HomeMy WebLinkAbout17-19151 CITY OF ZEPHYRHILLS '
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FIRE IiVORKS PERMIT
PERMIT INFORMATION � ' � LOCATlON lNFORMATION
Permit Number: 19151 Address; 4241 SKYDIVE LN
Permit Type: FIRE WORKS ZEPHYRHILLS, FL.
Ciass af Work: FIRE WORKS Tawnship: Range: Baok:
Proposed Use: NOT APPLICABLE Lo#(s): Block: Section:
Square Feet; Subdivision: CITY OF ZEPHYRNILLS
Est. Value: Parcei Number: 18-26-22-001 Q-08600-0000
Improv. Cost: OWNER lNFC?RMATION
Date Issued: 12/28/2(}17 Name: C(TY OF ZEPHYHRILLS
Tatal Fees: 505.00 Address: 4241 SKYDIVE LANE
Amount Paid: 505.00 ZEPHYRHILLS, FL. 33542
Date Paid: 12/28/2017 Phone:
Work Desc: SPECIAL EVENT FlREWQRK SNQW DECEMBER 31, 2017
CONTRACTOR S APPLICATION FEES
HAYES, OHN p VID F E P RMIT ES 0.00 PECIAL EV T 5.OQ
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Ins ections Re uir�d
FIRE W KS S E INSP CTI
Chapfier 633, Flarida Statutes,authorizes the City to charge and collect user fees to pay for the costs of fire
preventian and protection related activities such as inspections, plan revieuv,administrative fees,and ather
costs related to the aforementioned.
Complete Plans, Specifications and Fee Must Accom�any Application. Commencement of work without written approval af
the Fire Department's Fire Marshal or required permits or opening up for commercial activity without an approved final
inspection shall be charged dauble permit fee per day of operation or a minimum of$100.00, whichever is greater. All
work shall be perfarmed in accardance with City Codes and tlydinances.
"FIREWORKS" per Section 791.01, Florida S#atutes are considered as any combustible or eacplosive
compasition ar substance or combination of substances ar,except as hereinafter pravided,any article
prepared for the purpose af producing visible or audible effect by combustian,explosian,deflagration,or
detanatian.
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CONT S1 N TU E PERMIT taFFIC
PERMIT EXPIRES IN 6 MONTHS WI7'HOUT APPROVED INSPECTION
CALL�OR INSPECTION - 8 HOURS NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT- $13-780-0041
t ` Tenlporary Sales �hecklist
City of Zephyrhills
5335 8�'Street
Zephyrhills,Fl.33542
Phone:813-'780-0020/Fax:813-780-0021
REQUIREMENTS
� Detai�ed Plot Plan showing setup of Iocation. Refer to Ordinance 1038-09, Sec 4
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Notarized letter from praperty owner stating their approval. iu� {�
A flame retardant eertificate is required IF a tent is involved.Inspection rec�uired once tent
is erected and prior to opening for business.
Approved certified£'u�e extinguishers per NFPA 10. �LL Wt�R�C S�i�,LL�QNrpLy UV'I�y���VP�f�,li��
C�DES F�t�R1DA BUILCIINC Ct��E,
No Smoking signs must be placed autside entrances. ��+��a��ELECI°141�ClJD�,
AIti9�'Tf�IE�6TY�F Z��I�i'YRHI�,L�
IF there is a wire fence ar chain Iink fencing must have at Ieas������a��from tent and at Ieast
2 e�ts.
TF tent has sides,the sides shall be in the up pasition untess there is in.clement weather,
then 2 sides must be in the up position. R�VIL�!/pqT���—��17
FIREWORK REQUII2EMENTS—{In addition to the above) P A, t �X.�nAiw��� ���'�
Proaf of State Lreeuse. 'p�'�1
� Proof of Liability insurance.
�� List of items to be sal�at site.
Copy af Drivers License and Social Security Number af alI persannel dealing
with the sale of fireworks at the tent location.
