPrIt Iwo tdi activity specified in t hik pectose Of f Permit Within ti tiQtolati taCcholdor 40J itic 1 & thitleAl Slates Cade and the regulations issued thereu ider, € nto lilt xp ation date tthok�rt. ' �t � AMS -M, ., _ r INNS' an 'NOTICES'onteverse, -. f)i€' eATF ATF • Chicf, 1"EL - �' Couvs-yioademoc To 244 Needy Road Marha"Itt,WV25405-9431 Chief, t ederfil t ° vuh Liceming Clem" ii"7 t. ' �=�pstrattrt$t tints EAST COAST PYROTFOHNICS t Types of License at T' wnit 51 -IMPORTER OF EXPLOMV pEtrc atiti tart€#i ii s € `) + r %ardisad d r , a 57 WIN tireFFLC; Gf arey, changes') 'Hit ase asptsmkw rimwd Amw draft a — - mvilifiidtuv6smausti, d and- osot of orilt4wives to swift the id f ay alae t Aarliti, tr€ttraaae # by xi CFR Pert S CAS's' € A T * �i i F ti�i �s B iC MMAW-9 A Pa ed or s-oratted "the t �v)s1s a ` ` " orwaded to beeal ' ,shite it *4 s _ . tied of dao st BOX , L; t at i -1 d '(FrA) or a r amie pami dfaclitd hercATAW6A. SO 29704. yofAb ortiffirat i edto the liomut ar a� i , §l r rtff�i �tsz=e twtd `""f��pe cd C,�e€wt '� L` #�frtti�i - ria irufzt,rc� l�€id€rati'T`€t1 eirirrtr i ia91i i ale IT ? lxi k"da. Mtn q P i f'ac*;.°sats§ase €a�a vec is iat €meiraaa€rs ,s e saaatt sae; s: ae lctatsasYatsa €r. '(sk i=. :a sir Eca sa km—t4 (3C109'K wit Federal Fitittattivet 11ornae (t=FL) t tstafm t- °ce Information rederat btRiocives Licensing Center (FEE,) °loth=t`mc T@ - hotw Nuirtbm (877)283-3352 A I. 11mutta a: W 'A.at€.9Dv 7441 Neecdy, Road Fax Number OW) 6164401 rot t Peddle (27 C'Et .55 54(io(,tr. Licenfices or potn$ittaes my doring the itom of thea curtest€ iscen p $at S rcrsime t6tr it ts;aaioess or s�,irsaticst;s to a new twat€rest at which they ira oo d ri a tatrby to ctErry on such tiers€a m jai Worutlorie, The €tcens or licemiticc as r,loned ra grVC auMf"tion afters. nrw Immio a of th, bminssor operaliont ¢foe less than i(i day°e prior to woil rete mat with tits U-6of, Federal Explosives losives Lictr s ng Center. The lictose or pertnit will be valid fix the rvaaaainder orthe tette# of the or Mesal €icce re or pertat¢t, (Tear CE ef, rFI.C, sec , It the Remsec car Iwistaftfee is acret tpuali eth ref", the request for amearded t remme r pmuit to the C a ns at Industry Otirrafietis f€tt- dettlal in iterordance #title § SM") Right of Smit iteta (27 (71,7? 535.59+), (a) C'elthin perscans other nixie €he ficemec or p satfittec may scoure the right to carry' on the sorne explosive mateteds tsusittm are w tations a# Etre severs adder shown (fit, and for the remainder of tire form of, n carr at liecow or pennil Vitae it tsa rat tag dei. (t } `t 1tr surwai ing sgaouss o€ child, or meati(, administralm, ger other legal reps aeotat ve € f a itmeasorl liceaseft or p rrnt(€ems; and () A rectivef €tr truralec, in bankruptcy, ro an rotiatince Iry herroftt of ereditors (b) bit order to erre life eight pr,tOdtoi by this scolim, the l - 'on rt# persons cams'#m ing the busi#acas or ohoratious dealt f€rt#gist£ the ficerm cw= permit for for Haat hamate m of op erationt, for cndor rt?e#es of Sarahy sire st.-rc to heti Chief, HILL', withr a Tla € aya fresh; telt: Ime on whic.,s tt$t puccevaor befin s to carry € rl the boginess or opiaations- p "Dreamier# ora reveres side) t.a$t T tett ap�t$ty€ i.tetae#rttit ([,) tesfer stilette `itf�€i t i,icens `dlemitt eoar. EAST COAST PYROTECHNICS IN ¢ t t t # tium acres Name- t ( t j1<tratas ii' twit Flri caber. 5 7•S t t d 3.icat=3tcrkrttt 7'yp�d t„t t p t ti.€aa4iasar 5, 2049 h t @aisa ?Carte Neat Valid for the ate Or Me, Disp-miii,rai of Faiat„nc i V'c t Harneft t , Fire Marshal Division December 21, 2017 East Coast Pyrotechnics PO Box 209 Catawba, SC. 29704 Re: 65 Pope Lake Road Angier, NC 27501 Application Number 17-50042957 Mr. Prince, The application for the outdoor display of fireworks for the Langdon Wedding celebration has been reviewed and approved as submitted. The public display shall be in accordance with the NC Fire Prevention Code and NFPA 1.123. Prior to the issuing permits for fireworks display, a compliance inspection of the display site and demonstration of the display operation shall be approved. The compliance inspection will be conducted before the time of the show. ® Fire Protection for Fireworks o Portable fire extinguisher shall be placed at the discharge area and standby fire apparatus shall be placed down range for fall out. o Contact shall be made with the local Fire Department to establish terms for standing by with apparatus and personnel. ® Lillington Fire Department shall have a dedicated engine crew standing by at the Public Works site during discharge of the fireworks and not less than 30 minutes after completion of the shoot to provide protection to the city maintenance shop and surrounding area. o Confirmation with the local fire department shall be returned to this office. o Shoot time has been established for 7:OOpm at 65 Pope Lake Road, if changes are made contact needs to be made to this office by 910-984-6294 (Rodney Daniels). o Fireworks must never be left unattended. o Distance o At least 70 feet for diameter inch of shell must be provided between the shoot site and the public (6" largest mortar = 420 feet) Permits Harneft o Final inspection will be conducted that day of the event and the permit will be issued. i Setup o You may contact our office for a representative to meet on site during setup for any additional questions that may arise. (914) 984-6294. i 8.1.3®4* During the firing of the display, all personnel in the discharge site shall wear the following: o Head protection o Eye protection o Hearing protection o Foot protection o Cotton, wool, or similarly flame -resistant, long-sleeved, long-legged clothing ® 8.1.1* The sponsor shall consult with the AHJ and the operator to determine the level of fire protection required. e 8.1.2* The following shall apply to crowd control: o Monitors whose sole duty is the enforcement of crowd control shall be located around the display site and at other locations as determined by the sponsor. o The AHJ and the operator shall approve the provisions for crowd control. 3308.8 Fireworks Display Supervision. Whenever in the opinion of the fire code official or the operator a hazardous condition exists, the fireworks display shall be discontinued immediately until such time as the dangerous situation is corrected. Thank you again for submitting the plans for The Langdon Wedding celebration. Please review the plans and adhere to any notes and alterations that were made in addition to the original drawings. These remarks are for the plans that were submitted and its original intent. These remarks do not apply if the original intent changes or what was submitted on the above date changes. If you have any questions, please do not hesitate to call this office Sincerely, Rodney Da cels Chief Deputy Fire Marshal