Agenda - 05-20-2003-8g - Laserfiche WebLink

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r~ ~, PYROTECHNICS PERMIT CHECKLIST--- Blue CrossJBlue Shield Family. Day 2003 North Carolina General Statue 14-413 empowers County Commissioners in the State to issue permits for the use of pyrotechnics in connection with shows of all descriptions after satisfactory evidence is produced to the effect that the pyrotechnics will be used for the aforementioned purposes and no others. The Orange County Commissioners have adopted a policy which cites the completion of the following criteria as prerequisite to the issuance of a pyrotechnics permit. Verification of the receipt of information will be evidenced by the signature of the appropriate official on this form. Only after all criteria listed below have been met will the permit be issued. It should be further noted that all signatures must be written on the face of the permit in order for the permit to be valid. Penalties for use of pyrotechnics without a permit are cited in the North Carolina Building Code, Administration and Enforcement, Volume 1A, Chapter 8.1. CRITERIA APPROVED BY DATE 1. LETTER OF REQUEST RECEIVED FROM SPONSORING AGENCY Yes 5-2-03 2. FIRE DEPARTMENT CONFIRMED ADEQUATE FIRE PROTECTION Yeslfown of Chapel Hill 5-2-03 MEASURES WILL BE OBSERVED AT EVENT. Fire Department 3. LAW ENFORCEMENT CONFIRMED THAT ADEQUATE MEASURES Yes/Town of Chapel Hill 5-2-03 WILL BE IN PLACE TO ENSURE PUBLIC SAFETY DURING EVENT. 4. OUALIFICATIONS/LICENSE SUBMITTED FOR PYROTECHNIC Approved by Town of 5-2-03 OPERATOR Chapel Hill Fire Dept 5. SITE LAYOUT SUBMITTED BY THE PYROTECHNIC OPERATOR. Town of Chapel Hill Fire 5-2-03 De t. 6. INVENTORY OF PYROTECHNICS TO BE USED SUBMITTED Will be approved by Town 5-2-03 of Chapel Hill Fire Dept on da of dis la 7. CERTIFICATE OF INSURANCE FOR GENERAL LIABILITY COVERAGE Pam Jones reviewed. 5-2-03 RECEIVED; MUST INCLUDE COUNTY AS A NAMED INSURED ON THE Names County as FACE OF THE CERTIFICATE; MINIMUM LIMIT $1,000,000 PER Additional Insured as PERSOWPER OCCURRENCE. reugired; acceptabe limits 8. LOCATION OF PYROTECHNIC DISPLAY HAS CURRENT FIRE Yeslfown of Chapel Hill. 5-2-03 INSPECTION AND IS IN COMPLIANCE WITH THE STANDARD FIRE PREVENTION CODE, 1988, WITH NORTH CAROLINA AMENDMENTS. 9. SHOW SET UP HAS BEEN APPROVED BY THE FIRE OFFICIAL IN Chapel Hill has approved, 5-2-03 APPROPRIATE JURISDICTION PRIOR TO THE BEGINNING OF contingent upon Count' SHOW. a royal CERTIFICATION RESPONSIBILITIES: ITEMS 1-7: ORANGE COUNTY DIRECTOR OF PURCHASING AND CENTRAL SERVICES or ORANGE COUNTY DIECTOR OF EMERGENCY MANAGEMENT OR DESIGNATE. ITEM 8: JURISDICTION'S FIRE OFFICIAL ITEM 9: ORANGE COUNTY DIRECTOR OF EMERGENCY MANAGEMENT OR DESIGNATE" NOTE: THIS SIGNATURE CERTIFIES THAT THE FIRE OFFICIAL IN THE APPROPRIATE JURISDICTION HAS MADE THE SET UP INSPECTION. IT IS NOT INTENDED TO INDICATE THAT THE COUNTY'S EMERGENCY MANAGEMENT DIRECTOR MUST INSPECT AND APPROVE SET UP PERSONALLY. FOLLOWING CERTIFICATION OF ITEM 9, PLEASE RETURN THIS FORM TO THE PURCHASING AND CENTRAL SERVICES DIRECTOR.