FEEs
$30A0—City Registration(If Regulated by DBPR—Fee is Waived)
� $SOQAQ—Fireworks fee-Fire Department fee
$ SAO—Temporaty Sales Fee for lst two days
$ 1.00—Temporary Sales Fee per day for each consecutive day thereafter,nat to
exceed duration of 7 consecutive days and no more than two occurrences
during a 12 manth period on same property Ord#1038-09,Sec 6
$ 55.00—Tent Fee(4Q.00/BD, 15.00*/FD)—(*$15.00 waived for Fireworks)
$40.00—Eiectrical Fee(if applicable)
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Property Owner: � � �
Applicant: �� ��.{�"
Phone Contact: ���--� J� �t�-- � �� �
Address Site: � 2..� ( � �
Date(s)af�: �-� � 'Z— ?�(` 20 ('7 °�-� �
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Ordinance Na. 1038-09(for additional xequirements) '
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Skydive City/J David Hayes .;� ' _
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�t�=l�`.s'�'i(�,+�•,I�iD David TK Hayes<tk@skydivecfty.com>
Amer�can Wholesale Fireworks:Shipment#100001015 for Order#100001267
American Wholesale Fireworks<contact@americanwholesalefireworks.com>
To:David Hayes<tk@skydivecity.com> Thu,Nov 30,2017 at 1:22 PM
(��merican Fireworks
�- - - — _..._ _ - -
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' THANK YOU FOR YOUR ORDER FROM ,', order Questlons? �
; AMERICAN WNOLESALE FIREWORKS. ; call us:(�oisso-tns �
' You can check the status of your order by logging ' Emall:contaM
; � americanwholesalefireworks com �
; into your account. �
� Your order has shlpped!You can track the order using the trecking information in
this e-mail.As a reminder,they will call you before to setup the delivery so please '
be accessible at the phone#listed on the order.Aiso,upon delivery it is the
receivers responsibility to verify the carton count matches the bill of lading.In the i
event the shipment is damaged It must be acknowledged by the receiver and not
accepted.As always,if you ever need anyth(ng feel free to reach out anytime and
� thanks again! �
, Your Shipment #100001015 !
Order#100001267 �
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. ._. __.__ .._...._._.._
_.._..- --_....._..._..�--� --- - ------�-
�! Item Sku Qh, - '
:! 192 Proof-Dominator DM202C5 Z ,;
i j Z"Fiberglass Mortar Tube MORTAR2" lz
�� Touch of Gold-Dominator DM398C5 3 i;
�i Boom Box-Dom(nator DM5283-C
�� Buy Cases and Save 1 '
1 Case(4 Units)_
;� Echoin the Ear-Wfnda P8029-C
i i Buy Cases and Save 1 �'
�� 1 Case(12 Untts)_
;• Excaliber-Worid Class 1041-C
� Buy Cases and Save 1
'1 1 Case(4 Units)_
I Tap Shelf Fan Cake-Dominator !
:' Buy Cases and Save DM580-C Z
., 1 Case(2 Units)_ •�
�'' Patriotic Dominance-Domfnator DM574-C �
i� Buy Cases and Save 1 1
�I 1 Case(4 Units)_
•j Boom Shacka Lacka-Brfght Star BS8002-C 1 !'
,, Buy Cases and Save
1 Case(4 Uniks)_ �
i Detonator-Dominator DM204C5-C �
� Buy Cases and Save 1 i;
.i 1 Case(4 UNtr)_ �
•� #500 Tube Cake-Assorted Effects DM5019-C 1 j.
�� Buy Cases and Save ;;
1 Case(2 Unitr)_
:: Mammoth Strobe-Dominator DM590-C 2 �
;; Buy Cases and Save i;
" I; 1 Case(4 Unftr)_ ;
--------------------------�.
; BILL TO: SHIP TO:
• David Hayes David Hayes
Skydive City Inc Skyd(ve City Inc
PO Box 1599 4241 Sky Dive Lane
' Zephyrhllls,Florida,33539 Zephyrhills,Florida,33542
� United States United States
T:813-783-9399 T:813-783-9399
I
; ;
. PAYMENT METFIOD:
Credit Card(Authorize.net)
j Credit Card Type: Visa
Credit Card Number:xxxx-9711
� Processed Amount: $1,602.99 '
i �
,! Shipped By--------------------------Trecking Number ----i� �
i! www,rlcarriers.com 87128751-6 °
� _.. .. __ _. :; �
._ _ _ .__ - -- -- --- --.__ _
- - -- --- _�._._ .__ - ._._..._. __ �
Thank you, American Wholesale Fireworks! ; �
� �
https://mail.google.com/mail/uJ0/?ui=2&ik=0620e83463&jsver-7 QCYKmIiAi4.en.&view=pt&msg=1600e2ad4a7f83bc&q=fireworks&qs=true&search=qu... 1/2
:�
�ATE(MMIDD/YYYY)
AC R� CERTIFICATE OF AVIATION LIABILITY INSURANCE �y�yZ�,�
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 cert'rficate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed.If SUBROGATION IS WAIVED,subject to
the terms and conditions ofthe policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement s.
