07-26-2000 Council Agenda - Laserfiche WebLink

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APPLICATION FOR DISPLAY OF FIREWORKS/PYROTECHNIC SPECIAL EFFECTS Applicant instructions: 1. This application must be completed and returned at least 15 dayi prior to date of display. 2. Fee upon application is S__ and must be made payable to Name of applicant (Sponsoring Organi>ation1: City of T,i tt1 e Canada Address of applicant: 515 Little Canada Rd, Little Canada, MN Name of authorized agent of applicant: Melrose Pyrotechnics, Inc. Address of agent: 13255 Bradley Blvd., Becker, MN 55308 Telephone number of agent: 7630- 261 -2793 Date of display: August 5, 2000 Time ofdisplay: dusk Location ofdisplay: Spooner Park, 350 Eli Rd, Little Canada, MN Manner and place of storage of fireworks/pyrotechnic special effects prior to display: None — delivery and storage in truck day of the display Type & number of fireworks/pyrotechnic special effects to be discharged: 1 3G Aerial shel1B, upto 5" Minnesota state Iaw requites that this display be conducted underthe dinct supervision of a pyrotechnic operator certified by the State Fire Marshal Name of supervising operator: Mark C. Hanson Certificate No.: B0145 1 undcsstand and agree to comply with all provisions of this application and the requirements of the issuing authority, and will ensure that the fireworks/ pyrotechnic special effects are discharged in a manner that will not endanger persons or property or constitute a nuisance. Signature of applicant (or agent): . l�l t' ,( )C Required attachments. The following attachments must be included with this application: 1. Proof of a bond or certificate of insurance in amount of at least S 5,000,000,00 . 2. A diagram of the grounds, or facilities (for indoor displays), at which the display will be held. This diagram (drawn to scale or with dimensions included) must show the point at which the fireworks/pyrotechnic special effects are to be discharged; the location of ground pieces; the location of all buildings, highways. streets, communication lines and other possible overhead obstructions; 'and the lines behind which the audience will be restrained. For proximate audience (e.g. indoor) displays, the diagram must also show the fallout radius for each pyrotehnic device used during the display. 3. Names and ages of all assistants that will be participating in the display. The tikrhargc of the listed fireworks on the date a; the location sho on this application is hereby approved, subject to the following conditions, if any: X/171 / • Date: 77(/945-1 Date of application: 7 -12 -00 Signature of fire chief/county sheriff: Signature of issuing authority. `"� --__� Date: //-r,/ (City clerk/County auditor)) PAGE 38B