The URL can be used to link to this page

Home My WebLink About16-17417 CITY OF ZEPHYRHILLS '' ' . � 5335-8TH STREET ' ` �si3��so-oozo 17417 FIRE SPARKLERS PERMIT I PERMIT INFORMATION LOCATION INFORMATION � I Permit Number: 17417 Address: 7631 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: 34-25-21-0110-00000-0010 i Improv. Cost: OWNER INFORMATION Date Issued: 6/07/2016 Name: WAL-MART Total Fees: 100.00 Address: 7631 GALL BLVD Amount Paid: 100.00 ZEPHYRHILLS, FL. 33542 Date Paid: 6/07/2016 Phone: (479)204-1063 Work Desc: TEMPORARY RETAIL SALES SPARKLER-WALMART CONTRACTOR S APPLICATION FEES TNT FIREWORK WALMA T FIRE PERMIT FEES 100.00 � V � Ins ections Re uired FIRE INVENTORY O SITE 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 cost's 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 `.- --_. e�usuw MIlMt T11tl T .�[1r'l1tFf6E� (,"a5�s S111C0 CIIS�1 Sti0.t0 I� ��CHtEF FINANCtAI,OFF[CEIt HUREAU CI{lEF Jeff Atwahr BUREAR C�EF•, CHIEF FINANCIALOFF[CER Jnlim Hdu+ Keifh MeC�rthy Julins Bdaa ICeith McCarsl�y DMSION DIREECTOR gpggTy pROGR!#M MANAGER DIVISIO�T DYRECTOR SAFETY PROGRAM MANAGER s+*`. FLORIDA DEPARTMENT OF FINAIHCIAL SERYICES FI,pR1DA DEPARI'MENT OF FINANCIAI.SERVICES � DIYISION OF STATE FIRE MAILSHAL DIVISION 4F STATE FIRE MARSBAL ' 200 Eazt Gaines 9oreet-Tallehessa,Florida 32399-0342 " 2pp East(;eines Shett-'Cel(ehassec,Flotida 32799-03d2 Tel.650.413-3d44 Fwc.85P-010-2467 'leL$50-4I3-36dd Fe7t 854d1ii-2d6T CERTIFICATE OF REGIS'1'RATION CERTIF�CA'�E OI+'REGISTRATION ` DISTRIBUTOR OF SPARKLERS WgpLESALER OF SPARI�.ERS OFFICIAL COPY pF�ICIAL COPY THIS CERTiFIES THAT:American Promotional Events dba TNT Fuewarks 'THIS CER'TIFIES TT1AT:Ameri:can Promotianal Events dba TNT Fireworks 6255 SE 78th Stzeet 6255 S E 78th St Qcala FL 34472 � Ocala FL 34472 Has registered putsuant to the provisions of Florida Siatves to engage in tlae business of selling spazk2ers H�rea�ered pw�suaz►t to tlie pravitsioas of Flprida Statues to engage in the business of seUing spazklers to a whalesaler. to a retailer. Issue Data: 02/01/2016 Issue Date: 02JOiJ2016 Type: 07 Type; 07 - Ckass; 61 Class: 62 Caunty: Marion �a�ty; Marion LicenselPermit#: 565066-0001-2005 LicenseiPermit#: 565065-0001-2005 Facpiration Data: 01131l2017 � Eacpiration Date: Ol/31/2017 � . � �'�,.��'�� '�',�� ChietFinanciat Ofricer +�hiief I�Snanc'tai Utfices talps•Ihvmw2aUzermenammiP�mtNPermilCantrotier 1!7 tti Mtgs•IAvrm2ti�zdselve.cmJltdniNR+mIlCoedrottat I � st3aao-go2o • City of Zephyrhills Fire Fax-813-780-0021 i J' , � Permit Application Date Received —�p� � Phone Contact for Permit 800 868 9151 r-----•----�.•�_�__�__ -� . - Owners Name Wal-Mart#706 Owner's Phone Number 813 782 1957 Owner's Address 7631 Gall Blvd,Zephyrhills, FL 33541 Fee Simple Titleholder Name Titleholder Phone Number � � � Fee Simple Titleholder Address �-.. . _.__ ..._.,...�.--T..�.�._.. � . ,. . - . �. ::__.,,. -'...�..".�..e._-", .. .. _ . , , .. ._._. _ . I Job Address 7631 Gall Blvd � �ot tt � Sub Division Parcel# � � � _ _�.... ._.�'..� � Bio-Hazard Waste Storage-ANNUAL � Hazardous Material(Tier II or RQ Facility)ANNUAL � Comm Exhaust Kitchen Hood/Duct � Hood Installation � Controlled Bum � LP/Natural Gas-InstallaUon � Emergency Generator<30 kw � LP/Natural Gas-ANNUAL Sale � Emergency Generator>30 kw � Places of Assembly-ANNUAL � Fire Protection Maintenance-ANNUAL � Recreational Burn tr y emi �n er sprink�er � ❑ ❑ ❑ � X❑ spark�ers Inside Retail Sales of State Approved Sparklers Fire Alarm � ❑ ❑ ❑ � � Sprinkler System Installations Hood Cleaning � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) /� Hood Suppression � ❑ ❑ ❑ � � Torch Roofing/Tar Kettle �{�/J � �� _� � � � Fire Alarm Installation � Waste Tire Storage ANNUAL � Fire Pumps � Fire Works-SpARKLERS � Flammable Application-ANNUAL Valuation of Project � Fuel Tanks Q Other: � �.-�~_-_- -r....._.�-�n°..-..---•----��..."._._...�____._.a..w. �..._ � _._...._....��:..,.,..._.. ___ _.__..�._.__.__.__..��.�.�..-.��.._..�:-� 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,Oca a, FL 34474 License# �.�_:—•--� .�_ ---�---�------� Directions: Fill out application completely. i Owner 8 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 � deffAtwater Casia Sinco �� CHIEF FINANCIAL�FFICER �� $17REAU CHIEg Julius Halas DIVISION DIRECTOR Keith McCarthy � SAFETY PROGRAM MANAGER i• -�'� FLORIDA DEPARTMENT OF FINANCIAL SERVICES � DIVISION OF STATE FIItE MA,RSH�U zoo�c ca� es Street -Tallahassee,Flonda 32394-0342 Te1.850-413-3644 Fax.850-41�-2467 CERTIFICATE OF REG�STRATION RETA.ILER LOCAT�ON PERNIIT THIS CERTIFIES THA.T: Wal-Mart Stores Inc. 6255 SE 78th Street Oca1a F134472 Has registered pursuant to the provisions of Florida Sta�ues to engage in the business of selling sparklers at tlie following fixed place of business: Wa1-Mart#706 7631 Gall Blvd Zephyrhills FL 33541 Pasca Issue Date: 02/O1/2016 Type: 07 Class: 66 County: Marion License/Permit#: Sb5026-0018-2005 � °� : Expiration Date: O1/31/20I7 ' �` ,,�. � � . . .��,.,..,, .� - . r�i�� . . � - Chief Financial Officer , , " ' � � , DATE(MMIDD/YYYY) A�� CERTIFICATE OF LIABILITY INSURANCE iiii/2oi6 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 certi£cate 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 n.Everest Indemni Insurance Com an 10851 INSURED American Promotional Events,IriC. INSURER B. 1359629 DBA TNT Fireworks,IIIC. INSURER C. P.O.Box 1318 INSURER D: 45]1 Helton Drive Florence AL 35630 INSURER E: INSURER F. COVERAGES CERTIFICATE NUMBER: 12067057 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. NOIVVITHSTANDING 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. �TR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS POLICY NUMBER MM/DD/YYW MM/DD/YYYY A X COMMERCIAL GENEf2AL LIABILITY 1' N SI8GL00242-151 11/1/2015 11/1/2016 EACH OCCURRENCE $ 1 OOO OOO CLAIMS-MADE �OCCUR PR M SES Ea oNcu ence 5 SOO OOO MED EXP(Any one persan) 5 5�� PERSONAL&ADV INJURY S ] OOO OOO GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ Z OOO OOO POLICY�PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ 2,OOO OOO OTHER: $ AUTOMOBILE LIABILITY NOT APPLICABLE COMBINED SINGLE LIMIT � Ea accident XXXXXXX ANY AUTO BODILY INJURY(Per person) S XX�{XXXX AUTOS NED qUTOSULED BODILY INJURY(Per accident) 5 XX�{�{XXX NON-OWNED PROPERTY DAMAGE $ XXXXXXX HIRED AUTOS AUTOS Per accidenl 5 XX�{XXX UMBRELLA LIAB OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX EXCESS LIAB CLAIMS-MADE AGGREGATE 5 XXXXXXX DED RETENTION$ $ XXXXXXX WORKERS COMPENSATION NOT APPLICABLE STATUTE ERH AND EMPLOYERS'LIABILITY Y/N �� ANY PROPRIETOR/PARTNERIEXECUTIVE � `f 0 E.L.EACH ACCIDENT S XXXXXXX OFFICERIMEMBER EXCLUDED7 � N/A ` �� ,/ (Mandatory In NH) 1�� `.