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3 <br /> PYROTECHNICS PERMIT CHECKLIST <br /> North Carolina General Statue 14-413 empowers County Commissioners in the State to issue permits <br /> for the use of pyrotechnics in connection with shows of all descriptions after satisfactory evidence <br /> is produced to the effect that the pyrotechnics will be used for the aforementioned purposes and no <br /> others. <br /> The Orange County Commissioners have adopted a policy which cites the completion of the following <br /> criteria as prerequisite to the issuance of a pyrotechnics permit. Verification of the receipt of <br /> information will be evidenced by the signature of the appropriate official on this form. Only after all <br /> criteria listed below have been met will the permit be issued. It should be further noted that all <br /> signatures must be written on the face of the permit in order for the permit to be valid. Penalties for <br /> use of pyrotechnics without a permit are cited in the North Carolina Building Code,Administration <br /> and Enforcement,Volume 1A,Chapter 8.1. <br /> CRITERIA APPROVED BY DATE <br /> 1. LETTER OF REQUEST RECEIVED FROM SPONSORING AGENCY Nick Waters/verbal 6/30/97 <br /> 2. LETTER RECEIVED FROM FIRE DEPARTMENT INDICATING Nick Waters 6/30/97 <br /> SUFFICIENT MEASURES WILL BE TAKEN TO ENSURE THE SAFETY <br /> OF THOSE IN ATTENDANCE. <br /> 3. LETTER RECEIVED FROM LAW ENFORCEMENT INDICATING Nick Waters 6/30/97 <br /> SUFFICIENT MEASURES WILL BE TAKEN TO ENSURE THE <br /> SAFETY OF THOSE IN ATTENDANCE. <br /> 4. QUALIFICATIONS/LICENSE SUBMITTED FOR PYROTECHNIC Pam Jones 6/30/97 <br /> OPERATOR <br /> 5. SITE LAYOUT SUBMITTED BY THE PYROTECHNIC OPERATOR. Nick Waters 6/30/97 <br /> 6. INVENTORY OF PYROTECHNICS TO BE USED SUBMITTED Nick Waters 6-30-97 <br /> 7. CERTIFICATE OF INSURANCE FOR GENERAL LIABILITY Pam Jones permit <br /> COVERAGE RECEIVED;MUST INCLUDE COUNTY AS A NAMED conditioned <br /> INSURED ON THE FACE OF THE CERTIFICATE;MINIMUM LIMIT upon receipt <br /> $1,000,000 PER PERSON/PER OCCURRENCE. <br /> 8. LOCATION OF PYROTECHNIC DISPLAY HAS CURRENT FIRE Mike Tapp/Nick Waters 6/30/97 <br /> INSPECTION AND IS IN COMPLIANCE WITH THE STANDARD FIRE <br /> PREVENTION CODE, 1988,WITH NORTH CAROLINA <br /> AMENDMENTS. <br /> 9. SHOW SET UP HAS BEEN APPROVED BY THE FIRE OFFICIAL IN <br /> APPROPRIATE JURISDICTION PRIOR TO THE BEGINNING OF <br /> SHOW. <br /> CERTIFICATION RESPONSIBILITIES: <br /> ITEMS 1-7: ORANGE COUNTY DIRECTOR OF PURCHASING AND CENTRAL SERVICES <br /> ITEM 8: JURISDICTION'S FIRE OFFICIAL <br /> ITEM 9: ORANGE COUNTY DIRECTOR OF EMERGENCY MANAGEMENT OR DESIGNATE—NOTE: THIS SIGNATURE <br /> CERTIFIES THAT THE FIRE OFFICIAL IN THE APPROPRIATE JURISDICTION HAS MADE THE SET UP <br /> INSPECTION. IT IS NOT INTENDED TO INDICATE THAT THE COUNTY'S EMERGENCY MANAGEMENT <br /> DIRECTOR MUST INSPECT AND APPROVE SET UP PERSONALLY. <br /> FOLLOWING CERTIFICATION OF ITEM 9, PLEASE RETURN THIS FORM TO THE PURCHASING AND <br /> CENTRAL SERVICES DIRECTOR.i.iFwPMrcKL <br />