Loading...
HomeMy WebLinkAbout18-20509 CITY OF ZEPHYRHILLS 5335-8TH STREET (813)780-0020 20509 BUILDING PERMIT _-PERMIT INFORMATION LOCATION INFORMATION Permit Number: 20509 Address: 7050 GALL BLVD Permit Type: SPECIAL EVENT - ZEPHYRHILLS, FL. Class of Work: SPECIAL EVENT Township: Range: Book: Proposed Use: MEDICAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 35-25-21-0010-10500-0000 Improv. Cost: OWNER INFORMATION Date Issued: 11/28/2018 Name: FL HOSPITAL OF ZEPHYRHILLS_ Total Fees: 535.00 Address: 7050 GALL BLVD Amount Paid: 535.00 ZEPHYRHILLS, FL. 33542 Date Paid: 11/28/2018 Phone: (813)783-6189 Work Desc: CHRISTMAS TREE LIGHTING DECEMEBER 2, 2018 CONTRACTORS APPLICATION FEES PYROTECNICO OF FLORIDA INC SPECIAL EVENT 5.00 CONTRACTOR CERTIFICATE 30.00 FIRE PERMIT FEES 500.00 Ins ections Required FINAL REINSPECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80 (2)(c)the local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or first reinspection,whichever is greater,for each such subsequent reinspection. NOTICE: In addition to the requirements of this permit, there maybe additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management, state agencies or federal agencies. "Warning to owner: Your failure to record a notice of commencement may result in your paying twice for improvements to your property. If you intend to obtain financing,consult with your lender or an attorney before recording your notice of commencement." Complete Plans,Specifications Must Accompany Application.All work shall be performed in accordance with City Codes and Ordinances. NO OCCUPANCY BEFORE C.O. NO OCCUPANCY BEFORE C.O. CW � j &-- CONTRACTOR SIGNATURE PERMIT OFFICXR PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER Temporary Sales Checklist City of Zephyrhills 5335 8-h Street Zephyrhills,FI.33542 Phone:813-780-0020/Fax:813-780-0021 REQUIREMENTS XDetailed Plot Plan showing setup of location. Refer to Ordinance 1038-09,See,4 Notarized letter from property owner stating their approval. N/A A flame retardant certificate is required IF a tent is involved.Inspection required once tent is erected and prior to opening for business. X Approved certified fire extinguishers per NFPA 10. X No Smoking signs must be placed outside entrances. N/A IF there is a wire fence or chain link fencing must have at least 5 Ft setback from tent and at least 2 exits. N/A 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. FIREWORK REQUIREMENTS—(In addition to the above) ]S_ Proof of State License. X Proof of Liability insurance. / N/A List of items to be sold at site. r5tir/ X Copy of Drivers License and ocial Security er 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 X_ $ 5.00—Temporary Sales Fee for V 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 some property Ord#1038-09,Sec 6 $55.00—Tent Fee(40.00BD, 15.00*/FD)4*$15.00 waived for Fireworks) $40.00—Electrical Fee(if applicable) Property owner: Florida Hospital Zephyrhills Applicant: Pyrotecnico-,Samantha Goldston Phone Contact: 954.657.8403 Address Site: 7050 Gall Blvd. Zephyrhills, FL 33541 Date(s)of Sale: December 2, 2018 Ordinance No. 1038-09(for additional requirements) REVIEW DATE d b ALL WORK SHALL COMPLY WITH CITY OF ZEPHYR LLS NFFA CODES AND STANDARDS FIRE AND LIFE SAFETY EXAMINE 4ciIIEADWARTER3 D.S.LOCATIONS V.O.Bon 149 IAx. Atlanta,GA Montgomery,AL New Castle,PA 16103 724.652.1288 Auburn,NY New Castle,PA 01FICT W Ie Dallas,7X New Orleans,LA 724.652.9555 - www.pyrotecnlco.com Fort Lauderdale,FL Saluda,SC foil IRII WAILP O 854.4705 info@pyrotecnlco.com Jaffrey,NH Tampa,FL Las Vegas,NV Vineland,NJ :•IIALL FAMILY FIREWORKS • 1339 Florida Hospital ZephyrhMs- Firework Display Display Date: December 2,2018 PRODUCT RECAP: Body 4 2"36 Shot Box 8 49 Shot Fan Cakes 2 49 Shot Star Cakes Finale 1 100 Shot Barrage rf.I I .a 11 R-1 Florida Hospital Zephyrhills a 9 X i; Christmas Display s High LeveMreworks Display Site Plan* , o< o �9'h;l pjiz-�i °� °'•^•' Florida Hospital Zephyrhills o o o m v' .'4 4 a.. �.',.••,�,i�Ijj I i,i�hti .T���jlll �i�� �„ N o .qjj; .; "••,, I lll,, ... .-.';•1 fly I•r•• 7050 Gall Blvd, r s g r �aT II�I. Zephyrhills,Florida 33541 0 . " •`��`'�1. 'I" I°" South Parkin Lot Displaym l 1,u.1.1; I:� . 14Y F v1:fN •[Ic w Ir:.t g Headquarters U.S.Locations P.O.80x149 lAx Allanta,GA 877.924 New Castle,PA M03 724.652.1288 Las Vegas,NJ Soo.95t kMAIL Info®py7otecnico.com Montgomery,AL 800,25S VPO O,. Ict New Odeans.LA 800.78' . 724.652.9555 win VITAL[ F A M I L Y i t"a[W O R x S r 1969 800.854..4705 www.pyrotecnico.com Tampa,FL 888.35; Nov.7,2018 City of Zephyrhills Hello: The show on December 2,2018, will be shot electronically If you require any additional information please let me know. Thank you for your assistancel Sincerely, Samantha Goldston Sales Assistant) Pyeotecnico—Florida :954.651.4000 htta://Www.ovrotecnico;com I htto://Www.ovrotecnicofx.com a OTE I PYROTECNICO-fK nuura.nr nuwrr..un TECHNICIAN RESUME Charles Flanagan 544011 Street, Zephyrhills,FL 33542 Cell:813.310.5524 Email: creltano@pyrotecnico.com DOB: 10/17/1970 Age:46 Display Experience: Charles has been a lead technician for 10+years,he has experience with electrical fired displays and Is familiar.with all safety standards. Lead technician on following shows: NNP Southbend:July 4,2013,2014,2015,2016,2017 Tampa Yankees:2013,2014&2015,2016,2017 Season St.Leo University-Fall Family Day October 2014,201.5,2016 Florida Hospital Zephyrhills December 2015,2016 Page:4/10 Safety Data Sheet Ace.to OSHA HCS(29 CFR;1910.1200) Printing date:01/06/2017 Revision:01/06/2017 Trade name:Fireworks,Display (Coned.of page 3) Send for recovery or disposal.in suitable receptacles. Reference to other sections See Section 7 for information on safe handling. See Section 8 for information on personal protection equipment. See Section 13 for disposal information. Handling Precautions for safe handling. Handle with care.Avoid jolting,friction and Impact. Restrict the quantity stored at the work place. Keep out of reach of children. Information about protection against explosions and fires: In case of fire:Evacuate area. Explosion risk in case of fire.' Keep away from sparks and open flames.-No smoking. . Emergency cooling must be available in case of nearby fire. Conditions for safe storage,.including any incompatibilities Storage Requirements to be met by storerooms and receptacles: Avoid storage near extreme heat,Ignition sources or open flame. Information about storage in one common storage facility: Store in accordance with locaVregional/nationalfinternational regulations. Store away from foodstuffs. Store away from flammable substances. Further Information about storage conditions: Store in cool,dry conditions In well sealed receptacles. Store locked up. Specific end use(s)No relevant information available. Control parameters Components with limit values that require monitoring at the workplace: The product does not contain any relevant quantities of materials with critical values that have to be monitored at the workplace. Exposure controls Personal protective equipment: General protective and hygienic measures: The usual precautionary measures for handling chemicals should be followed. Keep away from foodstuffs, beverages and feed. Wash hands before breaks and at the and of work. Engineering controls:Provide adequate ventilation. (Contd.on page 5) Page:5/10 Safety.Data Sheet acc:to OSHA HCS(29 CFR 1910.1200) Printing date:01/06/2017 Revision:01106/2017 Trade name:Fireworks,Display (Confd.of page 4) Breathing equipment:Not required under-normal conditions of use. Protection of hands:When needed;Wear-gloves for protection against mechanical hazards. Eye protection: Arm Safety glasses Follow relevant national guidelines concerning the use of protective eyewear. Body.protection:When needed,wear protective clothing for protection against mechanical hazards. Limitation and supervision of exposure Into the environment No relevant information available. Risk management measures Organizational measures should be in place for all activities involving this product. Information on basic physical and chemical properties Appearance: Form:. Outer shell containing powder,granular,or solid materials. Color: According to product specification Odor: Odorless Odor threshold: Not determined. pH-value: Not applicable. Melting point/Melting range: Not determined. Boiling point/Boiling range: Not determined. Flash,point: Not applicable. Flammability(solid,gaseous): Fire or projection hazard. Auto-igriition_temperature: Not determined. Decomposition temperature: Not determined. Danger of explosion: Heating may cause an explosion. Explosion limits Lower. Not determined. Upper: Not determined. Vapor pressure: Not applicable. Density: Not determined. Relative density: Not determined. Vapor density: Not applicable. Evaporation rate: Not applicable. (ConVd.on page 6, i Page:6/10 Safety Data Sheet. acc.to OSHA HCS(29 CFR-1910.1200) Printing date:01/06/2017 Revision:01/06/2017 Trade name:Fireworks,Display (Conft of page 5) Solubility in/Miscibility with Water: Insoluble. Partition coefficient'(n-octanol/water):Not determined. Viscosity Dynamic: Not applicable. Kinematic: Not applicable. Other information No relevant information available. Reactivity: No relevant information available. Chemical stability: Thermal.decoinposition/conditions to be avoided:Risk of explosion if heated under confinement. Possibility of hazardous reactions Explosive;fire,blast or projection hazard. Toxic fumes may be released if heated above the decomposition point. Reacts with strong acids and alkali. Conditions to avoid Excessive heat. Sources of ignition:sparks,open flame,incompatible.materials Incompatible materials Oxidizers,strong bases,strong acids Hazardous decomposition products Carbon monoxide and carbon dioxide Nitrogen oxides Sulfur oxides(SOx) ME 13 Information on toxicological effects Acute toxicity: LD/LC60 values that are relevant for classification:None. Primary Irritant effect: On the skin: Not a skin irritant In unused form.Vapors/particles from used product are possibly irritating to skin. On the eye: Not an eye irritant in unused form.Vapors/particles from used product are possibly irritating to eyes. Sensitization:Based on available data,the classification criteria are not met. Carcinogenic categories IARC(International Agency for Research on Cancer): None of the ingredients are listed. (Conrd.on page 7) Page:7/10 Safety Data Sheet acc.to OSHA HCS(29 CFR 1910.1200) Printing date:01/06/2017 Revision:01/06/2017 Trade namm reworks,Display (Contd.of page 6) NTP(National Toxicology Program): None-of the ingredients are listed. OSHA-Ca(Occupational Safety&Health Administration): None of the ingredients are listed. Probable route(s)of exposure: Skin contact. Eye contact. Inhalation. Acute effects(acute toxicity,irritation and corrosivity): Danger of blast or crush-type injuries. Risk of thermal burns. Repeated dose toxicity:From product as supplied:None. CMR effects(carclnogenity,mutagenicity and toxicity for reproduction) Germ cell mutagenicity:Based on available data,the classification criteria are not met. Carcinogenicity:Based on available data,the classification criteria are not met. Reproductive toxicity:Based on available data,the classification criteria are not met. STOT-single exposure:Based on available data,the classification criteria are not met. STOT-repeated exposure:Based on available data,the classification criteria are not met. Aspiration hazard:Based on available data,the classification criteria are not met. Toxicity Aquatic toxicity No relevant information available. Persistence and degradability No relevant information available. Bloaccumulative potential:May be accumulated in organism Mobility in soil: No relevant information available. Other adverse effects No relevant information available. Waste treatment methods Recommendation, Must not be disposed of together with household garbage.Do not allow product to reach sewage system. Incinerate in accordance with local,state and federal regulations. The user of this material has the responsibility to dispose of unused material, residues and containers in compliance with all relevant local, state and federal laws'and.regulations regarding treatment, storage and disposal for hazardous and nonhazardous wastes. Residual materials should be treated as hazardous. (Confd.on page 8) Page:8/10 Safety Data Sheet acc.to.OSHA HCS.(29 CFR 1910.1200) Printing date:01/08/2017 Revision:01/06/2017 Trade name:Fireworks,Display (Conrd.of page 7) Uncieaned packagings Recommendation:Disposal must be made according to official regulations. a UN-Number DOT,ADR,IMDG UN0335 IATA FORBIDDEN UN proper shipping name DOT,ADR,IMDG Fireworks IATA FORBIDDEN Transport hazard class(es) DOT. Class 1.3 Label 1.3G ----------------------------------------------------------------------------------- ADR Class 1.3 Label 1.3G --------------------=------------- ------------------------------------------------- IMDG Class 1.1 •Label 1.3G -------------------------------------- --------------------------------------------- IATA Class FORBIDDEN Packing group' DOT II Environmental hazards Marine pollutant: No Special precautions for user Not applicable. (Conrd.on page 9) Page:9/10 Safety, Data Sheet acc.to OSHA HCS.(29 CFR 1910.1200) Printing date:01/06/2017 Revision:01/06/2017 Trade name:Fireworks,Display (Contd.of page 8) EMS Number: F-S,B-X Transport in bulk according to Annex'll of MARPOL73/78.and the IBC Code Not applicable. Safety, health. and environmental regulations/legislation specific for the.substance or mixture United States.(USA) SARA. Section 302(extremely hazardous substances): None of the ingredients are listed. -.Section 304(emergency release notification): None of the ingredients'are listed. •Section 355(extremely.hazardous.substances): None of the Ingredients are listed. Section 313(Specific toxic chemical listings): Contact manufacturer. TSCA(Toxic Substances Control Act) All ingredients:are listed. Proposition 65(California) Chemicals known to cause cancer:, Contact manufacturer. Chemicals known to cause reproductive toxicity for females: - Contact manufacturer. Chemicals known to cause reproductive toxicity for males: Contact manufacturer. Chemicals known to cause developmental toxicity: Contact manufacturer. Carcinogenic categories EPA(Environmental Protection Agency): None of the ingredients are listed. IARC(International Agency for Research on Cancer): Contact manufacturer. (Contd.on page 10) Page:10/10 Safety Data Sheet - acc.to OSHA HCS,(28 CFR 1910.1200) Printing date:01/06/2017 Revision:01/06/20.17 Trade name:Fireworks,Display (Conrd.of page 9) •.NIOSH-Ca(National Institute for Occupational Safety and Health): Contact manufacturer. This information is based on our present knowledge. However,this shall not constitute a guarantee for any specific product features and shall not establish a legally valid contractual relationship. . Date of preparation/last revision 01/06/2017/- Abbreviations and acronyms: ADR:European Agreement concerning the International Carriage of Dangerous Goods by Road IMDG:,International Maritime Code for Dangerous Goods DOT:US Department of Transportation IATA International Air Transport Association CAS:Chemical Abstracts Service(division of the American Chemical Society) LC50:Lethal concentration,50 percent LD50:Lethal dose,50 percent NIOSH:National Institute for Occupational Safety OSHA:Occupational Safety&Health TLV:Threshold Limit Value PEL•Permissible Exposure Limit REL:Recommended Exposure Limit LDLo:Lowest Lethal Dose Observed_ Expl.1.3:Explosives—Division 1.3 Sources Website,European Chemicals Agency(echa.europa.eu) Website, US EPA Substance Registry Services (ofmpub.epa.gov/sor internet/registry/substreg/home/ overview/home.do) Website,Chemical Abstracts Registry,American Chemical Society(www.cas.org) Patty's Industrial Hygiene,6th ed„Rose,Vernon;ed. ISBN:978-0=470-07488-6 Casarett and Doull's Toxicology:The Basic Science of Poisons,8th Ed., Klaasen,Curtis D., ed., ISBN: 978-0-07-176923-5. Safety Data Sheets, Individual Manufacturers SDS Prepared by: ChemTel Inc. 1305 North Florida Avenue Tampa,Florida USA 33602-2902 Toll Free North America 1-888-255-3924 Intl.+01 813-248-0573. Website:www.cherr telinc..com �...Le...�.J`1-♦ tj.xr ] �t 7.4'�••*•1•w1'..i-J.:�ef�i�}.��rf ��wN a`Ll���'Y=4.,iF..`•+F.iJ���M�,. iY- - � M _a Page:3/10 Safety Data Sheet acc,to OSHA HCS(29 CFR 1910.1200) Printing date:01/06/2017 Revision:01/06/2017 Trade name:Fireworks,Display (Contd.of page 2) Most important symptoms and effects,both acute and delayed: Blast injury if mishandled: Thermal burns,if mishandled. Danger:Danger of blast or crush-type injuries. Indication of any immediate medical attention and special treatment needed: Product may produce physical injury if mishandled. Treatment of these injuries should be based on the clinical presentation., _'f. hi -h,.FY TY.°=YCi':e ,u;J?r*°�, },>c:t,•,7fei.�'t tu� ?'.f::"ui._ iii�`'n::r=.'•: ��7.��i:':3P(v.}jiak'' ":sd;a :x�r.`u'_'`"nar€ n t t � �:;rr` ,t33 yet. r Yti;�. q '-•.tr?a':t•.'`.;t.t,r,:F�..; . ...r .L'[,R'f r'Yl I � I Sine (k:J::�.�tl•re:.re.`.rf:;;'y..P,.'t�S•Z- t�'[^.s/Y J}Y+r ;�_�' .[. t, .