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Home My WebLink About18-19716 CITY OF ZEPHYRHILLS 5335-8TH STREET (813)780-0020 19716 FIRE SPARKLERS PERMIT PERMIT INFORMATION LOCATION INFORMATION Permit Number: 19716 Address: 7631 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: 34-25-21-0110-00000-0010 Improv. Cost: OWNER INFORMATION Date Issued: 5/21/2018 Name: SUPER WAL-MART Total Fees: 100.00 Address: 7631 GALL BLVD Amount Paid: 100.00 ZEPHYRHILLS, FL. 33542 Date Paid: 5/21/2018 Phone: (479)204-1063 Work Desc: FIRE SPARKLER SALE -WAL-MART CONTRACTORS APPLICATION FEES TNT FIREWORKS WALMA T FIRE PERMIT FEES 100.00 J FIRE INVENTOR ONSITE INSP Ins ections Required 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. KAh L 6� CONTRI&CTOR SIGNATURE PERMIT OFFICCA PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE - 813-780-0041 81.3-780-0020 C4 of Zephyrhills Fire Fax-813-780-0021 Permit Application Date Received Phone Contact for Permit 800 1 868 9151 Owners Name Wal-Mart#706 Owner's Phone Number Owner's Address 7631 Gall Blvd,Zephyrhills, FL 33541 Fee Simple Titleholder Name Titleholder Phone Number Fee Simple Titleholder Address Job Address [7631 Gall Blvd Lot# Sub Division Parcel# Bio-Hazard Waste Storage-ANNUAL Hazardous Material(Tier 11 or RQ Facility)ANNUAL Comm Exhaust Kitchen Hood/Duct Hood Installation Controlled Bum LP/Natural Gas-Installation Emergency Generator<30 kw LP/Natural Gas-ANNUAL Sale Emergency Generator>30 kw Places of Assembly-ANNUAL Fire Protection Maintenance-ANNUAL Recreational Burn P Mry F e—m Ji F 7n M Fe—r 7 Sprinkler F� 0 El 0 FX Sparklers Inside Retail Sales of State Approved Sparklers Fire Alarm 7 0 0 11 F-1 Sprinkler System Installations Hood Cleaning F-1 0 El 0 7 Standpipes(Sprinkler Sys) Hood Suppression F] 0 0 0 F Torch Roofingrrar Kettle F-1 Fire Alarm Installation Waste Tire Storage ANNUAL F7 Fire Pumps Fix Fire Works-SPARKLERS F-1 Flammable Application-ANNUAL Valuation of Project Fuel Tanks Other: Contractor Company Signature Registered Y/N Fee Current [_=/N Address License# ELECTRICIANI Company Signature Registered Y/N Fee Current L_L/NJ Address License# PLUMBER Company Signature Registered Y/N Fee Current =/N Address License# F_ MECHANICAL Company I Signature Registered Y/N Fee Current N Address License# Vendor Company ITNT Fireworks Signature Registered I Y/N Fee Current L�/N Address 16255 SE 78th Street, Ocala, FL 34474 License F_ 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 Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(hftp://appraiser.pascogov.com) -Site plan at store-placement dictated by Fire Marshals office -State Sparkler Licence attached -Product List attached Jimmy Patronis Casia Sinco CHIEF FINANCIAL OFFICER BUREAU CHIEF Julius Halas Keith McCarthy DIVISION DIRECTOR SAFETY PROGRAM MANAGER ty�VMS 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: Wal-Mart Stores Inc. 6255 SE 78th Street Ocala Fl 344.72 Has registered pursuant to the provisions of Florida Statues to engage in the business of selling sparklers at the following fixed place of business: Wal-Mart#706 7631 Gall Blvd Zephyrhills FL 33541 Pasco Issue Date: 02/01/2018 Type: 07 Class: 66 County: Marion License/Permit#: 565026-0018-2005 Expiration Date: 01/31/2019 . lip Chief Financial Officer TNT® FIREWORKS Site Plan Worksheet STORE NAME I LOCATION#LAYOUT OF WAL-MART LOCATION'S TYPE OF EVENT: In-store sales of Consumer Fireworks Walmart 706 Zephyrhills, FL REAR OF BUILDING '177..7.,77....:.. - Action ADey(Seasonal Ahle) 77, Hfrerorks .. s Registers LT Lj l i E FRONT INSTURCTIONS:Wal-Mart generally places the sales displays of consumer fireworks Products in the front of the stores on the front side aisles(Action Alley)near the entrancelexit which Is known as the seasonal aisle.This is a general overview of a typical Wal-Mart Super Center and product placement may/should be dictated by instruction of the Inspector depending on the individual locations needs and or store setup. REVIEW DATE CITY OF ZEPHYRHILLS FIRE AND LIFE SAFETY EXAMINE ALL WORK SHALL COMPLY WITH NFFA CODES AND STANDARDS <01777031> 01777031 - REPRINT - TNT FIREWORKS PACK LIST - REPRINT - 21362 Order #: 1777031-53-00002 Chain Store Sales-FL Chains Order Date : 4/4/14 Terms : Net 60 Days CUST PO: 4903886257 SCAC: RNLO PRO # : 035966601 SLSMN: Chain Stores - East SHIPMENT NBR: null WLSL Lic # : Sold To: 1410002 Ship To: 1056090 - WAL0706 WALMART - CORPORATE 00001 WALMART 0706 702 SW 8TH STREET 7631 GALL BLVD BENTONVILLE, AR 72716 ZEPHYRHILLS, FL 33541 SFM # : Desc/Case Packing Item Quantity Selling Suggested CP # Ordered Units Sell Price -------------------------------------------------------------------------------- *************************** Counter Cases *********************** DUMP BIN SNP/SPK #2 J13 673115 1 CS 1 EA 1590 . 0000 1/1 Containing: #8 SPARKLERS ASST 2 PDQS J 380247A 336 EA 336 EA 2 . 00 2/42/6/5 27736022755 4 PAK SNAP 4 PDQS J14 320532J 480 EA 480 EA 2 . 00 4/40/4/50 27736022960 Case Totals : 1 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) Page No 1 <01891202> 01891202 - REPRINT - TNT FIREWORKS PACK LIST - REPRINT - 21362 Order 4 : 1891202-53-00002 Chain Store Sales-FL Chains Order Date: 9/26/14 Terms : Net 60 Days CUST PO: 8154561444 SCAC: RNLO PRO # : 035970345 SLSMN: Chain Stores - East SHIPMENT NBR: null WLSL Lic #: Sold To: 1410002 Ship To: 1056090 - WAL0706 WALMART - CORPORATE 00001 WALMART 0706 702 SW 8TH STREET 7631 GALL BLVD BENTONVILLE, AR 72716 ZEPHYRHILLS, FL 33541 SFM # : Desc/Case Packing Item Quantity Selling Suggested CP # Ordered Units Sell Price -------------------------------------------------------------------------------- *************************** Assortments *********************** BLAST ZONE USA SS J10 102018 1 CS 10 EA 29 . 9700 10/1 70046873 RED WHITE BOOM SS J10 102019 1 CS 6 EA 49 . 9700 6/1 550503498 FUN BLAST SS COM W/PDQ J12 102205 1 CS 24 EA 9 . 9700 24/1 550437037 CELEBRA MI GENTE NY12 102242 1 CS 20 EA 19 . 9700 20/1 551358835 *************************** Base Fountains *********************** JUMBO 20 RKT FTN PDQ J09 200815 1 CS 48 EA 5 . 0000 48/3 550503486 ************************ ** Sparklers ****************** **** #8 GOLD SPARKLER J10 380262 2 CS 96 IP 2 . 0000 48/6/5 27736023127 #20 NEON SPARKLERS J11 380266 1 CS 48 EA 5 . 0000 48/7 70077709 ** ************************ Counter Cases ******************* *** DSP WM SS TR NY14 672674 1 CS 1 EA 2018 . 0800 1/1 Containing: BLAST ZONE USA SS J10 102018 20 EA 20 EA 29 . 97 10/1 70046873 SMOKE BALLS BOX OF 8 J12 351052 96 EA 96 EA 2 . 00 4/24/8 550437025 FUN BLAST SS COM W/PDQ J1 102205 24 EA 24 EA 9 . 97 24/1 550437037 BACKYARD SHOW WOPDQ USA SS 102015A 20 EA 20 EA 19 . 97 10/1 70055727 SIGN NFPA SM FRWKS NO SMOK 730644E 2 EA 2 EA 0 . 00 1/1 Page No 1 REPRINT - TNT FIREWORKS PACK LIST - REPRINT Order # : 1891202-S3-00002 Desc/Case Packing Item Quantity Selling Suggested CP # ordered Units Sell Price -------------------------------------------------------------------------------- #8 SPARKLERS ASST 2 PDQS J 380247A 84 EA 84 EA 2 . 00 2/42/6/5 27736022755 4 PAK SNAP 4 PDQS J14 320532J 160 EA 160 EA 2 . 00 4/40/4/50 27736022960 GROUND BLOOM FLOWER 20 CT 290157A 20 EA 20 EA 5 . 00 2/20/20 551358833 Case Totals: 9 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 ® DATE(MWDDNYYY) A�o CERTIFICATE OF LIABILITY INSURANCE 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 endorsement(s). CONTACT PRODUCER LOckton Companies NAME: 3280 Peachtree Road NE,Suite#250 PHONE FAX No): A/C No Ext Atlanta GA 30305 E-MAIL (404)460-3600 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Everest Indemnity Insurance Company 10851 INSURED INSURER B: 1359629 American Promotional Events,Inc. DBA TNT Fireworks,Inc. INSURER C: P.O.Box 1318 INSURER D: 4511 Helton Drive INSURER E: Florence AL 35630 INSURER F COVERAGES CERTIFICATE NUMBER: 12067057 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 I ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDDfYYYY MMIDD A X COMMERCIAL GENERAL LIABILITY Y N SI8GL00242-171 11/l/2017 11/1/2018 EACH OCCURRENCE $ 1 000 000 DAMAGE TO R NTED CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 5OO OOO MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO- LOC OTHER: COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY NOT APPLICABLE Ea accident $ XXXXXXX ANY AUTO BODILY INJURY(Per person) $ XXXXXXX OWNED SCHEDULED BODILY INJURY(Per accident) $ XXXXXXX AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ XXXXXXX AUTOS ONLY AUTOS ONLY Per accident $ XXXXXXX UMBRELLA LIAB OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX EXCESS LIAB CLAIMS-MADE AGGREGATE $ XXXXXXX DED RETENTION$ PERT $ XXXXXXX WORKERS COMPENSATION NOT APPLICABLE STATUTE EH R AND EMPLOYERS'LIABILITY IN ANY PROPRIETORIPARTNER/EXECUTIVE Y N/A E.L.EACH ACCIDENT $ XXXXXXX OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ XXXXXXX If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ XXXXXXX DESCRIPTION OF OPERATIONS I LOCATIONS I 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 12067057 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Wal-Mart al- THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 7631 GALL BOULEVARD ZEPHYRHILLS FL 33541 AUTHORIZED REPRESENT vE (D 19884019 ACORD CORPO TION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD