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HomeMy WebLinkAbout16-18031 CITY OF ZEPHYRHILLS 5335-8TH STREET ' (si3)�8o-oozo 18031 � FIRE WORKS PERMIT ,r'' ' " PERMIT INFORMATIQN LOCATION INFORMATION ' � Permit Rlumber: 18031 Address: 4241 SKYDIVE LN / Permat Type: FIRE WORKS ZEPHYRHILLS, FL. Class �f Work: FIRE WORKS Township: Range: Book: Propos�d Use: COMMERCIAL Lot(s): Block: Section: , Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est�. Value: Parcel Number: 18-26-22-0010-08600-0000 �� Improv. Cost: OWNER INFORMATION Date Issued: 12/30/2016 Name: CITY OF ZEPHYRHILLS ' Total Fees: 535.00 Address: 4241 SKYDIVE LANE , Amount Paid: 535.00 ZEPHYRHILLS, FL. 33542 ! Date Paid: 12/30/2016 Phone: (813)780-0000 Wo'r,k Desc: ONE DAY FIREWORK EVENT DECEMBER 31, 2016 CONTRACTOR S APPLICATION FEES HAYES,JO N DAVID FIRE PERMIT FEES 500.00 SPECIAL EVENT 5.00 CONTRACTOR CERTIFICATE 30.00 �L/ � ('�`\ \� \ - ` �\ \� i V �-�C ` 'I Ins ections Re uired FIRE WO KS SITE INSPECTI N 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 F;re 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. y I ! ~� ' �JOr � CONTRACTOR SI ATURE PERMIT OFFIC � PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOURS NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE DEPT- 813-780-0041 , L;, i�= _ , _ �' Temporary Sales Checklist c��/ , City of Zephyrhills � /� � 5335�`�Street � Zephyrhills,FI.33542 �� o��'9� � Phone:813-780-0020/Fax:813-780-0021 �� ��� ' REQUIIiEMENTS ����� o� . �CS .� Detailed Plot Plan showing"setup of location. Refer to Ord 1038-09, Sec 5 .r 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 rior 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 fencing must have at least 5 Ft setback from tent and at least 2 exits. IF 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. , FjIREWORK REQUIREMENTS—(In addition to the above) Proof of State License. ' Proof 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. ' F�EEs $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 St 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 $55.00—Tent Fee(40.00BD, 15.00*/FD)-{*$I5.00 waived for Fireworks) $40.00—Electrical Fee(if applicable) P operty Owner: C `F- L � �� --� � Applicant: �d�l n �JGW�� �I G�U�' ihone Contact: �j(3--�� �� (� y 8� Address Site: �Z y � S'��f � r !K J a n� Date(s)of�: �.ve_���- �e.e e��-�►- � i , �Zv r h Ordinance No. 1038-09(for additional requirements) . � �: . r . � .�_ � e. .� .: • .«r+.�.�� . ..-L�.' '.iv...?,"."iYaf�:. . . . 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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAl10N ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATNELY AMEND,IXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.TFiIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATNE 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 pollcy,cerlain pollcles may requlre an endorsement A statement on thfs certificate does not confer rights to the j certificate�older In Ileu of such endorsemen s. CONTACT r�,oouc�r. I NAME. Falcon Insu ence Agency,If10. PHONE F� P O Box 291388 ac,No,e�c: ac,No: Kerrville,TX 78029 E-MAIL A�ORESS: RODUCER CUSTOMERIDNo. IfySURED INSURER(S)AFFORDING COVERAGE % NAIC No Skydive Cit , Inc. iNsuRERa,.0 S.SPECIALTY INSURANCE COMPANY ioo� 4241 Sky Dive Lane INSURER B Zephyrhills,FL 33542 INSURER C INSURER D INSURER E INSURER F THIS IS TO dERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED �JOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICAT�MAY BE ISSUED OR MAY PERTAIN,THE INSURANCEAFFORDED 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. AIRPORT 8�F80 LIABILITY COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INSURERLET�R POLICYNUMBER EFFECTIVEDATE EXPIRATIONDATE ADDITIONALINSURED9(Y/N) SUBROGATIONWAIVED?(Y/N) UA00167344-06 02/18/2016 02/18/2017 Y N COVERAGE il OPTIONS LIMIT APPLIESTO LIMIT APPLIESTO $ 100,000 BI ea,PER $ PD �REidI�IS LIABI i ITY $ 1,000,000 �OCC $ 2,000,000 AGGR FRtM111SEShIE(�ICALPAfMENT $ EAPER $ EAOCC � $ BIEAPER $ AGGR PRODUCTS LIAi ILITY EXTENDED $ EA OCC COMPLETED $ BI EAPER $ AGGR OPERATIONS �(7ENDED LIABILITY $ EA OCC HANGERKEEPERS INCLUDI NG TAXI � I LEGALLIABILIT� INFLIGHT $ EAA�RCRPFT $ EAOCC I -- i � $ i � $ EA OCC $ AGGR - -- --- -------- $ EA OCC $ AGGR I INCLUDED EXCLUDED ICOVERAGE s - CODE I DESCRIPTION OPTIONS LIMIT APPLIESTO LIMIT APPLIESTO a I $ $ I I ----- I DESCRIPTION OF OPERATIONS!REMARKS(Attach ACORD 101,Additlonal Remarks Schedule,if more space is required) ZEPHYRHIL�S MUNI,ZEPHYRHILLS, FL Certificate H Ider is included as an Additional Insured. CERTIFICA E HOLDER CANCELLATION , Clty Of Ze hyrhills and Zephyrhills Municipal Airport SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE i 39450 SO fh AVC. EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Zephyfhills,FL 33542 CCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE , ���� ���'. II I O 2009 ACORD CORPORATION.All rfghts reserved. -I ACORD 20(2009112) The ACORD name and logo are reglstered marks of ACORD � DATE(MM/DCWYI'1� .a►�o►�r�� CERTIFICATE OF AVIATION LIABILITY INSURANCE at�l�rs - � �—� 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 REPRESENTATNE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the pollc,y,certain pollcies may require an endorsement A s�tement on this certiftcate does not confer rights to the certiflcate holder In Ileu of such endorsemenb(s. CONTACT PRODUCER NAME. Falcon Insurance Agency,I�C. PHONE F� P O Box 291388 ac,No,e�a: ac,No. Kerrville,TX 78029 E-MAIL PLORESS: RODUCER CUSTOMERIDNo. INSURED INSURER(S)AFFORDING COVER.4GE % NAIC No Skydive City, Inc. INSURERA U.S.SPECIALTY INSURANCE COMPANY i00% 4241 Sky Dive Lane INSURER B Zephyrhills,FL 33542 INSURER C INSURER D INSURER E INSURER F 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. AIRPORT 8�F80 LIA8ILITY COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INSURERLETTER POLICYNUMBER EFFECTIVEDATE EXPIRATIONDATE ADDITIOf�lALINSURED7(Y/N) SUBROGATIONWAIVED7(Y/N) UA00167344-06 02/18/2016 02/18/2017 Y N COVER.4GE OPTIONS LIMIT APPLIESTO LIMIT APPLIESTO $ 100,000 el ea,PER $ PD PREMISIS LIABILITY $ 1,000,000 6qOCC $ 2,000,000 AGGR I PREMISES MEDICAL PAYMENT $ EA PER $ EA OCC $ BIEAPER $ AGGR PRODUCTS LIABILITY EXTENDED $ FA OCC COMPLETED $ BIEAPER $ AGGR OPERATIONS �7ENDED LIABILITY $ EA OCC HANGERKEEPERS INCLUDING TAXI LEGALLIABILITY INFLIGHT $ EAAIRCR.4Ff $ EAOCC � $ EA OCC $ AGGR $ FA OCC $ AGGR INCLUDED EXCLUDED COVERAGE CODE DESCRIPTION OPTIONS LIMIT APPLIESTO LIMIT APPLIESTO � $ $ DESCRIPTION OF OPERATIONS/REMARKS(Attach ACORD 101,Additlonal Remarks Schedule,if more space Is required) ZEPHYRHILLS MUNI,ZEPHYRHILLS, FL Certificate Holder is included as an Additionel Insured. CERTIFICATE HOLDER CANCELLATION Pasco County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 8731 CIIIZe�S D�. EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN New Port Richey,FL 34654 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ��� Ci'/�"—�'� O 2009 ACORD CORPORATION.All rlghts reserved. ACORD 20(2009/12) The ACORD name and logo are reglstered marks of ACORD �I. J � i � � ^,—u.��� � I David TK Hayes<tk@skydivecity.com> . ���'l%T. : } n 1�.�� � � Receipt from Galaxy Fireworks -T14 � . 2 messages ;' Galaxy Fireworks-T14 via Square<receipts@messaging.squareup.com> Mon, Dec 26, 2016 at 2:09 PM Reply-To: G�alaxy Fireworks-T14 via Square <r mfzhcrdqnqyxutivoayhm3tfpfdg4udqnndu25cniy.rYUZ.RtizyeiAPinWudec.810270d295ec7bbOd56f1d258f363b3aed4a0578@reply.squareup.com i To: tk@skydivecity.com Square automatically sends receipts to the email address you used at any Square seller. 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