�f�.�fi' �:;..M.v�.�:M�^�i�, ::4.r,.s..,.;s...-a,,.5,w:. o.�J.r.'} ..a>ir, n''*`��"%'F.iutF.Y.+.,.i. 05.._t_ -.. ..7`kr?°a%s:..r.s:4'.•:;i,':tj7riii<;:5.":.},;_...f,,•-:}e;',i..,s:,-.ili:.r. ,t�,dd.:'�.1.'.:.':,, F;.r,'�.... Extinguishing media Suitable extinguishing agents: DO NOT fight fire when fire reaches explosives. Flood area with water. If no water is available,.carbon dioxide, dry chemical or earth may be used. If the fire reaches the cargo,withdraw and let fire bum. For safety reasons unsuitable extinguishing agents: None. Special hazards arising from the substance or mixture Explosive;fire,blast or"projection hazard. During heating or in case of fire poisonous gases are produced. Advice for firefighters Protective equipment: Wear self-contained respiratory protective device. Wear fully protective suit. Additional information: Eliminate all ignition sources if safe to do so. In case of firer Evacuate area. Fight fire remotely due to the risk of explosion. Cool endangered receptacles with water spray. Flammability Classification: (defined by 29 CFR 1910.1200) Explosive.Can explode under fire conditions. Individual devices will randomly explode. Mass explosion of multiple devices is possible under certain conditions. Burning material may produce toxic and irritating vapors. In unusual cases, shrapnel may be thrown from exploding devices under containment.See 2012 Emergency response Guidebook for further information. r.,...3._ ,�._ �,,,1":,.:n.v ai�svnYC'#'%at•.--ea'27.t.'rr-✓`:�?a'> ;�"F::�:u;fatorS:a:,t.'x-v.:;fr;. >:5.1':.q�: r-i,.�,.,H_a riio:.a�,i..g5;; ,}. f'S. .r e` C :J:.•✓re e,.�;vh ;1.,1r-.t.,,: " t':i�r ,�Y�+:°,'"�:Y.i. _ ;�{;_, s...a'}*, }:a_ ""d .�. :.a.-Y:.=r: .a5_aaA:� - <ar.,.s�..i,. �'�s:.�- :�..5rc.:t9_. .t_.i�'<..h.'b..n i:$ii'�:•.1::: ..d. a�J>eln�>r :,F,..:::K.,ri Personal precautions, protective equipment and emergency procedures Wear protective equipment. Keep unprotected persons away. Remove persons from danger area. Ensure adequate ventilation. Isolate area and prevent access. Environmental precautions Do not allow undiluted product or large quantities of it to reach ground water, water course or sewage system. Methods and material for containment and cleaning up Pick up mechanically. (Confd.on page 4) Page: 1/10 Safety Da1a Sheef acc.'to OSHA HCS.(29 CFR 1910.1200) Printing date:01/0612017 Revision:01/06/2017 f Product Identifier. Fireworks,Divlsiori 1.3 Explosive Trade name: Fireworks,Display Product code: Fireworks,1.3G UN0336 Recommended use,and restriction on use Recommended use:.Explosive product for professional use for entertainment and technical purposes Restrictions on use:Contact manufacturer/supplier Details of the supplier of the Safety Data Sheet Manufacturer/Supplier: Pyrotecnico Fireworks Inc. 299 Wilson Rd - New Pestle,PA 16101 724-652-9555 Emergency telephone number: ChemTel Inc. (800)255-3924,+1 (813)248-0585 •Classification of the substance or mixture Eipl.1.3 H2O3 Explosive;fire,blast or projection hazard. ------------------------------------------------------------------------------------- Label elements OHS label elements The product is classified and labeled according to the!Globally Harmonized System(GHS). Hazard pictograms: GHS01 Signal word:Danger Hazard statements: H2O3 Explosive;fire,blast or projection hazard. Precautionary statements: P210 Keep away from heat/sparks/open flames/hot surfaces. No smoking. P250 Do not subject to grinding/shock/friction. P280. Wear protective gloves/protective clothing/eye protectionlface protection. P373 . DO NOT fight fire-when fire reaches explosives. P370+133801n case of fire:Evacuate area. P372 Explosion risk In case of fire. (Coned.on page 2) Page:2/10 Safety Data Sheet acc.to OSHA HCS(29 CFR 1910.1200) Printing date:01/06/2017 Revision:01/06/2017 Trade name:Fireworks,Display (Coned.of page 1) P401 Store in accordance with local/regional/national/intemaflonal regulations. P501 Dispose of contents/container in accordance with local/regional/national/international regulations. ------ --------------------------------------------------------------------- Other hazards There are no other hazards not otherwise classified that have been identified. Explosive Product Notice PREVENTION OF.ACCIDENTS IN THE USE OF EXPLOSIVES-The prevention of accidents in the use of explosives is a result of careful planning and observance of the best known practices.The explosives user must remember that he is dealing with a powerful force and that various devices and methods have. been developed to assist him in directing this force. He should realize that this force,if misdirected,may either Will or injure both him and his fellow workers. WARNING-All explosives are dangerous and must be carefully handled and.used following approved safety procedures either by or under the direction of competent,experienced persons in accordance with all applicable federal, state, and local.laws, regulations, or ordinances..If you have-any questions or doubts as to how to use any explosive product,DO NOT USE IT before consulting with your supervisor, or the manufacturer,If you do not have a supervisor. If your supervisor has any questions or doubts, he should consult the manufacturer before use. Chemical characterization:Mixtures Components: Components for product possesing only physical hazards do not require reporting.These components are considered proprietary. Description of first aid measures General information: Information.is only applicable to product contents, and not to product as normally supplied. This information is applicable to damaged, leaking, or'spilled product as contact with contents is possible under these conditions. After inhalation:Supply fresh air;consult doctor in case of complaints._ After skin contact: Wash with.soap and water. In case of minor burns,flush with cool water. If skin irritation is experienced,consult a doctor. After eye contact: Remove contact lenses if worn. Rinse opened eye for several minutes under running water.If symptoms persist,consult a doctor. •After swallowing: . Unlikely route of exposure. Do not Induce vomiting;immediately call for medical help. (Coned.on page 3) WC 00 0313 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce'our right against the:person or organization named in the Schedule.-(This agreement applies only to the,extent that you perform work under a written contract that requires you to obtain this agreement from us.). This:agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule 1. ( ) Specific.Waiver Person or.Organization Job Description 2. (x) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. Endorsement E fecti4e 06/07/15 Policy No.73-872096-04-02 Endorsement No.61 Insured Pyrotecnico Insurance Company Countersigned By, Continental Indemnity Company IV (Ed.4-84) ©1983 National Council on Compensation Insurance. ^---n n --- / , ® DATE(MWDD/YYYY) ACIORV CERTIFICATE OF LIABILITY INSURANCE 1 1/0712 01 8 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 vertlficate 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 Ileu of such endorsements. PRODUCER CONTAUT NAME: Melanie Allen MCGRIFF,SEIBELS&WILLIAMS,INC. PHONE 800.476=2211 AX P.O.Box 10285 A/C No Birmingham,AL 35202 &MAIL mall rlH:com ADDRESS �c9 INSURERS AFFORDING COVERAGE NAIC INSURER A.ContlnentalIndemnl Company 28258 INSURED INSURER B: Pyrotecnico Fireworks,-Inc. P.O:Box 149 INSURER C: New Castle,PA 16103 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:T5S6F4JY REVISION NUMBER: THIS IS TO CERTIFY THATTHE 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.LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1LTR TYPE OF INSURANCE POLICY NUMBER POLICY EYFF' POLICY EXP UMW COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE. $ETORERTED - CLAIMS-MADE DOCCUR PREMISES a occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $- POLICY❑JPERO- El LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMB Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PRO Y DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LLA O EACH OCCURRENCE $ EXCESS LIAB HCLCACIUMBS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION 738720960414 08/07/2018 06/07/2019 X PER OTH- AND EMPLOYERS'.LUU911ITY YIN (Blanket Waiver of Subrogation Incld) TAT ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ 1.000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000_ tl yS describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE.POLICY LIMIT $ $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,AddlUonai Remarks Schedule,may be attached If more space Is required) Fireworks Display Date:Dec.2,2018 