3.3. SR 05-17-2004Item ~ 3.3.
TO:
FROM:
DATE:
S U BJ ECT:
MEMORANDUM
Mayor and City Council
Joan Schmidt, City Clerk
May 17, 2004
Consider Application for Display of Fireworks/Pyrotechnic
Special Effects from Melrose Pyrotechnics, Inc.
Request
Approval for Display of Fireworks/Pyrotechnics Special Effects
Applicant
Mekose Pyrotechnics, Inc.
Back~round
Melrose Pyrotechnics, Inc. has made application for display of fireworks/pyrotechnic special
effects for Saturday, July 4, 2004 at 10 p.m. at 509 Highway 10 m Elk River, Minnesota.
Action Requested
Council motion approving an application for display of fireworks/pyrotechnic special effects
for Melrose Pyrotechnics, Inc. to conduct a pyrotechnic display at 509 Highway 10 in Elk
River, Minnesota.
S:\Council\Joan\Fireworks\melrosetech.doc
APPLICATION FOR DISPLAY OF FIREWORKS/PYROTECHNIC SPECIAL EFFECTS
Applicant instructions:
1. This application must be completed and returned at least 15 days prior to date of display.
Name of applicant (Sponsoring Organization):. Elk River Area Chamber of Commerce
Address of applicant: 509 Highway 10, Elk River, MN 55330
Name of authorized agent of applicant: Melrose Pyrotechnics, Inc.
Address of agent:
9405 River Road SE, Clear Lake, MN 55319
Telephone number of agent:
320-743-6496
Date of display:
July 4, 2004
Time of display: approx. 10pm
Location of display:.__ Elk River, Minnesota
Manner and place of storage of fireworks/pyrotechnic special effects prior to display:
Delivery and storage in truck on day of display
Type & number of fireworks/pyrotechnic special effects to be discharged:
1.3G Aerial shells - up to 6 inch shells
Minnesota State law requires that this display be conducted under the direct supervision of a pyrotechnic
operator certified by the State Fire Marshal.
Name of supervising operator: Charles Kuklok Certificate No.: O 0558
I understand and agree to comply with all provisions of this application and the requirements of the issuing
authority, and will ensure that the fireworks/pyrotechnic special effects are discharged in a manner that will not
endanger persons or property orcx~.sflnte a nuisance. /
Signatureofapplicant(oragen; '~~(-O~t(',/2/v~-x~v~---~~ Dateofapplication: 4-30-04
Required attachments. The following at~chmpnts must be included with this application:
1. Proof of a bond or certificat{ of i~urance in amount of at least $ 5,000,000.00 .
2. A diagram of the grounds, or'~aeSlities (for indoor displays), at w~ch the display will be held. This
diagram (drawn to scale or with dimensions included) must show the point at which the
fireworks/pyrotechnic special effects are to be discharged; the location of ground pieces; the location
of all buildings, highways, streets, communication lines and other possible overhead obstructions; and
the lines behind which the audience will be restrained. For proximate audience (e.g. indoor) displays,
the diagram must also show the fallout radius for each pyrotechnic device used during the display
3. Names and ages of all assistants that will be participating in the display. Paul Isder, 28
James Kingery, 27
The discharge of the listed fireworks on the date and at the location shown on this application is hereby approved,
subject to the following conditions, if any:
Signature of fire chief/county sheriff:
Date:
Printed name of above official:
Phone:
Signature of issuing authority:
(City clerk/county auditor)
Date:
Printed name of above official: Phone: