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HomeMy WebLinkAbout16-17512 . —% CITY OF ZEPHYRHILLS �� � — ' :' � 5335-8TH STREET � (813)780-0020 �75'i2 BUILDING PERMIT ��� PERMIT INFORMATION ' LOCATION INFORMATION Permit Number: 17512 Address: 38116 5TH AVE Permit Type: SPECIAL EVENT ZEPHYRHILLS, FL. Class of Work: SPECIAL EVENT Township: Range: Book: Proposed Use: COMMERCIAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: Improv. Cost: OWNER INFORMATION Date Issued: 6/23/2016 Name: CITY OF ZEPHYRHILLS Total Fees: 535.00 Address: 38116 5TH AVE Amount Paid: 535.00 ZEPHYRHILLS, FL. 33542 Date Paid: 6/23/2016 Phone: Work Desc: FIREWORK SPECIAL EVENT- SATURDAY JUNE 25, 2016 CONTRACTOR S APPLICATION FEES PATRIOTIC FIREWORKS SPECIAL EVENT 5.00 ' FIRE PERMIT FEES 500.00 � CONTRACTOR CERTIFICATE 30.00 � � / � ✓� � ' � � � Ins ections Re uired REINSPECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80 (2)(c)the local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or first reinspection,whichever is greater,for each such subsequent reinspection. NOTICE: In addition to the requirements of this permit, there maybe additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management, state agencies or federal agencies. "Warning to owner: Your failure to record a notice of commencement may result in your paying twice for improvements to your property. If you intend to obtain financing,consult with your lender or an attorney before recording your notice of commencement." Complete Plans,Specifications Must Accompany Application.All work shall be performed in accordance with City Codes and Ordinances. NO OCCUPANCY BEFORE C.O. NO OCCUPANCY BEFORE C.O. � � �� ONTRACTOR SIGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTIOIV - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER � � , . ; �, , ` '• •� Temporary Sales Checklist J.�� City of Zephyrhills 5335 8'h Street Zephyrhills,FI.33542 Phone:813-780-0020/Fax:813-780-0021 dtEQUIRE TS Detailed Plot Plan showing setup of location. Refer to Ord 1038-09, Sec 5 Notarized letter from property owner stating their approval. , A flame retardant certificate is required IF a tent is involved.Inspection required once tent ' is erected and prior to opening for business. Approved certified fire extinguishers per NFPA 10. No Smoking signs must be placed outside entrances. ��OR�tS F���qI�S�G �Oq���° IF there is a wire fence or chain link fencing must have at least 5 Ft setback fron�0 � ��E�Q��'��vy; 2 exits. �F�Epg,Y�R���,� I_F tent has sides,the sides shall be in the up position unless there is inclement weather, h/��'�RDIN�` then 2 sides must be in the up position. , FIItEWORK RE UIltEMENTS- � Q (In addition to the above) ,I Proof of State License. ��� ��-I��I ��•�5���Vl�yy�A�,. Proof of Liability insurance. � �(�������/� - List of items to b� at site. ���A7J���H�S Co of Drivers Licen e � py s and ocial Secunty umber of all personnel dealing with the sale of fireworks at the en ocation. FEEs ,�._ .r.--, •---`��..,� - - � � isLtatiQ�If Regulated by DBPR-Fee is Waived) " �� "eworks fee- ' Department fee � . A-= p ary Sales Fee for 15`two days `�:A9 porary Sales Fee per day for each consecutive day thereafter,not to exceed duration of 7 consecutive days and no more than two occurrences during a 12 month period on same property Ord#1038-09,Sec 6 $55.00-Tent Fee(40.00BD, 15.00*/FD)�*$15.00 waived for Fireworks) ��t�,b.i61,i(����(3pf� $40.00-Electrical Fee(if applicable) 'L�v`� Property Owner: �- � ,� � � � Applicant: J�,���,..til �,AP.P (�P �fr `.►.� P� �VP.r��s 1�G —� . Phone Contact: '7,�-7� � �-�/� J Address Site: ��`/// 6, ��J� 7�T�. , JlS — Date(s)of.� /��//� n �,�.,-f �o (�� Ordinance No. 1038-09 (for additional requirements) ....'r^�.�.,. ! � "' � �++K ' . � � . . J� t � � � �(. .� � c -- •""" I � �� � �. , ' , "` �" �� - „��►� �► � ,,��. _"°' �„ . '� ., �. 1 � �4 ' t.' !�^g � �`� � R' � ='''f` � �. '�+ r � �` '+',' �g � y~ � � � � � � � �+� ��y� _ ".� � �fi-�'��. � 'jy, 4 '"+� n� � � "'�V r,�+�fin. 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Y. 1 �'.�''J�-��=21�"R�7' (p �'w;:?,�kr'�, ,.yf, ;'i.... �' f.:"r;•f.'. �;+.^e:.�,;:. � �- ,.'.�7, `,' .z r:i�;Fei+::'�; ,, a . +�� ��':s�{;'r�<<•.: �i � ..� j� f"'o',;':„� '.,, " ' . . . ;?;;,;�.;: :Q i'A"~t.9�2J . ,, << ,�+ ,��i;. .::,, . ... .,. . .;�','� ��ae�" {.a?''a`<. � �:. ,z .q�*. :r• F;IA�,;�Sl ., 'J:,}.L�i ������ � � � �� , . � ���� � � : - � � �� " �'� � PA.RT II. APPLICANT INFORMATION Name of Organization: s�mp�y E�e�rs tlpplicant must be a not for profit entity, register to do business in the State of Florida �i , Contact person: Drew Cecere I� M3111rig 3Cidt'eSS: 12360 66th st n#a4 Lar�o, FL 33773 P�loIle nllTribET�111C1Ud1IIg aTOa COdO�: 727-674-1464 ' Alternate phone number �Z� s, _ a„ ' Fax number(inc3uding area code); 727-223-3779 � Email address: Simplyeventsfl@yahoo.com � Date incorporated: 2013 Current corpozate status: (Circle One) Acrive x Inactive Employer ldentification Number(EIN: 3�-1693sso P.ART II. EVENT SPUNS4RSffiP Name of eVent: SummerFest Do you have any co-sponsors for#he event?: x No Yes If yes,please list: We are looking for Co-Sponsors to Cover Firework cost of$2000 last year we paid for fireworks. ' Will an admission fee be charged to attend this event? X No Yes If yes,how much will the fee be? � Please note, an application for any level of City subsidy of a special event must be filed with the City Manager by June I for events occurring during the following fiscal year (October I- September 30) 2 , � . PART III. EVENT INFORMATION Name of proposed event: summerFest Date{s) and time(s) of proposed event: 6/25/16 4pm-9pm Praposed event location: • ZeR�r Park If the proposed event is a parade,please list the point of origin,path, and the termination point as well as estimated number of entries(Attach maps as n.eeded to clarify the parade route): Will the event r uire the closure of a state hi wa . x No Yes � � Y� If yes, a separate request form for state road closure must be submitted with this application. Will the event require closure of a City streetJavenue?: x No Yes Estimated number of vendors: so ' Estimated number of food/beverage concessionaires: s Is it proposed that alcoholic beverages be sold, served or consumed at this event? x No Yes If yes, a�s application for a permit for consumption of alcoholic beverages ntust also be submitted � aftd approved Briefly describe the proposed event and the specific activities associated with it: � A 4th ofl�ly GPlebration including intPrartivP kidc arPa vanrinrqy familY gamac anri ontartainmant UVP Wl�ll�f� �IkP�fini�the e��ent "�ith firo�ernrkc hn�eiavar ctill Innlrino fnr cn�ncnrc*�.� .+�+� Have you held th�is event before in Zephyrhills? No x Yes Tf yes,when: 2o1s�une z�th , Estimate of anticipated number of spectators/participants attending the event: �,nnn � 3 • Y ' In the event of inclement or hazardous weather, do you have an alternate date selected? xNo Yes If yes,what is the alternate date?: What electrical services will be required/provided for the event? (Plense be as specific as possible): xt t sta e. What other utilities will be required for the event? Restrooms arba e cans and collection Please list a11 equipment, e.g. stage, tents, vehicles, etc. that you propose to use in the event or bring onto City property, streets or parks areas (All subject to approva�Note that tents 1 D'x 10'or larser will also reAuire a fire ratin�certi�cate. Please provide/attach a description including a map and location and number of public facilities to be provided for the event(e.g., toilets, garbage cans, etc.): Please attach documentation of the appropriate application for Pasco County Health Deparfinent permitting for public facilities. 4 i . . , � . • PART IV. REQUIRED FACILITIES.AND INSURANCE INFORMATION Who is your liability carrier£or this event? Hiscox Insurance • Attach proof of liability insurance in the amount of One Million Dollars ($1,000,000.00.) All policies shall name the City o}'Zephyrhills as an additional insured for the even� Uwe agree to obtain and maintain the required liability insurance and to secure all necessary local, state and federal permits and to comply with all terms and conditions applicable to the conduct af special events, as set forth in Urdinance No. 943-06 as amended. Uwe certify that the information contained in this.application is true and accurate to the best of my/our knowledge. As applicant for the event, Uwe agree to release and hold harmless the City of Zephyrhills from liability of any kind for any and all damages arisiwg out of any loss or injury resulting from the conduct of tlus event. This release includes a release for any and all losses or injury arising while conducting an event using City of Zephyrhills facilities or property and for any and all losses or injtuy to persons attending this special event. Uwe certify that individuals will not be barred from participation in this event due to race, creed,color,national origin, sex, age,or physical impairraent. By: s��� Date' S[$,/16 , � Title• Co Owner Printed Name• Sonya Bradley 5 \ . . .-%� e • . '1:� • . " ': . ` .- ' :r. • ' f � / y - . � � ! �-',/a,�Ct �� i � ' �, . ,'�� - ��l�,�'� , s � ` " �Pc�� • ' �Ml'•GA�'�f ;; • _ ,� S������I� 1 ' • �_ �� S � - ��4l11`i L '�1°i.Li���tiLV LiE1�a7E+���aL+� • �: . ., . . DIVISI�lmT��'S��k'i�E 11►[�►��t�e�. � %�. •.. , 240$ast Cniues Street =T�Ficuida 3?399-031l2' � ' , '�'e1;.850-41��5�4 �a�.$�t�-41Q�2467 � 1` Y ; � ' , �ER'�TCt�Z'� 4�F J[��ST�A�E�� _- F , � �c�z��.����s��� � a��,�Q�� ��� �a�T:Pa#a.otic Fireworks Isic. 13�,4 S I�g�School Rd � � Yndian�polis�N 4�241 �� ��s xegist� p�xr�x�n.t t�o t�prow�isi,ans of�'Iorida•�t'a�.ues to�gag�ir�the b�usi�.�ss a�selli�.g sp�klers �a ret��nr. . . ; ;. �'� 'ssue�ate. f,?22I4�/2Qf 6 • . � �: o� - � w� JLGM717• ' } � ux�ty' �P o`� ,: , ,�o . . , �icens� '�#: � 593505-0401-2 . , �xpaation. � 0��'3]./2017 ' � ;� : , }, . ... . L• � ' • • � . i � M I� i t � , i: Ch�ief�in t�fficer . � �� .;: . � .� � ' . ;i .y ,z .� .� . ? 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A atatemaM ort this cenlflcar�doe�s nat eenfer Nghts to the cor�ll4�te ho(der in lieu of such ertdorsament(a). � vRooue�x .� �ltton GAiiagher raonN f� � _ ��� One Ci6vetarld Center,Flaor 30 ' 1375 East9th 5heat wo�ss: �6VP�81�d OH 4d��'4 • iwau AFFORDIHG CbVERAnE NAICit IN8URRtA: VBr@St IRdACt11'il Itf$UhEo tN8t�F2ER 9; f�atriotic Fireworks 1na �Nsw�c: ' 1314 S.Hi�h School Road ����a: tndianapoise 1N 46�41 . �nssu��e: • � lNflURER p• ,�� COVERAGES CERT[PlC�1'�NUEI�6ER:g(}7'�y�072 i2�V15lON!3U@�18ER: TN16I 0 CERTI THAT e POLlCI�5 IN5URANC LISIED AVE BE�N l58UED Tfl i SURED NAMED A80 FDR TFiE PpLICY PERlQD �' IN41CA7E0. 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