Fillable COUNCIL BLUFFS FIRE FEC EF SPECIAL IC HN (City of Council Bluffs)

Fill Online, Printable, Fillable, Blank COUNCIL BLUFFS FIRE FEC EF SPECIAL IC HN (City of Council Bluffs) Form

Use Fill to complete blank online CITY OF COUNCIL BLUFFS (IA) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

COUNCIL BLUFFS FIRE FEC EF SPECIAL IC HN (City of Council Bluffs)

On average this form takes 6 minutes to complete

The COUNCIL BLUFFS FIRE FEC EF SPECIAL IC HN (City of Council Bluffs) form is 2 pages long and contains:

  • 0 signatures
  • 0 check-boxes
  • 23 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Council Bluffs

BROWSE CITY OF COUNCIL BLUFFS (IA) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
COUNCIL
BLUFFS FIRE
D
E
PAR
TM
E
N
T
PERMIT APPLICATION
F
O
R
D
I
S
P
LA
Y
OF
FIREWORKS /
PYR
O
T
E
C
HN
IC
SPECIAL
EF
FEC
T
S
INSTRUCTIONS:
1. A Pyrotechnic Display of Fireworks Permit Application shall be submitted to the Council Bluffs
Fire Department at least 30 days in advance of the pyrotechnic display.
2. The application submittal must include the supporting documentation as follows:
a) Lead Pyrotechnic Operator shall have a “shooter certified” certificate from the
Pyrotechnics Guild International (PGI). All other non-PGI certifications shall be reviewed
for reciprocity certification. Resume required for Lead pyro-technicians.
b) A Certificate of Insurance. Please see application below for insurance requirements.
c) A complete list of all pyrotechnic devices to be displayed. Displays before a proximate
audience require the submittal of device list and effect descriptions.
d) Site plan(s) which detail the firing site and device layout and an overall site plan indicating
the locations of spectators, the firing site, the fallout perimeter, and fireworks storage area.
e) e) Letter of permission to display fireworks by the property owner.
f) f) A PGI Shooter Certified Operator as approved by the Fire Department shall be designated
as the responsible party and shall be required to be on site.
3. Mail submittal to:
Council Bluffs Fire Department
Fire Marshal’s Office
200 South 4
th Street
Council Bluffs, IA 51503
4. Additionally, a $150.00 permit fee is required to be submitted to the Council Bluffs Fire
Department made payable to the City Treasurer.
5. All indoor pyrotechnic displays shall require minimum of (1) one standby fire personnel on scene,
at the expense of the shooter or event sponsor.
6. Additional personnel and/or equipment may be required as per the authority having jurisdiction.
7. All outdoor pyrotechnic events shall be reviewed by the Fire Marshal’s Office. A minimum of (2)
two standby fire personnel and equipment will be required for events on all City-owned property.
Events on privately-owned property may require the presence of standby fire watch fire personnel
as determined by the Fire Chief or his designee. All standby firewatch personnel will be provided
by the Council Bluffs Fire Department at the expense of the event sponsor or shooter.
8. Call (712) 328-4646, e-mail
pubed@councilbluffs-ia.gov or fax (712) 328-4916 with questions
regarding these regulations.
Council Bluffs Fire
Department
200 South 4
th
Street
Council Bluffs, IA 51503
Tel: 712-328-4646
Fax: 712-328-4916
http://www.councilbluffs-ia.gov/index.aspx?nid=212
Permit for Pyrotechnic Display
Date and Time of Display: Rain Date:
SITE INFORMATION
Name
Property Owner’s Name
Address
City, State, Zip
Telephone Number
Telephone Number
Fallout Perimeter Designated by
Maintained by
PYROTECHNIC COMPANY
Name
Address
Contact Person
Telephone#
Number of Personnel to be onsite
Lead Pyrotechnic Operator
Support Personnel
Support Personnel
Support Personnel
Support Personnel
The undersigned do hereby agree to comply with all Local, State, and Federal Laws.
Name of Applicant (type or print) Signature of Applicant
Name of Property Owner (type or print) Signature of Property Owner
Date of Application
INSURANCE REQUIREMENTS
An original certificate of insurance shall be submitted to the City of Council. Please submit an insurance
certificate a minimum of thirty days prior to the date of the event for approval by the City Legal
Department. The following represents the City’s insurance requirements. Any exceptions to these
requirements must be specifically granted by the City Council and made known to the City Legal
Department.
1. An original certificate of insurance with the original penned signature of the agent writing the
certificate is required. (Stamped signatures are not accepted.)
2. The name, address and phone number of the agent signing the certificate shall be typed under the
agent’s signature.
3. Copy of a Power of Attorney or other document showing the agent’s authority to sign for the
insurance company shall be attached to the certificate (a copy of the agent’s insurance license will
be accepted).
4. “The City of Council Bluffs, Iowa, and its employees are named as additional insured” shall be
specifically indicated on the certificate.
5. The name and date of the event being covered shall be indicated on the certificate.
6. The minimum liability limit required by the City is one million dollars (must be occurrence form
general liability coverage).
7. All addresses on the certificate shall list a street address; P. O. Box addresses are not accepted.
PERMIT REQUIREMENTS
•
Pyrotechnic Plan giving date, time, exact location, etc.
•
List and descriptions of all pyrotechnic devices to be used.
•
Qualifications and experience of the operator.
•
Diagrams showing placement of devices.
•
Proof of financial responsibility.
•
Material Safety Data Sheets (MSDS)
•
Flame retardency certifications of scenery if applicable.
•
Storage locations of pyrotechnic materials.
•
Live demonstration of materials to be used.
•
Agreement to provide a minimum of (2) two stand-by fire personnel on scene at the applicable
cost per hour.
•
Additional personnel and/or equipment may be required by the authority having jurisdiction.
•
Applicable laws include, but are not limited to: NFPA 1123, 1124, 1126,101, IFC and all local,
State and Federal laws.
OPERATOR QUALIFICATIONS:
•
Operators shall be at least 21 years old Assistants at least 18.
•
Provide copies of all licenses and certificates, resume of experience.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

COUNCIL BLUFFS FIRE FEC EF SPECIAL IC HN (City of Council Bluffs)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 17 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document