Public fireworks display permit application

Public fireworks display permit application

Required for State Fire Marshal permits
NFPA 1123NFPA 160/1126
Name of sponsoring organization*
Address of sponsoring organization*

Street Address

Street Address Line 2

CityState

Zip Code
Name of sponsoring organization contact*

First NameLast Name
Phone Number of sponsoring organization contact*
Please enter a valid phone number.Format: (000) 000-0000.
Email of sponsoring organization contact*
example@example.com
Date of display*

MonthDayYear
Date
Location of display*
Address of Display*

Street Address

Street Address Line 2

CityState

Zip Code
Type of fireworks to be discharges*
Single largest diameter of fireworks to be discharged (if NFPA 1123)*
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*

First NameLast Name
Certificate number*
Required attachments

The following attachments must be included with this application:
1. Proof of a bond or certificate of insurance in amount of at least $1.5 million minimum for indoor displays,
2. A diagram of the ground at which the display will be held. This diagram (drawn to scale or with dimensions included) must show the point at which the fireworks 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.
3. Names and ages of all assistants that will be participating in the display.
File Upload*

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I understand and agree to comply with all provisions of this application, MN Statute 624.20 through 624.25, MN State Fire Code, National Fire Protection Association Standard 160, 1123 and/or 1126, applicable federal law(s) and the requirements of the issuing authority, and will ensure that the fireworks are discharged in a manner that will not endanger persons or property or constitute a nuisance.
Signature of applicant*

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Please verify that you are human*
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Public fireworks display permit application

MINNESOTA STATE LAW REQUIRES THAT THIS DISPLAY BE CONDUCTED UNDER THE DIRECT SUPERVISION OF A PYROTECHNIC OPERATOR CERTIFIED BY THE STATE FIRE MARSHAL.