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Home My WebLink About18-19715 CITY OF ZEPHYRHILLS 5335-8TH STREET (813)780-0020 19715 FIRE SPARKLERS PERMIT PERMIT INFORMATION LOCATION INFORMATION Permit Number: 19715 Address: 7422 GALL BLVD Permit Type: FIRE SPARKLERS ZEPHYRHILLS, FL. Class of Work: FIRE-SPARKLERS Township: Range: Book: Proposed Use: COMMERCIAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 35-25-21-0010-07200-0011 Improv. Cost: OWNER INFORMATION Date Issued: 5/21/2018 Name: BEAR STEARNS COMMERCIAL MORTG ( Total Fees: 100.00 Address: 5221 N O CONNOR BLVD STE 600 Amount Paid: 100.00 IRVING, TX. 75039-4414 Date Paid: 5/21/2018 Phone: (217)235-7101 Work Desc: FIRE SPARKLER SALE - RURAL KING CONTRACTORS APPLICATION FEES TNT FIREWORKS RURAL KING FIRE PERMIT FEES 100.00 Ins ections Required FIRE INVENTORY ONSITE 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 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. "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. lbe-a-, 6�p CONVACTOR SIGNATURE PERMIT OFFIC60 PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE - 813-780-0041 8'13-780-0020 City of Zephyrhills Fire Fax-813-780-0021 Permit Application F 8007771 8687] F9151 Date Received Phone Contact for Permit Owner's Name FRural King#0101 Owners Phone Number Owners Address F7422 Gall Blvd,Zephyrhills, Florida 33541 Titleholder Phone Number Fee Simple Titleholder Name Fee Simple Titleholder Address F— Job Address 7422 Gall Blvd Lot# Sub Division Parcel F-1 Bio-Hazard Waste Storage-ANNUAL Hazardous Material(Tier 11 or RQ Facility)ANNUAL F� Comm Exhaust Kitchen Hood/Duct Hood Installation Controlled Bum o LP/Natural Gas-Installation Emergency Generator<30 kw LP/Natural Gas-ANNUAL Sale F-1 Emergency Generator>30 kw Places of Assembly-ANNUAL Fire Protection Maintenance-ANNUAL Recreational Burn P Mry Pe—m-,J Fnq er Sprinkler F-1 11 0 o [X--J Sparklers Inside Retail Sales of State Approved Sparklers Fire Alarm 0 11 0 Sprinkler System Installations Hood Cleaning n 0 EI Standpipes(Sprinkler Sys) Hood Suppression F--1 Torch Roofing/Tar Kettle Fire Alarm Installation E-] Waste Tire Storage ANNUAL Fire Pumps Fire Works Flammable Application-ANNUAL Valuation of Project 0 Fuel Tanks Other: Contractor Company TNT Fireworks Signature Registered Y/N Fee Current LY/N Street, Ocala, FL 34474 License# AddressFi��i] F ELECTRICIAN Company F Signature Registered Y Fee Current Address License# PLUMBER Company Signature Registered Y/N Fee Current Y Address License# MECHANICALI Company F— Signature Registered Y/N Fee Current Y/NJ Address _J License# OTHER Company Signature Registered Y/N Fee Current N AddressF-- License# cz "_'_"�" Directions: Fill out application completely. Owner&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 gov'com) Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pasco -Site plan at store-placement dictated by Fire Marshals office Jimmy Patronis Casia Sinco CHIEF FINANCIAL OFFICER BUREAU CHIEF Julius Halas Keith McCarthy DIVISION DIRECTOR SAFETY PROGRAM MANAGER FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF STATE FIRE MARSHAL 200 East Gaines Street -Tallahassee,Florida 32399-0342 Tel.850-413-3644 Fax.850-410-2467 CERTIFICATE OF REGISTRATION RETAILER LOCATION PERMIT THIS CERTIFIES THAT: TNT Fireworks 6255 SE 78th St Ocala F134472 Has registered pursuant to the provisions of Florida Statues to engage in the business of selling sparklers at the following fixed place of business: RURAL KING#101 7422 GALL BLVD. ZEPHYRHILLS FL 33541 Pasco Issue Date: 02/01/2018 Type: 07 Class: . 66 County: License/Permit#: SR17-000467 Expiration Date: 01/31/2019 ` Chief Financial Officer <024AO657'> 02440657 REPRINT - TNT FIREWORKS PACK LIST - REPRINT - 21362 Order # : 2440657-53-00002 Chain Store Sales-FL Chains Order Date: 11/2/17 Terms: Net 30 Days CUST PO: 4198346101 SCAC: SEFL PRO # : 244432546 SLSMN: Chain Stores - East SHIPMENT NBR: 296109 WLSL Lic #: Sold To: 2711092 Ship To: 2718761 - RK 0101 MID STATES DISTRIBUTION-2 RURAL KING #101 1370 MENDOTA HEIGHTS RD. 7422 GALL BLVD. MENDOTA HEIGHTS, MN 55120 ZEPHYRHILLS, FL 33541 SFM #: Desc/Case Packing Item Quantity Selling Suggested CP # Ordered Units Sell Price -------------------------------------------------------------------------------- ** ************************ Counter Cases *********************** FDP SNAP&SPARKLER DOM VS1 X13 673266 1 CS 1 EA 341. 