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HomeMy WebLinkAbout15-16857 � I � CITY OF ZEPHYRHILLS ; 5335-8TH STREET , (s13)�so-oo20 1 6 7 FIRE WORKS PERMIT PERMIT INFORMATION LOCATION INFORMATION Permit Number: 16857 Address: 38499 CR 54 Permit Type: FIRE WORKS ZEPHYRHILLS, FL. Class of Work: FIRE WORKS Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 02-26-21-0010-06000-0010 Improv. Cost: OWNER INFORMATION Date Issued: 12/30/2015 Name: MCLEOD MELBA TRUSTGRAY JEFFREY Total Fees: 535.00 Address: PO BOX 9 Amount Paid: 535.00 SYDNEY FL 33587-0009 Date Paid: 12/30/2015 Phone: (315)729-5191 Work Desc: FIREWORK TEMPORARY SALE -- DECEMBER 31 2015 THROUGH JANUARY 1 2016 CONTRACTOR S APPLICATION FEES EDWARD ENTZ F RE . R S FIRE PERMIT FEES 500.00 CONTRACTOR ERTIFICATE 30.00 TEMPORARY SALES 5.00 e� � � I Y � - � -- � � ��3 Ins ections Re uired FIRE WORKS SITE I PECTI 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. "FIREWORKS" per Section 791.01, Florida Statutes are considered as any combustible or explosive composition or substance or combination of substances or,except as hereinafter provided,any article prepared for the purpose of producing visible or audible effect by combustion,explosion,deflagration,or detonation. � � CONT � TOR S A' RE PERMIT OFFIC P IT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOURS NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE DEPT- 813-780-0041 .- -- �� / ��f� --7�i-� �3� z � . � Temporary Sales Checklist � -�r3 � � �3 �� ��sr I City of Zephyrhills i 5335 8'h Street �, Zephyrhills,Fl.33542 Phone:813-780-0020/Fax:813-780-0021 REQ IREMENTS 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. , IF there is a wire fence or chain link fencin must have at least 5 Ft setback from tent and at least I — � / 2 exits. vIF tent has sides,the sides shall be in the up position unless there is inclement weather, then 2 sides must be in the up position. FIREWO REQUIREMENTS–(In addition to the above) Proof of State License. JProof of Liability insurance. List of items to be sold at site. Copy of Drivers License and Social Security Number of all personnel dealing with the sale of fireworks at the tent location. FEEs $30.00–City Registration(If Regulated by DBPR–Fee is Waived) $500.00–Fireworks fee-Fire Department fee �( $ 5.00–Temporary Sales Fee for 1 S`two days $ 1.00–Temporary 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) $40.00–Electrical Fee(if applicable) Property Owner: ���_� '`� � � � �F�� / Applicant: � �' � � ��CW o R�C� Phone Contact: �'� 3 – �� � � /� l �5 Address Site: 3��(�9 �.� 5`� �A S '`� Z e-(�1�y r 1�.;�l S �� 33S�t 2 Date(s) of Sale: �2-31- �s ;,��,v 1 - 1 - t � Ordinance No. 1038-09 (for additional requirements) DATE� � �`�'��� I, �,��S,�r�„�'�. V►��„ GIVE FERMISSION Tt): " EDWARD ENTZE & � EDWAR.,D ENTZE FIREWORKS ° 145 BIRCI�CW4077 AV�NUE PLANT CITY,FLORIDA 33563 . , �� TU SET UP AND OPERATE A TEMPORARY STAI'�D ON�MY PROPERTY , LOCATED AT: � � �' �SY��i C� S r�' ��s� �����t t.� t�� � ( "�7 s" �'�-- - Ltk"T#� � . � BLQCi�� S�BDT�IC3�� � � � 1 O AGENT SIGNATURE . � STATE OF FLORIDA . ; CC}I:�J'I`IT O�HILLSBOR4UGI� �"A�t}R�TC'1�A��SCRI�BED$EFORE�E T�1t� � 7 � DAY' O�' �r�.. 2(6�BY' �"�-�e�� ���Y '�i0 IS FII�+C��T�,L�L.� _y� �Q�i�4R FfA�PRODI�CED �fS IDII��ICATIQ� �� � ( Y"� JENNIfER F�fACGN1�tt0 \' 'F'J � '� Naqty PuCitc-State of Plorid� ' �= Commission#�fF 234363 1R,�`," My Comm.Explres May 26.2019 T� • Ba�dM th►ouph National Notaty Assn. �.� -- � � � '• ���� - .�. ,. E ��: �+. � 'S 't� ' - , -r i . +���P�"- � F � JF i �.R`� F ti f' •Y, }}��f' [ . . . �...._ Sxy, J ��, y,�„y '��� .�T E �y 1`� � _ .. ` 11 - � '� 4 - �, # ` . i � i�`� 'r r�.�� . � : �,r, ` �'--� rk++ ,� � � � � "` � • .x t; rrky- �h �- �a� . ' � . „�•� . 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COLLIN�S STREET 5 • 5 �' � 5 RL'ANT CITY FL 33566 5 5 � � � , 5 - 5 5 5 5 C���efi��taon i� M���t� o�t�d� ���te S � 5 Th� a�ticl�� c��s�rsb�d a�n �ha� ��r�i�ac��� h��� ��er� treat�d w�th � �I��e-r��a�d��at ���roved 5 5 ch�m'scal ��tc� f3��� Qh� �ppls��tsoc� �� ���d ���er�o��! wa� ��sa�� �� ���f�r�'aanc� �eth C�ai�fio�ni� 5 5 Fcr� IV�ar�ha� �od�a R�I� f�b�a� �d�� ��:��� �����c� ���d ������ t�9FP� 7��m9�, ��A9 B�, 41�.� 109e 5 5 s����s � 8>>,9,0��� 5 . 5 Descra tio� o� ote't� ��rt�fe�c4: 5 5 � 5 5 ALL PURPOSI:CANOPY TOP 20WX30 � BLUE/WHIT6 VINYL C 5 � r� � 5 ������ ��������N�� ������� ���� ���� ���� �� ������� ��� ��__.____._.w._ �► 5 � ����a���� �s�� �� ��������c� ���� ��� �.d��� �� `��� �'a��a� � JOFIN BOYLE STATGSVILL6 NC ' � _� _� ._ _._ _...�_��'����_..�._.�..___-----_ 5 r �������: ��,�---______--- � 5 5 hdame o�A�S�IFcatc�r?3g F��6itE ;�E�SIS�d51� 6C6E79S{l �,P�Cf;�r�(6��Jt�S"i RIES IkV�. Gl I�r�r�r_fP�J��c1�r�r�r�iJ�rJ�rJ�c1�r�Gi�rJ�rJ�cJ�r.�l�u"r�SG4c-����lct�lr�-J�fc-!f�J��r-J�rr�P�"�c1��..l�?r�r?l�rJ�c�r�-.f�c_!c-�.€�t�l�r��r�c.l�c3?ir_ifr���l���r_lc�I°°�Jc�-.1"e�l�����r�_f"G�J"rJ�r.PGS G L 1 I . �• � • � � + • .- � Category Code Business Type Un'rts Tax I 47.01 380.OQ0010 Retail sales Receipt Fee 30.00 ' Hazardous Waste Surcharge 0.00 Law Library Fee 0.00 I Paymerrts not received priorto Oct 1.are delinquent. Business EDWARD ENTZE JR 105 BURCHWOOD AVE Make checks payable in US funds to: PLANT CITY,FL 33563�502 Doug Belden,Tax Collector PO Box 30012 Tampa,FL 33630-3012 � Remember to write your account number on check. Name EDWARD ENTZE JR Please Pay $30.00 $30.00 $30.00 $30.00 $30.00 Mailing 105 BURCHWOOD AVE Address PLANT CITY,FL 33563�502 If Jul 31, Aug 31, Sep 30, Oct 31, Nov 30, � Recelved 2015 2015 2015 2015 2015 � gy X Signature&Titie ' 1 swear or a�rm this application for business tau is For ih business, occupation or profession indicatetl hereon and is true and correct. 7 00015331 2016 9 Dec 79 2a1510�48am PD031003 .�;cc"�,�z,r�� ���TIFICATE C3F L.IAI�mLITY fNSUi�ANCE °A'�`"'�°°"�'Y", � 6/2512a�5 7i-nS C�RTiFICA'1'� t5 ISSUED A3 A MA77�R��In�FORMATlON ONI.Y AND CONFERS NQ RIGHTS UPON 7NE C�RTIFICATE iiOLDER. 7HIS CERTIFICATE DOES N07 A��lkNtATIV�t,Y OR NEGATIVELY AM�ND, �xT�Np QR ALTER 7W� COVERAGE AFFbR17�b BY TH� P4UCIE3 g�LOW. THIS QER'f1FICATE �F INSUR�INC� bbE$ NOT CONSTITUTE A CONTRACT BE7W�EN TME ISSI11Nca INSUR�R(S), AUTHQRIZED REPRE3ENTATIV�17R t�RODUGER,AND TFIE CER77FICA7�W41.pER. INIPORTANT: If the certlticata hotdel'I5 an ADDITI�NAL IN3URED,tha p4tEcy((�5)must 6o andorsed. If SLIB}�DGATIDN!3 WAIVED,subJact to tha tarms and condldons oi the polley,csttaln pottotes may roqulre an endorsamenG A�tatemont on this certlflcata daes not confor rfghts to the cartifloate holdor ln llou of such anCorsement s. pRapUCER ��; Britton GaUagher RHaic�uA,��,?,�R5A..71 b0 �a c.wnti;�,�6y5_�,ZZ(L One Gleveland Center,�laor�0 .MAIL 1375 East 9th Street Cleveland 0�144174 MSUR6R S APFORDRJG G01/6RAGE f3AIC p -1NSUf�a p• �suR� �5g7 wsu�e:Fverest Indemnity Inc iran.. o , J�ke's Finaavorks Ina n�su►�e c: �500 E 77th 7err� INFURER Q: � Pittsburg KS 89762 wsu��• INSURPR F- CQV�RAG�S CERTi�ICAT�NUAnBER:749�964�6 R�1►ISION NUMBEft: THIS IS TO CER7IFY ThIRT TWE POLICI�$OF INSURANC�LISTEO BELOW H�qVE��EN ISSU�D TQ THE IN$URED NAME17 AeOVE FOR THE pQLICY PERIOQ INDiCATGQ, Nb'1'IMTH9TANbING ANY REQUIRGMEM7,T�RM OR CONDITI4N OF ANY CONTRACT OR 4TH�R DOCUM[N7 WITH RESP�CT TO WHICH TMIS CERTIFICATE MAY S�ISSUED OR MAY PERTAIN,TM�fN5URANCE AFFORDED BY 7FIE Po�ICIEs oF„�CRIBED MEa�IN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ANt7 CONDmONs OF SUCH PdLtCIES.LIMITS BHOwN MAY HAVE BCEN REDUCED 6Y PAIp CLAIMS, IL 6H 7ypE OF INSURANCE POLICY EFP ROLICY EXP POLICYNt1M8ER Ml60 MMIoa LIMITS B GEN�{��,{�AgILIiY SIpGL00320-151 211512D75 2/15/2019 UGW OGCURR�NCE S1 oU0 D00 x COMMERCIALG@NCRAL LIlIpI�ITY , ��S�E&oCetIIwnrr 5500 OOD CIAIMS-MADE �OCCUR ME9 EXP fyW 4t15 4r�Qn � —• PERSOIdAL a ADV INJURY S1 000 000 GENERAL AGGREGATE 32 000 000 j GEN'L AGGREOATE UMIT APpLl�S PER: PFippUCTS-CAMplOP AGG tp 400 b00 POLICY �'Rd- LOC s nurnuparlE unBtilrr � Ea aeddOn! ,ann aura op4fl.Y INJUFxY{her pereon) S �Q��� AUT08ULED BODILY INJUAY(Pe�ecddo�� $ PIIREp AUT08 AUTO&WNED PbpacEcR oY DAMAC�E � S A �MBREf,LALlAD ?C pGCUR F.7CC6018367 2/15/201¢ 2/15/2016 Ep,CHOCCURRC•NC� 57,009,900 X EXCESSLIAB ����3_�� QGOREOATE $1�d04,�P0 OEO RETENT�bN 6 tl WORKER690MPENSATiON 4VCSTAN• OTH- AND EMPLOYERS'LIA611JYy Y f N ANY PROPflIETOR/PAR7NERIEXECtIFIVC• OFfICER/MEM8ERE7ICWD�d7 ❑ N�A E,L�EACHACCIDENT 5 (Mandofnry I�N E.l�OISEASE-EA EMPLQYE 3 H ync,dpsCf�bB Ill dB� DESCRIP7'IONbFOf�ERATI0N56olmv E.L.013S/�S�-pOLICYLIMIT $ PESGRIP7lON OF OPERqTtON8!L000.T1QN5!VE3i�¢�g(p��h ACOR6 70��Addlllonal RumarKA 9S119filllo,If moro zpqco la requirvd) Sales Lacation,38d99 Country Rd 54 East,Pasco Zephy�hills,FL 33G42; l.and Owt�er.Jeffery Gray • Torm;February 15,2p95 fhraugh February 14,Zp1G , Th�Certificafe Wolder and the abave listed are Additianal lnsuteds with respects to Genetsl L,iability policy as required by written contaGt, CER71FlCATE HpLbER CANCELLATI�M SHOULD ANY OF THE ABOVE DESCRIH�4 POLICIES 9E GANCELL@D 6�ppRE 7NE EXpIRAT10N Dq'f� THEREQF, NOTICE WILL BE DELIVERpp IN E&�Fireworks ACCORbANCE WITH THE ppLiCY PRdVf$IpNS. � Edward�nize '!05 Burchwood Ave AUTNORIYppREPRESENTAIIVE F+lant City FL 39afi3 , ��� �1988-�010 ACo�o CORPaRATiON. Ali rfghts reservad. ACORb 25(2010ld5) The qC4RD name arld fogo are reg�sterad marks of ACpRD �,