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Home My WebLink About16-17416 CITY OF ZEPHYRHILLS 5335-8TH STREET � • -` (sis)�so-oozo 1 1" 6 FIRE SPARKLERS PERMIT PERMIT INFORMATION - LOCATION INFORMATION . � � Permit Number: 17416 Address: 7838 GALL BLVD Permit Type: FIRE SPARKLERS ZEPHYRHILLS, FL. Class of Work: FIRE-SPARKLERS Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 35-25-21-0010-00700-0000 Improv. Cost: OWNER INFORMATION Date Issued: 6/07/2016 Name: PRIMERICA GROUP ONE Total Fees: 100.00 Address: 3629 MADACA LN Amount Paid: 100.00 TAMPA FL 33618 Date Paid: 6/07/2016 Phone: (813)933-0629 Work Desc: TEMPORARY RETAIL SALES SPARKLER PUBLIX CONTRACTOR S � APPLICATION FEES T IREWOR S P BLI FIRE PERMIT FEES 100.00 � � _ ` � � Ins ections Re uired FIRE INVENTORY ON ITE INSP Chapter 633, Florida Statutes,authorizes the City to charge and collect user fees to pay for the costs of fire prevention and protection related activities such as inspections, plan review,administrative fees,and other costs related to the aforementioned. � Complete Plans, Specifications and Fee Must Accompany Application. Commencement of work without written approval of the Fire Department's Fire Marshal or required permits or opening up for commercial activity without an approved final inspection shall be charged double permit fee per day of operation or a minimum of$100.00, whichever is greater. All work shall be perFormed in accordance with City Codes and Ordinances. "SPARKLERS" per Section 791.01, Florida Statutes, means a device which emits showers or sparks upon burning,does not contain any explosive compounds,does not detonate or explode, is handheld or ground . based,can not propel itself through the air,and contains not more than 100 grams of chemical compound - which produces sparks upon burning. CONT CTOR SIGNATURE PERMIT OFFIC PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE - 813-780-0041 � AMERICAN PROMOTIONAL EVENTS � EAST Check No. - 10098504 ` tlba TNT Fireworks - POeOX1318 Check Date - 4/28/2016 �• � 4511 Helton Drive Industrial Park Florence,AL35630 Stub 1 of 1 • � � � � -• � � • • •+ � 042616ZEPFL 4/26/2016 PERMIT EEES 260.00 260.00 260.00 260.00 2016 TNT FlrewoCks ' Sparkler Sales Locatians ^ Chain Store# Address tit ST Zip County Local Jurisdiction In Store Date Publix PU61245 7838 6AL�BOULEVARQ ZEPHYRHILLS FL 33541 Pasco Zephyrhills Week of Mayl6tb � Wal-Mart WAL0706 7637.GALL BOULEVARD ZEPHYRHILLS FL 33541 Pasco Zephyrhills Week of May 9th I Page 1 of 1 �� - � � � May 13, 2016 Jackie Boges Building Dept 5335 8th Street Zephyrhills, FL 33542 Dear lackie, ' Enclosed please find all permitting information for the locations that we will be furnishing with state approved sparklers this 4th of July season. If there is any additional information you need please contact me at 1-800-243-1189. You may also contact Kelly Alley in our Ocala office at 1-500-868-9151. Thanks again for all of your hef�. Sincerely, Jake Harrington Assistant Director of Compliance TNTO Fireworks harrin�tonj@tntfireworks.com AMERICAN PROMOTIONAL EVENTS,INC. P.O.BOX 1318•4511 HELTON DRIVE•FLORENCE,AL 35630 PHONE(256)764-6131 •FAX(256)760-0154 www.tntfireworks.com . - � 813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 ' ' Permit Application Date Received – '– O Phone Contact for Permit 800 m 868 9151 y Owners Name PUblix#1245 Owners Phone Number 813 782 1957 ownersAddress 7838 Gall Boulevard,Zephyrhills, FL 33541 Fee Simple Titleholder Name Titleholder Phone Number � � � Fee Simple Titleholder Address ��.'