0000 1/1 Containing: #8 SPARKLERS ASST 2 PDQS J 380247A 68 EA 68 EA 2 . 00 2/42/6/5 27736022755 2 PAK SNAP 4 PDQS J14 320516J 205 EA 205 EA 1 . 00 4/40/2/50 27736022922 DSP AG SS HALF PALLET J17 NR 673580 1 CS 1 EA 1366 . 5700 1/1 Containing: RAZZLE DAZZLER USA SS J10 102017 3 EA 3 EA 49 . 99 6/1 27736025596 PROUD EAGLE SS J10 USA 102072 6 EA 6 EA 29 . 99 10/1 27736013111 SMOKE BALLS BOX OF 8 J12 351052 48 EA 48 EA 2 . 00 4/24/8 27736028337 SIGN NFPA SM FRWKS NO SMOK 730644E 1 EA 1 EA 0 . 00 1/1 SUPER VALUE PACK REV J09 200722 7 EA 7 EA 10 . 00 12/3 27736017775 CRACKLING SALUTE J07 320474 24 EA 24 EA 2 . 00 4/24/10 27736019656 CRAZY EYE BALLS J09 290067A 42 EA 42 EA 1 . 00 6/32/3 27736013210 COLOR BLAST SS AG J11 102016A 14 EA 14 EA 19 . 99 10/1 27736025589 LASER RAINBOW W/YP 200573U 3 EA 3 EA 5 . 00 16/1 27736028047 CRAZY FUN PAK SS N12 PDQ 102126A 21 EA 21 EA 2 . 00 4/21 27736027545 2 PAK SNAP 4 PDQS J14 320516J 120 EA 120 EA 1 . 00 4/40/2/50 27736022922 Page No 1 REPRINT - TNT FIREWORKS PACK LIST - REPRINT - Order # : 2440657-53-00002 Desc/Case Packing Item Quantity Selling Suggested CP # Ordered Units Sell Price -------------------------------------------------------------------------------- GROUND BLOOM FLOWER 20 CT 290157A 20 EA 20 EA 5 . 00 2/20/20 27736030255 JALAPENO POPPER YP PDQ 201183 12 EA 12 EA 2 . 00 3/16 27736036110 PATRIOT PAK TRAY SS 102446 20 EA 20 EA 9 . 99 24/1 27736013043 Case Totals : 2 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 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 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) �...�' 11/1/2018 5/8/2018 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 have ADDITIONAL INSURED provisions or 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 certificate does not confer rights to the certificate holder in lieu of such endorsements). PRODUCER Lockton Companies CONTANAME:CT 3280 Peachtree Road NE,Suite#250 PHONE NE No Atlanta GA 30305 E-MA IL (404)460-3600 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Everest Indemnity Insurance Company 10851 INSURED American Promotional Events,Inc. INSURER B: 1359629 DBA TNT Fireworks,Inc. INSURER c: P.O.Box 1318 INSURER D: 4511 Helton Drive Florence AL 35630 SNSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 12067058 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. 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. INSR ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD LIMITS Y A X COMMERCIAL GENERAL LIABILITY N SI8GLt}p242-171 111112417 1111/2018 EACH OCCURRENCE $ 1 000 000 DAMAGE TO CLAIMS-MADE o OCCUR PREM IS RENT Ea ocauence $ 500,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑JERCOT- FI LOC PRODUCTS-COMP/OP AGG $ 2,000 000 OTHER: $ AUTOMOBILE LIABILITY NOT APPLICABLE COMBINED SINGLE LIMIT $ Ea accident XXXXXXX ANY AUTO BODILY INJURY(Per person) $ XXXXXXX OWNED AUTOS ONLY AUTOSULED BODILY INJURY(Per accident) $ XXXXXXX HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ XXXXXXX $ XXXXXXX UMBRELLA UAB OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX REXCESS LIAB CLAIMS-MADE AGGREGATE $ XXXXXXX DED I I RETENTION$ $ XX7Y—XXX WORKERS COMPENSATION NOT APPLICABLE STATUTE ERH AND EMPLOYERS'LIABILITY Y/N '—" ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ XXXXXXX OFFICERIMEMBER EXCLUDED? N 1 A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $If yes,describe under XXXXXXX DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ XXX,XXXX DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) 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 Certificate holder is an additional insured on the General Liability as required by written contract subject to policy terms,conditions, and exclusions. CERTIFICATE HOLDER CANCELLATION 12067058 Rural King SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE #0101 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7422 GALL BOULEVARD ACCORDANCE WITH THE POLICY PROVISIONS. ZEPHYRHILLS FL 33541 AUTHORIZED REPRESENT T E7 0198E-201 ACORD CORPORATION. All rights reserved. . ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD TNT° FIREWORKS Site Plan Worksheet ADDRESS 7422 GALL BLVD. CITY ZEPHYRHILLS STATE FL ZIP 33541 PHONE 813.779.0200 STORE NAME/LOCATION# RURAL KING#101 TYPE OF EVENT: In-store sales of Florida State-approved sparklers NORTH V LA SOUTH SPECIAL INSTURCTIONS located approximately 75ft from an exit SIGNATURE DATE STORE MANAGER/TNT®Representative