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).