._..s�"."_ - – Job Address� 7838 Gall Boulevard Lot# � Sub Division Parcel# t�...-'-,`..'•'."•„- ------ .------�--•.,--_-...,-- -�<-w- - „r ----�-----�-�-^�r � Bio-Hazard Waste Storage-ANNUAL � Hazardous Material(Tier II or RQ Facility)ANNUAL � Comm Exhaust Kitchen Hood/Duct � Hood Installation � Controlled Burn � LP/Natural Gas-Installation � Emergency Generator<30 kw � LP/Natural Gas-ANNUAL Sale � Emergency Generdtor>30 kw � Places of Assembly-ANNUAL � Fire Protection Maintenance-ANNUAL � Recreational Burn r y emi �n er Sprinkler � ❑ ❑ ❑ � X❑ Sparklers Inside Retail Sales of State Approved Sparklers Fire Alarm � ❑ ❑ ❑ � � Sprinkler System Installations Hood Cleaning � O ❑ ❑ � � Standpipes(Sprinkler Sys) j �y'/ /// Hood Suppression � ❑ ❑ ❑ � � Torch Roofing/Tar Kettle � < < � �v � Fire Alarm Installation � Waste Tire Storage ANNUAL � Fire Pumps � Fire Works SPARKLERS � Flammable Application-ANNUAL Valuation of Project � Fuel Tanks Q Other: f'� .......,...�.»,.. .,.__........_.._._.._....�_�.._..-......am.v,.......�...._.�_..v....,..s..........�..r..wa_.�..._... ' ....._.. '.7"""" �_....w ...r...._�.. .._._.................�.....�� Contractor Company Signature Registered Y/N Fee Current Y/N Address License# ELECTRICIAN Company Signature Registered Y/N Fee Current Y/N Address License# PLUMBER Company Signature Registered Y/N Fee Current Y/N Address License# MECHANICAL Company Signature Registered Y/N Fee Current Y/N Address License# Vendor Company TNT Fireworks Signature Registered Y/N Fee Current Y/N Address 6255 SE 78th Street,Oc a, FL 34474 �icense# �.'._-'_--_.. �___._ _ � -------�-----�--, Directions: Fill out application completely Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner) If over$2500,a Notice of Commencement is required(Mechanical work over$5000) Supply two(2)sets of drawings with applicable documentation Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com) -Site plan at store-placement dictated by Fire Marshals office -State Sparkler Licence attached -Product List attached � . � Je�'Atwater - Casia Siaco, CHIEF FINANCIAL UFFICER BUREAIJ CHIEF JriIins Halas Keitli McCarthy DIVISIUN DIRECTOR -�� . SAFETYPROGRAM VIA.NAGER � FLORIDA DEPARTME�IT OF FINANCIAL SERVICES _ _ _ . .. .. .. .. , . - . �DIVTSTON QF`STATE_:FIRE;MARSHAL 200.East;Gaines Street -Tallahassee;.Eloride.32399-0342 Te1.850-4I3-3644 �Fax..8511a410.2467 - -a...�..._.�.�.L._ti� - - - - -- -- - =------- — -- - - CERTIFICATE OF REGLSTRATION RETAILER LOCATION PERN.QT `THIS CER'TIRIES THAT: Publix Supermarket"s 6255 SE 78t�Street o�a�a FL�a47z . . Has registered pursuant tp the provisions of Flonda.Statues to engage in the business of selTing sparklers; a`.t�the"following.fixed place,of business: Publix#.1�245 783$Gall Blvd Zephyrliills FL 33541_Pasco Issue Date: 02/41/2016. Type: 07 Class: 66. County; Marion `LicenselPermit#: 1186,82-0014-2008 Expiration�Datec U1/31/2017 ' ' j:1 e-�ts9`%�lSi`Ibl�:NJ �` � . �� ,� Chie�k'ivao.cial Officeir . . , " • ' � DATE(MMIDD/YYYY) i A�� CERTIFICATE OF LIABILITY INSURANCE 11/I/2016 