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Retail of Consumer Fireworks Guide and Application FillableF.1 Retail of Consumer Fireworks Application Town of Tillsonburg By-Law 4293 Application Process: 1. Submit the following documents to the Customer Service Centre, 10 Lisgar Ave, Tillsonburg, twenty-one (21) days prior to the proposed display/sales and storage start date: • Completed Retail of Consumer Fireworks Application; • A Site Plan of the display/sales and storage location(s); • A draft Fire Safety Plan: Fire Safety Plans are required by the Ontario Fire Code, Section 5.2 Explosives, Fireworks and Pyrotechnics and must be compliant with Section 2.8 of the Ontario Fire Code. The Tillsonburg Fire Department can provide assistance with Fire Safety Plans but will not prepare this documentation for you. The Ontario Fire Code is available electronically from the Ontario Fire Marshal’s website. Upon submission of the above documentation the applicant will be required to pay the application fees in accordance with the current Rates and Fee By-Law. 2. The Tillsonburg Fire Department will contact the applicant to arrange a site plan inspection. If the Tillsonburg Fire Department provides approval the application will be forwarded to the Clerk’s Office for review. 3. If the application is approved the applicant will be notified when the licence is ready for pickup at the Customer Service Centre, 10 Lisgar Ave, Tillsonburg. F.1 Retail of Consumer Fireworks Application Town of Tillsonburg By-Law 4293 Application Date: _______________________________________________________ Business Name: _______________________________________________________ Business Identification Number:____________________________________________ Business Address: __________________________________ P.O. Box: ___________ Town: __________________________ Province: _________ Postal Code:_________ Business Phone Number: _____________________ Fax:_______________________ Email: _______________________________________________________________ Applicant(s) Name:______________________ Telephone Number: _______________ Applicant(s) Address: ___________________________________________________ Town: __________________________ Province: _________ Postal Code:_________ The applicant is the owner or tenant of the location where the fireworks will be displayed and sold:  Owner  Tenant The applicant is the owner or tenant of the location where the fireworks will be stored:  Owner  Tenant Property Owner information (if applicant does not own the property): Address: ___________________________________________________ Town: __________________________ Province: _________ Postal Code:_________ Proposed Date of Sales:  Victoria Day  Canada Day  Labour Day  New Year’s Eve Description of structure of which the fireworks will be displayed and sold:  Store  Trailer  Other (describe fully): ______________________________________________ Location where fireworks will be displayed and sold:  Same as business address  Other: Address: ___________________________________________________ Town: ______________________ Province: _________ Postal Code: _________ Location where fireworks will be stored:  Same as business address  Other: Address: ___________________________________________________ Town: ______________________ Province: _________ Postal Code:_________ Where and how will the fireworks be stored and displayed? ______________________________________________________________________ ______________________________________________________________________ Quantity of fireworks stored at the location of sales: ___________________ kg Quantity of fireworks on display: ________________ kg Quantity of fireworks stored at the off site storage location: ______________ kg Number, type, capacity and location of fire extinguishers: ______________________________________________________________________ ______________________________________________________________________ Fire and explosion safeguards to be undertaken: ______________________________________________________________________ ______________________________________________________________________ Name(s) of manufacturer of fireworks: ______________________________________________________________________ ______________________________________________________________________ Site Plan(s): Please attach a site plan of both the proposed display/sales location and the proposed storage location. As a minimum, the attached plans shall include the following:  Drawing scale or provide plan fully dimensioned  Fireworks display location  Fireworks storage location  Doors and windows (dimensioned)  License display location  NO SMOKING sign location(s)  Location of fire extinguishers (type and size)  Other fire and life safety equipment, if any  Fire safeguards  Explosion safeguards  Other: Fire Safety Plan: Please attach a draft Fire Safety Plan that shall:  provide for the emergency procedures to be followed in case of fire, including: • sounding the fire alarm, • notifying the fire department, • instructing occupants on procedures to be followed when the fire alarm sounds, • evacuating occupants, including special provisions for persons requiring assistance, • procedures for use of elevators, and • confining, controlling and extinguishing the fire,  provide for the appointment and organization of supervisory staff to carry out fire safety duties,  provide for the training of supervisory staff and the instruction of other occupants in their responsibilities for fire safety,  include documents and diagrams showing the type, location and operation of the building fire emergency systems,  provide for the holding of fire drills and set out fire drill procedures,  provide for the control of fire hazards in the building,  provide for the maintenance of building facilities provided for the safety of occupants, and  provide for alternative measures to be provided for the safety of occupants during a shutdown of any or all fire protection equipment or systems. Application and Licence Fees: Fees are in accordance with the current Rates and Fee By-Law. Licences are valid from the date of issue until December 31 of the year issued. DECLARATION: I, (please print name) __________________________ of _______________________ declare that all the statements contained in this application are true. Further, I hereby indemnify and save harmless Town of Tillsonburg and all employees, councillors, agents and representatives of the Town of Tillsonburg, from any and all claims, demands, damages, costs, expenses, actions and causes or actions, whether in law or equity, howsoever caused or attributed to, directly or indirectly, a Consumer Fireworks retail event initiated by the owner, occupier or person in charge of the premises. Signature of Applicant: _________________________________ Date: _____________________________________ Signature of Owner: ____________________________________ Date: _____________________________________ NOTE: Owner’s signature required if Applicant is not the property owner of either the display and sales or the storage location(s).