Application for Public Fire Works Display Indoor/Outdoor

Application for Public Fire Works Display Indoor/Outdoor

Application fee: $0
East Baton Rouge Parish, Louisiana - 14100 Airline Hwy, St. George, LA 70817

(225)251-4800 FAX: (225)251-4991 Email: fireprevention@stgeorgefire.com
Deadline: Minimum of 5 Days Prior to the Proposed Display
Directions: This Application must be accompanied by proof of required liability insurance and approved site inspection with diagram.

This application shall contain the following information in the form of an affidavit sworn to and subscribed to before a notary public.
Name of Firm Association or Festival :
Email of requesting party:
example@example.com
Address:
Street
City
State
Zip
Name of Fireworks Company and Pyrotechnic Operator who will conduct the display:
Contact Information:
Date of the Display

MonthDayYear
Date
Time
Length of Display
Location of Display:
Provide all fire prevention plans which will be present and available to assure the public safety at the display
List the Louisiana State Fire Marshal licensed manufacturer importer distributor or jobber who will supply the public display:
Manner and place of fireworks storage prior to and during display

LA Fire Marshal Operator Number

	Using:	Liscence Numer
Pyrotechnic Operator License:
Special effects Operator License

Copy of Financial Responsibility Insurance or Other:

Cancelof
A plot plan showing the selected discharge site, spectator viewing area, parking areas, and the fall out area in feet per the NFPA Standard 1123 or 1126. (Add the plot plan in area below)
Plot Plan:

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Applicant Certification: I certify that I am familiar with and will comply with Louisiana Revised Statues 51 :650-660 of the State Fire Marshal's Act and NFPA Standards 1123 (Outdoor Display of Fireworks), 1124 (Manufacturer, Transportation, and Storage of Fireworks), and 1126 (Indoor Display ofFireworks). Furthermore, I will comply with the LA Revised Statue 32: 1501-520 and all regulations adopted and regulated by LA State Police. Questions or comments should be directed to St. George Fire Prevention at 225-251-4800.
Signature

Clear
Should be Empty: