THE CORPORATION OF THE TOWN OF COBOURG

CONSUMER FIREWORKS RETAIL SALES PERMIT APPLICATION

(Pursuant to By-Law No.096-2010)

No person shall sell any consumer fireworks to any person at any time, except on the statutory holidays known as Victoria Day and Canada Day and the seven days immediately preceding such days.

Applicant Information:Application Date: ______

Name: ______

Business or organization name: ______

Mailing address:______

Telephone numbers: Home - ______Business - ______Cell - ______

Permit applied for: Fixed site* - $100.00 + H.S.T. ($113.00 total)

Trailer Site* - $100.00 + H.S.T. ($113.00 total)

*Valid for quantities up to 1000 kg. gross weight.

Note:Any application for a trailer site permitmust be accompanied by:

-Written permission from the registered property owner (where the applicant is not the property owner);

-A site plan drawing detailing the location of the trailer on the site, including distances from structures, public thoroughfares, property lines, etc.

-A copy of your liability insurance certificate.

Sales Location:

Physical address: ______

Telephone number(s): ______Alternate number: ______

Conditions:

1)Fireworks on display must be separated into lots, not exceeding 25 kg.

2)Fireworks must be kept away from accelerants.

3)Fireworks on display must be in consumer packs (blister packs).

4)Fireworks not in consumer packs (i.e. loose fireworks) must be locked up or otherwise inaccessible to the public.

5)A fire extinguisher shall be in the area of the display and shall be accessible at all times.

6)Customers are not permitted to handle any fireworks.

7)The fireworks display shall not be near a fire exit, nor shall it obstruct access to exits.

8)All requirements, as set out in By-Law 096-2010, shall be abided by.

9)Applicant agrees to abide by the requirements of Natural Resources Canada’s “The Consumer Fireworks Retail Package”, as it applies to their specific business. A copy has been provided with this application.

10)“Safety Instructions for Consumers” sheets shall be provided to customers purchasing fireworks.

I/we understand and agree to abide by the provisions as set out in By-Law No. 096-2010, and by any and all terms and conditions as set out by the Fire Chief.

Signature:______Date:______

Signature:______Date:______

COBOURG FIRE DEPARTMENT SECTION
Site inspected by: ______Date: ______
Payment information:
Cash □ Cheque □ (Please make your cheque payable to: The Corporation of the Town of Cobourg)
A receipt will be mailed to you by the Town of Cobourg’s Finance Department.

PERMIT NUMBER:______DATE OF ISSUE: ______

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