5/13/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ' CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certifcate does not confer rights to the certificate holder in lieu of such endorsement(s). � PRODUCER Lockton Companies NAMEACT 3280 Peachtree Road NE,Suite#250 PHONE F� A/C No: ' Atlanta GA 30305 E-MAIL (404)460-3600 ADDRESS: INSURER S AFFORDING COVERAGE NAIC# iNsuReR a:Everest Indemni Insurance Com an 10851 INSURED American Promotional Events,IIIC. INSURER B: 1359629 DBA TNT Fireworks,IllC. INSURER C: P.O.Box 1318 INSURER D: 4511 Helton Drive INSURER E. Florence AL 35630 INSURER F. COVERAGES CERTIFICATE NUMBER: 12067055 REVISION NUMBER: XXXXXXX THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS , CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �LTR TYFE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS POLICY NUMBER MMIDD MM/DDIYYYY � A X COMMERCIALGENERALLIABILITY y N SI8GL00242-151 11/1/2O1$ 11/1/2016 EACHOCCURRENCE 5 1 OOOOOO CLAIMS-MADE �OCCUR DAMAGE TO RENTED PREMISES Ea occunence 5 5�0 0�� MED EXP(Any one person) $ 5�� PERSONAL 8 ADV INJURY $ 1 OOO OOO GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 OOO OOO POLICY❑PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ 2 OOO OOO OTHER: $ AUTOMOBILE LIABILITY NOT APPLICABLE COMBINED SINGLE LIMIT $ Ea accident XX�X�{X ANY AUTO BODILY INJURY(Per person) $ XX�{�{XXX AUTOS NED qUTOSULED BODILY INJURY(Per accident) S XX�XXX NON-OWNED PROPERTY DAMAGE $ XXXXXXX HIRED AUTOS AUTOS Per accidenl $ �{X�{XXXX UMBRELLA LIAB OCCUR NOT APPLICABLE EACH OCCURRENCE S XXXXXXX EXCESS LIAB CLAIMS-MADE AGGREGATE $ XXXXXXX DED RETENTION$ S XXXXXXX WORKERS COMPENSATION NOT APPLICABLE PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETORIPARTNER/EXECUTIVE Y�N E.L.EACH ACCIDENT 5 XXXXXXX OFFICER/MEMBER EXCLUDED9 � N�A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ }{�{�{}{�{�{�{ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ XX�XXX DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additlonal Remarks Schedule,may ba attached if more space is required) THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER,APPL(CABLE TO THE CARRIERS LISTED AND THE POLICY TERM(S)REFERENCED. City of Zephyrhills and Certificate holder is an additional insured on the General Liability as required by written contract subject to policy terms,conditions, and exclusions. CERTIFICATE HOLDER CANCELLATION 12067055 PUbI1X SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE #1245 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7838 GALL BOULEVARD ACCORDANCE WITH THE POLICY PROVISIONS. ZEPHYRHILLS FL 33541 AUTHORIZED REPRESENT VE� � � � O 1988-20 ACORD CORPO TION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD � � i TNT`� FIREVUORKS Site Plan Worksheet ADDRESS_ ��3 g C<c I 1 I�tivC� CITY � hs� ��S STATE FL ZIP �3�'y{ PHONE g«-��'�� STORE NAME/LOGATION# �L��I X �' I�i�h TYPE OF Ei�ENT: 9n store saies of��otida State•approved sparklers H � � � � � �, �'lN�.� �Pt��i.S�r s SOUTH SPECIAL INSTURCTION3 loaated aanroxtmatalv 75ft from eR exit F r�� ...�.�� ..