`� E.L.DISEASE-EA EMPLOYEE S XXXXXXX If yes,describe under t S f DESCRIPTION OF OPERATI�NS 6elow E.L.DISEASE-POLICY LIMIT $ XX�{XXX DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 107,Additional Remarks Schedula,may be attached if more space Is required) I THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER,APPLiCABLE TO THE CARRIERS LISTED AND THE POLICY TERM(S)REFERENCED. City of Zephyrhills and Cectificate holder is an additional insured on the General Liability as required by written contract subject to policy terms,conditions, and exclusions. CERTIFICATE HOLDER CANCELLATION 12067057 Wal-Mart SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE #O�OE) THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7631 GALL BOULEVARD ACCORDANCE WITH THE POLICY PROVISIONS. ZEPHYRHILLS FL 33541 AUTHORIZED REPRESENT VE� !�' ^f , (%/ O 1988-20 ACORD CORPO TION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD l TNTO FlREINORKS I� Site Plan Worksheet STORE NAME!LOCATION#LAYOUT OF WAL-MART LOCATION'S TYPE OF EVENT: In-store sales of Consumer Fireworks Walmart 706 Zephvrhills. FL REAR OF BUILDING ,�`�':,°�"'.� t-' �"''�'":'fi �=°""_"'.,'� q :.,., , - .., _ _ � .....:..-� -. _ .::. � - -:.v-� � . � .. ��. • ,•.i. C F.�. 3. , .<:� =':v -4�a . ,.ps.�;v..z i 3 ,:.m�'a.� - . .._. . . �...1.....-:wyY x._ s..c�-s� - . . .. . ., a�.. . , I �� "�� :[�`•:`-++=i�"•=, `� ^:"h'•' ��._�».� i{M<" ��^ .�, .... `'��'a'�.,y �.".. .;''_%:.�„° -- -- — --- Ad1on A � � - - — .. �eY(&acaatl Ai�le) - Faatorlct �, r ,' " i Registers 1 1 , , ' , , 1 , , � , �, - �� , i•. " ; � , &�IAANCIE7f �� , FRON'f INSTURCTIONS:Wal•Mart qeneraliv qlaces�e sales disulavs of consumer fireworks aroducts in the front of tha stores on the front side alsles(Actton Allev)near the entrancelexit which is known as the seasonal aisle This is a neneral overview of a tvpical Wal-Mart Suaer Center and oroduct placement may/should be dictated by instruction of the Inspector deaendina on the indivfdual locations needs and or store setua. , <53-02121648> . 53-02121648 - REPRINT - TNT FIREWORKS PACK LIST - REPRINT - 21362 Order # : 2121648-53-00002 Chain Store Sales-FL Chains Order Date: 2/25/16 Terms : Net 60 Days CUST PO: 4105990016 SCAC: PRO # : SLSMN: Chain Stores - East SHIPMENT NBR: 109010 ' Sold To: 1410002 Ship To: 1056090 - WAL0706 WALMART - CORPORATE 00001 WALMART 0706 702 SW 8TH STREET 7631 GALL BLVD BENTONVILLE, AR 72716 ZEPHYRHILLS, FL 33540 Desc/Case Packing Item Quantity Selling Suggested CP # Ordered Units Sell Price -------------------------------------------------------------------------------- *************************** Counter Cases *********************** DUMP BIN SNP/SPK #2 J13 673115 1 CS 1 EA 1590 . 0000 1/1 Containing: TNT SNAPS 4PK J09 320532 459 EA 459 EA 2 . 00 153/4/50 550503480 #8 SPARKLERS ASST 2 PDQS J 380247A 336 EA 336 EA 2 . 00 2/42/6/5 550503481 Case Totals : 1 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 Page No 1 - REPRINT - TNT FIREWORKS PACK LIST - REPRINT - ' . Order # : 2121648-53-00002 Desc/Case Packing Item Quantity Selling Suggested CP # Ordered Units Sell Price -------------------------------------------------------------------------------- 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 , , <53-02121649> . 