Fillable C APPLICATION FOR FIREWORKS DISPLAY (City of Gallatin)

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C APPLICATION FOR FIREWORKS DISPLAY (City of Gallatin)

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C
ITY OF GALLATIN, TN BUILDING CODES DEPARTMENT
132 WEST MAIN STREET GALLATIN, TN 37066 (615) 451-5968 WWW.GALLATINTN.GOV
APPLICATION FOR FIREWORKS DISPLAY
Address of Display: __________________________________________________________________________
Property Owner: _____________________________ Address: _______________________________________
Event: _____________________________________ Event Sponsor: __________________________________
Event Coordinator: _______________________________________ Phone #: ___________________________
Pyrotechnic Company: _______________________________________________________________________
State Reg. #: ________________________ ATF Federal Explosives License/Permit*: ____________________
Company Address: ________________________________________ Phone #: __________________________
Pyrotechnician(s): ________________________________________ State Reg. #: ________________________
On-site contact person: ____________________________________ Cell Phone #: _______________________
Date/Time of display: __________________________ Indoor display: _______ Outdoor display: _______
Location of nearest building (Outdoor only): ______________________________________________________
*Any person importing, manufacturing for commercial use, dealing in, transporting or causing to be transported,
or otherwise receiving display fireworks must obtain an ATF Federal explosives license or permit for the specific
activity. (An explosives license is also required to manufacture consumer fireworks and articles pyrotechnic.)
It is hereby agreed by the undersigned that said operations will be carried on in strict compliance with all City, State,
Federal, and NFPA regulations affecting such operations.
Signed: ________________________________________________ Date: _______________________________
Print Name: ____________________________________________ Title: _______________________________
DO NOT WRITE BELOW
FOR OFFICE USE ONLY
Having complied with the safety measures, as set out in Tennessee Code Annotated, Title 68, Chapter
104 and applicable rules and regulations governing the storage and use of fireworks and having paid
the required fee, the pyrotechnic company listed above is hereby granted this Permit to engage in the
display of fireworks as a permit holder.
This permit is site and date specific, as listed above and not transferable.
Approved Signature: _____________________________________ Date: _______________________
This Permit only valid when signed by Authority Having Jurisdiction
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City of Gallatin Building Codes Department
Fire Prevention Division (Fire Codes and Inspections)
Pyrotechnic permit Application
1. Complete City of Gallatin Pyrotechnic Permit application.
2. Complete State of Tennessee Application for Public Display of Fireworks Permit and all documentation
as required.
3. Provide Certificate of Liability Insurance for $1,000,000.00 listing the City of Gallatin as the Certificate
Holder.
4. Provide detailed site plan and shell summary / event presentation schedule. (Also required by the State
of Tennessee’s pyrotechnic license and exhibitor license.)
5. Provide a legible copy of the current Federal Fireworks License/Permit.
6. Submit permit fee of $150.00 (credit card or check made payable to City of Gallatin). Pyrotechnic
permits are issued for single day display. For multiple day displays, please contact our office for special
instructions.
7. At least 30 days in advance of intended event, submit all above listed documentation and the permit fee
to:
City of Gallatin
Building Codes Department
132 West Main Street, Room 202
Gallatin, TN 37066
8. A pre-event inspection will be scheduled with the City of Gallatin Fire Department.
All fireworks displays conducted within the City of Gallatin must be permitted.
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C APPLICATION FOR FIREWORKS DISPLAY (City of Gallatin)

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Completed 4 August 2020

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