Fireworks Permit Application Form printable pdf download

FIREWORKS PERMIT APPLICATION

Fire Prevention Division

500 W. Big Beaver Road

Troy, MI 48084

248-524-3419

This application is for the storage of, and/or use of approved fireworks, and for displays before a

proximate audience. Approved fireworks are those defined in Michigan Public Act 256 of 2011, “Michigan

Fireworks Safety Act”. This includes “consumer grade fireworks” and “display fireworks.” Display fireworks

also require a separate permit/license from the State of Michigan to discharge, a copy of which must be

provided with this application. A $125.00 application fee is to be paid upon submittal of this application.

Make check or money order payable to City of Troy. Once approved, this permit shall expire 30 days from

the issue date. PERMIT SHALL BE POSTED ON SITE

Application Date: _____________________

Date of Event: __________________Hours of Operation: START: __________ END: _______________

Applicant Name: ________________________________________ Date Of Birth:__________________

Applicant Address: _______________________________________________Phone: _______________

Address Where Fireworks will be Stored / Displayed: __________________________________________

____________________________________________________________________________________

I hereby acknowledge that I have read this permit application and that the information given is correct. I

understand that if approved, the permit is non-transferrable. I further understand that the permit

application fee is non-refundable and therefore will not be returned if the permit is denied.

This permit application shall include an approved Hazardous Materials Inventory Statement (HMIS)

upon submittal and is subject to associated fees, payable to the City of Troy, upon issuance of the

permit. The HMIS and its directions can be found at:

Signature of Applicant: ____________________________________________________________

(THIS SECTION TO BE COMPLETED BY THE FIRE DEPARTMENT)

PREMISE #: ___________________

INSPECTION DATE: ______________

INSPECTOR: ______________________________

INSPECTION APPROVED:

D.O.T. CLASS:

1.4G

1.3G

TOTAL AMOUNT: __________________ LBS (Gross Weight / Net Explosive Weight / Documentation)

SECURED FROM PUBLIC:

WATER EXTINGUISHER:

NO SMOKING SIGNS

PERMIT ISSUE DATE: ___________________

PERMIT EXPIRATION DATE: _________________

COMMENTS: _________________________________________________________________________

_____________________________________________________________________________________

09-12

Web Site:

Plan Submittal: FD_Plans@troymi.gov

Fireworks Permit Application Form