�� "_ ' ' �53-02157442> ' , ' S3-02157442 - REPRINT - TNT FIREWORKS PACK LIST - REPRINT - 21362 Order #: 2157442-53-00002 Chain Store Sales-FL Chains Order Date: 3/24/16 Terms : Net 30 Days CUST PO: SCAC: PRO # : SLSMN: Chain Stores - East ' SHIPMENT NBR: 143917 Sold To: 1420005 Ship To: 2056670 - PUB1245 PUBLIX - COMPANY 0002 PUBLIX 1245 PO BOX 32008 7838 GALL BOULEVARD LAKELAND, FL 33802 ZEPHYR COMMONS ZEPHYRHILLS, FL 33541 Desc/Case Packing Item Quantity Selling Suggested CP # Ordered Units Sell Price -------------------------------------------------------------------------------- *************************** Assortments *********************** MEGA STORM USA SS AM BOX J13 102310 1 CS 8 EA 49 . 9900 8/1 27736023714 *********�*********�******* Counter Cases *********************** DSP PUB SS HALF PALLET J15-NR 673403 1 CS 1 EA 1440 . 5300 1/1 Containing: LIGHTNING BLAST SS AM BOX 102309 12 EA 12 EA 29 . 99 12/1 27736023745 THUNDER BOOM USA SS J12 WO 102024B 15 EA 15 EA 19 . 99 10/1 27736025992 STORM SHOCK USA PDQ SS J10 102023 20 EA 20 EA 10 . 00 24/1 939667 GROUND BLOOM FLOWER 20 CT 290157A 20 EA 20 EA 5 . 00 2/20/20 27736030255 SUPER VALUE PACK REV J09 200722 7 EA 7 EA 10 . 00 12/3 912288 ' SMOKE BALLS BOX OF 8 J12 351052 48 EA 48 EA 2 . 00 4/24/8 807590 STRIKER J10 200862 3 EA 3 EA 5 . 00 24/1 944809 2 PAK SNAP 4 PDQS J14 320516J 120 EA 120 EA 1 . 00 4/40/2/50 27736022922 TNT CRACKLING SALUTE J07 320474 24 EA 24 EA 2 . 00 4/24/10 958451 J SIGN NFPA SM FRWKS NO SMOK 730644E 1 EA 1 EA 0 . 00 1/1 MINI CALIFORNIA RKT 3PK J 200849A 24 EA 24 EA 2 . 00 6/24/3 27736025602 CRAZY EYE BALLS J09 290067A 42 EA 42 EA 1 . 00 6/32/3 27736013210 CRAZY FUN PAK SS N12 PDQ 102126A 21 EA 21 EA 2 . 00 4/21 27736027545 Page No 1 - REPRINT - TNT FIREWORKS PACK LIST - REPRINT - _ • F Order # : 2157442-53-00002 Desc/Case 'Packing Item Quantity Selling Suggested CP # Ordered Units Sell Price -------------------------------------------------------------------------------- FDP SNAP&SPARKLER DOM VSl X13 673266 1 CS 1 EA 341 . 0000 1/1 Containing: #$ SPARKLERS ASST 2 PDQS J 380247A 68 EA 68 EA 2 . 00 2/42/6/5 27736022755 2 PAK SNAP 4 PDQS J14 320516J 205 EA 205 EA 1 . 00 4/40/2/50 27736022922 *************************** Promotional Supplies *********************** PALLET WRAP, RED J13 730659 1 CS 1 EA 0 . 0000 1/1 Case Totals : 3 CS Total Pallets : PL Total Repack Cases : CS DECLARATION OF COMPLIANCE American Promotional Events, Inc . , dba TNT Fireworks, certifies that all consumer fireworks identified on this invoice have been tested by the American Fireworks Standards Laboratory and found to conform with all applicable regulations, standards and bans enforced by the U. S . Consumer Product Safety Commission. Testing and certification for these items complies with rules, standards and bans applicable to consumer fireworks : Performance Standards 16 CFR 1500 . 17 (a) (9) 16 CFR 1500 . 17 (a) (11) 16 CFR 1500 . 17 (a) (12) 16 CFR 1507 Powder Content Bans 16 CFR 1500 . 17 (a) (3) 16 CFR 1500 . 17 (a) (8) 16 CFR 1500 . 85 (a) (2) Cautionary Labeling 16 CFR 1500 . 14 (b) (7) 16 CFR 1500 . 83 (a) (27) Contact information for laboratory that performed conformity testing. American Fireworks Standards Laboratory (AFSL) 7316 Wisconsin Avenue, Suite 214 Bethesda, MD 20814 301-907-9115 afslhq@afsl .org CONTACT INFORMATION FOR INDIVIDUAL MAINTAINING RECORDS ON WHICH DECLARATION IS BASED: NAME: Kathie Pendergrass ADDRESS : 4511 Helton Drive Florence, Alabama 35630 TELEPHONE: 256-764-6131 FAX: 256-767-7200 E-MAIL: pendergrassk@tntfireworks . com. www. tntfireworks . com ' Page No 2