CONTACT
PROIXICER NAME:
Falcon Insurance Agency, II1C. PHONE FAx
P.O.Box 291388 c No�,a c No:
Kerrville, TX 78029 E-MAILADDRESS:
RO DU C E R CUSlDMER ID Na
INSURED INSURER(S)AFFORDINGCOVERAGE % NAIC No.
Skydl�e City, InC.
iNsuRERn.U.S.SPECIALIY INSURANCE COMPANY 100%
4241 Sky Dive Lane INSURERB
Zephyrhills, FL 33542 INSURERC
INSURER D
INSURER E
INSURER F
THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED.NOTWITHSTANDING ANY REQUIREfU�NT,TERM OR CONDRION OF ANY CONTRACT OR OTHER DOCUMENT WffH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDffIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAID CLAIMS.
AIRPORT&FBO LIABILITY COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
INSURERLETTER POLICY NUMBER EFFECTNE DAlE EXPIRAl10N DA1E ADDITIONAL INSURED7(Y/N) SUBROGAl10N WANED?(Y/N)
UA0016734407 02/18/2017 02/18/2018 Y N
COVERAGE OPTIONS LIMIT APPLESTO LIMIT APPLESTO
$ 100,000 BIEnPER $ PD
PREMIStS LIABILITY
$ 1,000,000 ep,ocC $ 2,000,000 AGGR
PREMISES MEDICAL PAYMENT $ EA PER $ EA OCC
$ BIEAPER $ AGGR
PRODUCTS LIABILfTY EXTENDED
$ EA OCC
COMPLElED $ BIEAPER $ AGGR
OPERATIONS EXiENDED
L1481LfTY $ EA OCC
INCLUDING TNO
H4NGEf�EPERS
LEGAL LIABLI7Y IN RIGHT $ EAAIRCRAFT $ EA OCC
$
$ EA OCC $ AGGR
$ EA OCC $ AGGR
INCLUDED EXCLUDED
COVERAGE
CODE DESCRPTION OPTIONS LIMIT APPLESTO LIMIT APPLESTO
$ �
DESCRIPTION OF OPERATIONS/REMARKS Attach ACORD 101,Additional Remarks Schedule, if more s ace is re uired
ZFPHYRHILLS MUNI,ZEPHYRHILLS, FL
Certificate Holder is included as an Additional Insured.
CERTIFICATE HOLDER CANCELLATION
Clt ofZe h rhillsandZe h rhillsMunici alAir ort SHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORETHE
Y P Y P Y P p EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN I
39450 SOUtII AV@. ACCORDANCE 1MTH THE POLICY PROVISIONS. �
Zephyrhills, FL 33542 AUTHOPoZEDREPRFSENTATNE '
�� Vei--�•:
02009 ACORD CORPORATION.All rights reserved. �
ACORD 20(2009/12) The ACORD name and logo are regisUered marks of ACORD �
Jacc�ueline Boges
From: Nathan Coleman
Sent: Thursday, December 28, 2017 9:53 AM
To: Jacqueline Boges
Subject: Re: FIRE WORK SHOW
That would fine as long as all criteria is met down town. He will place the NOTAM during the time of his event.
Thanks,
Sent from my iPhone
On Dec 28,2017, at 9:46 AM,Jacqueline Boges<jbo�es@ci.zephyrhills.fl.us>wrote:
Hello Nate,
TK hayes will be having a firework show on Sunday, December 315t was this approved by the airport?
dackic Bo�es <image001.j pg>
813-780-0020 ext 3513
"A rule I have had for years is.to treat the Lord Jesus Christ as a personal friend.,His is not a creed,a mere doctrine,
but it is He Himself we have"Dwight L. Moody
Florida has a very broad public records law. Electronic communications regarding
most City of Zephyrhills business are public records and available upon
request. Your e-mail communications may therefore be subject to public
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