Fillable BENTON COUNTY Temporary Use Permit Application Fireworks Planning (Benton County Government)

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BENTON COUNTY Temporary Use Permit Application Fireworks Planning (Benton County Government)

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BENTON COUNTY
Temporary Use Permit Application – Fireworks
Planning Department
2113 W. Walnut Street
Rogers, AR 72756
(479) 464-6166
e-mail: planning@bentoncountyar.gov
website: bentoncountyar.gov/county-development/
PRIMARY CONTACT: _____ Property Owner _____ Applicant
PROPERTY OWNER INFORMATION
Property Owner Name: ______________________________________________________________________________
Physical Street Address for Firework Stand/Tent: Street: _________________________________________________
City: ___________________________________________________________________ Zip: _____________________
Property Owner’s Phone: ____________________________________________________________________________
Property Owner’s Email: _____________________________________________________________________________
Property Owner’s Mailing Address: Street:______________________________________________________________
City: ____________________________________________________________________ Zip: _____________________
PROPERTY OWNER CERTIFICATION – NOTARIZED
LICANT
APPLICANT INFORMATION
Applicant’s Name: _________________________________________________________________________________
Applicant’s Phone: __________________________________________________________________________________
Applicant’s Email: __________________________________________________________________________________
Square Footage Size of Tent or Building: ________________________________________________________________
DATES of OPERATION: June 20, 2020 – July 10, 2020
Property Owner’s Signature: _____________________________________ Date: ________________
Property Owner’s PRINTED Name: _______________________________________________________
State of ________________, County of ____________________________________________________
Subscribed and sworn to before me this _________day of _____________________________ 20_____
Notary Public ___________________________________ Commission Expires: ___________________
Parcel #_______________________________
Checklist: (see contact list on back)
______ AR State Retail License
_____ Temporary 911 Address
_____ Temporary Electrical Permit
_____ Site Plan
_____ Application Fee - $100
Notary Stamp
FIREWORK INSPECTION CHECKLIST
IMPORTANT NOTE
CONTACT LIST
Arkansas State Fire Marshal Benton County Fire Marshal Benton County 911 Administration
Little Rock, AR (479) 271-1003 (479) 271-1085
(501) 618-8624
For Temporary Electric: For Temporary Use Permit - Fireworks
Benton County Community Risk Reduction Benton County Planning Department
(479) 271-1003 (479) 464-6166
GENERAL CONDITIONS
• State License Posted
• Certification of Flame Retardant Treatment to Tent
• NO Combustible Materials within 25’ of Tent
• 12’ Fire Break Around Tent
• Location is 25’ from Buildings, Parked Vehicles or Other Tents
• Dumpster is 30’ from Firework Storage and Tents
• NO Gas-Powered Equipment within 25’ of Tent
• NO Flammable Liquids within 25’ of Tent
• Proof of Temporary Electrical Permit
• Provision of Safe and Adequate Parking on Site
FIRE PROTECTION
• TWO (2) 2-A Fire Extinguishers Mounted, Assessible and Inspected
• Water Extinguisher Mounted, Assessible and Inspected
LINE SAFETY
• NO SMOKING Signs Posted
• TWO (2) Exits Both Minimum Openings of 48” Wide
• EXIT Signs Posted
• Aisles and Walkways Clear and a Minimum of 48’ Wide
• Pathway of 36” Between Contents and Exterior Wall
ELECTRICAL
• Extension Cords in Good Working Order
• Lighting Cords and Fixtures in Good Working Order
The Benton County Fire Marshal will issue the Temporary Use Permit upon inspection of the facility. NO retail sales
shall be conducted on site without the Temporary Use Permit posted on site. The Temporary Use Permit applicant
MUST contact the Benton County Fire Marshal to schedule an inspection. Actual issuance of the Temporary Use
Permit shall be performed by the Benton County Fire Marshal.
Firework stands and commercial fireworks displays are commercial activities that are temporary and are required
to be removed following the expiration of a permit.
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BENTON COUNTY Temporary Use Permit Application Fireworks Planning (Benton County Government)

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Completed 5 August 2020

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