53-02121649 - REPRINT - TNT FIREWORKS PACK LIST - REPRINT - 21362 Order # : 2121649-S3-00002 Chain Store Sales-FL Chains Order Date: 2/25/16 Terms : Net 60 Days CUST PO: 4105990024 SCAC: PRO # : SLSMN: Chain Stores - East SHIPMENT NBR: 109011 Sold To: 1410002 Ship To: 1056090 - WAL0706 WALMART - CORPORATE 00001 WALMART 0706 702 SW 8TH STREET 7631 GALL BLVD BENTONVILLE, AR 72716 ZEPHYRHILLS, FL 33540 Desc/Case Packing Item Quantity Selling Suggested CP # Ordered Units Sell Price -------------------------------------------------------------------------------- *************************** Assortments *********�************* BACKYARD SHOW WOPDQ USA SS Jl 102015A 6 CS 60 EA 19 . 9700 10/1 70055727 BLAST ZONE USA SS J10 102018 10 CS 100 EA 29 . 9700 10/1 70046873 DUMP BIN BLAST ZONE SS J15 102018B 1 CS 48 EA 29 . 9700 48/1 27736007677 DUMP BIN RED WHITE BOOM BX SS 102380B 1 CS 40 EA 49 . 9700 40/1 27736023325 DUMP BIN THUNDER MAX SSCOM J1 102213B 1 CS 20 EA 79 . 9700 20/1 27736029563 FUN BLAST SS COM W/PDQ J12 102205 4 CS 96 EA 9 . 9700 24/1 550437037 *************************** Base Fountains *********************�* CAROUSEL J11 200863 2 CS 72 EA 1 . 0000 36/1 550437044 GOOD VS . EVIL YP 201180 1 CS 18 EA 10 . 0000 18/2 555316305 JALAPENO POPPER 3 PDQ OF 16 E 201183 1 CS 48 EA 2 . 0000 3/16 555316297 JUMBO 20 RKT FTN PDQ J09 200815 1 CS 48 EA 5 . 0000 � 48/3 550503486 SHORT STACK 200924F 1 CS 112 EA 1 . 0000 4/28 554010832 �************************** Ground Spinners *********************** ' GROUND BLOOM FLOWER 20 CT BOX 290157A 2 CS 80 EA 5 . 0000 2/20/20 551358833 *************************** Smoke *********************** SMOKE BALLS BOX OF 8 J12 351052 2 CS 192 EA 2 . 0000 4/24/8 550437025 *************************** Sparklers *********************** Page No 1 - REPRINT - TNT FIREWORKS PACK LIST - REPRINT - . . � , � . Order # : 2121649-53-00002 Desc/Case Packing Item Quantity Selling Suggested CP # Ordered Units Sell Price -------------------------------------------------------------------------------- #20 NEON SPARKLERS J11 380266 2 CS 96 EA 5 . 0000 48/7 70077709 #8 SPARKLERS ASST 2 PDQS J14 380247A 3 CS 252 EA 2 . 0000 2/42/6/5 550503481 14 IN SUPER PAK MG J12 380265 3 CS 324 EA 2 . 0000 2/54/20 70077744 *************************** Promotional Supplies *********************** � SIGN -SPARKLERS NO SMOKING 730643E 2 CS 2 EA 0 . 0000 1/1 Case Totals : 41 CS Total Pallets : PL Total Repack Cases : CS DECLAR.ATION 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 afslhqCafsl .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: pendergrasskc�tntfireworks . com. www. tntfireworks . com Page No 2 I � r o w Q. � t. ;�jv =`aF7"' �� G.� I III � ��...� City of Zephyrhills BUILDING PLAN REVIEW COMII�NTS Contractor/Homeowner: / /f�� Date Received: �-� -�� Site: ��' � � Permit Type: ��Z,Cf' A roved w,! comments:L� PP � Approved w/the below comments: ❑ Denied w/the below comments: ❑ �r�r-��1-�/�,� ---- /�,!r� .�-� �,,,,oy �v'� e),�'J�a.. ��,�,�� , —�- � - ',� � I I� This comment sheet shall be k t with the ermit andlor 1 eP P p �s- �.'��<� � G ie � � I � Gene Brown—Fire Safety Officer Dat Contractor an or Homeowner � (Required w comments are present)