Location:Florida Hospital Zephyrhills CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Florida Hospital Zephyrhills PO BOX 149 AUTHORIZED REPRESENTATIVE 7050 Gall Blvd. Zephyrhills,FL 33541 Page 1 of ©1988-2016 ACORD CORPORATION. All rights reserved. A/`ADn OC 19Ai R/A1% Tho Art%Dn Henn—A Inns era—11.0...A—11—n1 APA10111 Headquarters U.S.Locations P.O.Box 149 IAN Atlanta,GA 877,924 New Castle,PA 16103 724.652.128.8 Las Vegas,NV 800.95t MAIL P Into®pyrotecnlco.com Montgomery,AL 800.25! ,r 724.652.9555 WIN L New Orleans,LA 800.783 O I 724. VITAL* ►A M I L r r-LIt*w0 A x s.1 s e s 800.854.4705 www.pyrotecnlco.com Tampa,FL 888.35; Nov.7,2018 City of Zephyrhills Hello: This is a letter of authorization for Jane Freeman of Florida Hospital Zephyrhilis to pickup the permit for the show on December 2,2018. If you require any additional Information please let me know.. Thank you for your assistance! Sincerely, Samantha Goldston Sales Assistants Pyrotecnico— Florida :954.651.4000 httn-//miww.pyrotecnico.com I htto-://www.ovrotecnkofxxom PYROTECN[CO-& ACC .80 04 Pub13•a.,Relaeions 81�-7BO��if58 p.8 SITE DMO=ATION FOR ME-W OU5 MPLAY Ch'p01mtoo.Bponsoring MO.F1flxi da•49 t °Z I a 7050 'Gall 8 _Zep�h�:11s-, _vL_�54,1 ane'�reeman pn.i!b83.6192 I7ats tuad.tltrje ofprc duation:, December 2,2018 LaCetion-o�p�duotion: R7:orida Eo&a�t$1, Zenhvrliills Nwmcor.=&opm or:,Charles Flanagan °fol e"ts' Will update when we have them scheduled Confltmdo])of Licease hold by operetor: See attached EVl,�O:1C9'O�p0rrnit!!C`S i40: �'!;_ :Ses gt@aohed Nu�61?eza�d�,y�e�'•of��ratechn�dvvices and.igattrfalato°bo WDS-forpyfotWWcswed: ogle att he'd -19iiagtd$".on olte(pressarWd water.—.at hm 2�_.. 2 Dfdg:�s df'�wis�re pxodaotion to be cq�adrwtal{to lncindegoiutaf�cLsge fall.vnt.rad�, ..odmidioacelo.¢ati");Aaa attached l�orin8�afeguerds iYi.p7Qca; i atrGuaC 3e5tors tto iri4PD f�1$$T►3A e. pawor 7'or SrIng sources be.msttiated to ttatiories or isolattd pnwef•sOppk�,s + .fa��rstelnae`ehswreeosalustaooi�etr[a!ffila$(�•atepiaterlacl�). • odt W boloft•vmttendod • ..gmuic�n�lStotdbutoan2S`ofttiie#�i3ng/h�dl3ng:area oppsdpaiato dksance from sufllonW(=t IM thm toloe*Oot:t.ndka) aIlaocasspo�ts:are•bl�okodoffiotb1;rinpJhe�iU.irigarea • i 1 84780-0020 City of Zephyrhll1s:Peimlt Application Fox-818.780-0021 EUllmnppepaMlenR , i Data Racetvod Phonr.Contact for Pormlllln Owner's kame onl a asp a ep yr _1 s 7 Owner Phone Number Owners Address a V .; ep yr 1 S; Owner Phone.Number I t FeaStmpto.TiUehotdorNsme Ownerphonrkliiilbar Fos Simple TiUeholderAddrdso J06ADDRES3 a v ., @p yr 1 S, LOTH SUBONIS(ON ��� -PARCEL IUD (ODTARM FROM PROPERTY TAX NOTICE) WORKPROPOSEO NEWCONSTR ADDIALT M SIGN M MOVE 'M DEMOLISH e INSTALL e REPAIR PROPOSED USE SFR COMM Q OTHER TYPE OF CONSTRUC110N Q BLOCK FRAME Q STEEL 0 OTHER] DESCRIPTION OF WORK )r@WQr s display for Hollqay I re8 I J Dg December 2,2018 i BUILDING SIZE SQ FOOTAGE HEIGHT VALUATION 0FTOTAL.CONSTRUCTION BUILDING ELECTRICAL (S AMP SERVICE Q PROGRESS ENERGY W.F E.C. Q PLUM91Hb .�..� . [] MECHANICAL S VALUATION OF:MECHANICALINSTALIATION O i*S Q ROOFING M SPECALTY:[,-1 OTHER FINISHED FLOOR ELEVATIONS �� FLOOD ZONE AREA AYES MNd BUILDER COMPANY SIGNATURE ` REOISTeREO YIN FEeCURR(E�W /N Address License ( ELECTRICIAN COMPANY SIGNATURE REOIETEhED I YIN FEECURRIMr /N Address r Ucens4lF �� PLUMBER I COMPANY SIGNATURE REOIeTERED I YIN FEECURRErrr I YIN. Address License! MECHANICAL COMPANY SiQNATUit REGISTERED YIN PeEMIRWIT�1?t — i Address. UoensoY � i OTHER. COMPANY Pyrotecnico Fireworks ! SIGNATURE PAGISTERID I YIN FUCURlrEN'r�Y''IN Address ' New Castirg, PA 161 ucanso''# 1 RESIDENTIAL Allach(2)Plot Plane,(Z).sele of SWlding Plans;(1)set of Enew Forms;R-O-W Peril fornewconsWction, Minimum ton(10)wailing days rllo'r submittal data.Rogt*od omsita,Construction Pigs,Stonmvater plans w/801 Fence Instolled, t Sonl1my Facilities a 1 ddrfipstat;SAO,Wark Pemdt for ubdhArionsAorgo projects COMMERCIAL Attach(3)eormpiete sets atBulidiTgPlana tuaatira Solely Pagol(1)set of Energy Forms.R.O.WPemgt for now eonswefilon. Miroirriurdtett(10)wtiftg'daysli(tarsub Rai dale—AttitAredonsite.ConsWcOan Plans,StomlvralarPlansw/$Ot Fence tnstaaod, SonitinyFgo0l0od a,14tiprpster.Site Work Porm11 for eli'gow pro(ecls All cammefdal roquiremenls muslmeal cwmp0ance SIGN PERMIT Attach(2)ails of F.rip(naered Plans: •"'PROOFIft SURVEY requhaii for elf NEW construction. i Directions: F01 out applkallop completoly. Owner a Contradoir sign back of sppBcagon,nalarized . It over S2500,atvoucoofCommoncomentIsrequttod.(A/Cupgrade$over$6000) Agent(tor tho contractor)or Power of Altomey(for the owmar)would be someone with notarized loiter from owner authorizing soma I OVEATHECOU_NTERPERMiTTiNG (Front ofAppOcaOanOnly) Retools Sewers SeMce,Upgrades AR: Fences(Plot/Surnay/Footags) DHvoways•Nol.over Co.01of if on pub0o.roadvoys.rleada ROW i F 1 1 i i 1 NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to'deed'restrictions" ! which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any } applicable deed restrictions. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or contractors to undertake work,they may be required to be licensed in accordance with state and local regulations. If the contractor Is not licensed as required by law,both the owner and contractor may be cited for a misdemeanor violation under stale lavvs If the,owner or Intended contractor.are uncertain as to what licensing requirements may apply for the intended worki fhey:.are advised to cant act.the Pitsco County'Building Inspection Division--Licensing Section at 727-847- 8000, Fuftheimorei If.the.owrier has ftifed a coniiactof or,contractors, he Is advised to.have the contracior(s),sign portions of the'contiactor*Block"of tills application for which they will be,responsl5le. If you,as the owner,sign as the contractor,that maytiaan indication tliaf fie js not-propefiylkcensed and Is not e.nliliedao permitting privileges In Pasco County, TRANSPORTATION IMPACT/UTILITIES.IMPACT AND RESOURCE RECOVERY FEES:.The undersigned understands lhat.T'ansporta"on Impact Fees and.Receurse Rae ery Faes may apply to lha.conslrucIlan of new buildings,change.of us.a nexisting bu(idings,or expari tan of exjsting buildings,as spacinad In Pasco.County Ordinance number 89.07 and t 90 07,es amended. The understgned also understands,that such foes,as may be.due,vrilLfse Identified at the time of permitting, It Is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to receiving a°cart ificato of occupancy'or final power release, If the.project doas.not Involve a,certificate of occupancy or final power release;the fees.must.be.paid prior to;permlt Issuance. Furthermore,_lf Pasco.County Water/Sewer impact tees are due,they must be paid pdor.to permfl issuance In accordance with appiicabie Pasco County ordinances, CONSTRUCTION LIEN LAW(Chapter 713,Florida Statutos,as amended):If valuation of work Is.$0,60.0,00 or more,I certify that.1,the applicant, have been provided willi a copy of the "Florlda Construction.Lion Law—Homeowner's. Protection Guide prepared by ths.Fforlda:Deparlmant-of Agriculture and Consumer Affairs. If Ihe.applicant Is someone other then lho.'owner','Lcertify thatl have obtained a copy of the above descrlbed document and promise In good faith to deliver It to the'owner"prior to'commencement, CONTRACTOR`SIOWNERsS AFFIDAVIT: I certify that all the information In this application is accurate and that ail work will be done in compliance with all applicable laws regulating construction,zoning and land development, Application Is hereby made to obtain a permit to do work and Installation as Indicated. I certify that no work or Installation has commenced prior to Issuance of a permit and that all work will be performed to meet standards of all laws regulating construction,County and City codes,zoning regulations,and land development regulations In the jurisdiction, t also certify that I understand that tiie regulations of other govemrnent agencies may apply to the Intended work,and that it is my responsibility to Identify what actions.I must take to be In compliance. Such agencies Include but are not limited to: Department of Environmental Protection-Cypreas Bsyheads,Wetland Areas and Environmentally Sensitive Lands,WatedWastewater Tfealm6nt. Southwest Florida Water Management District-Wells, Cypress Bayheads, Weiland Areas, Alledng Watercourses. Army Corps of Engineers-Seawalls,Docks,Navjgakia Waterways, Department of Health & Rehabllitalive Services/Environmental Health Unit-Wells, Wastewater Treatment, Septic Tanks. US,Envirdnmental Protectlorl Agency-Asbestos abatement: Fdd6r.ai Aviation AuthodiyAunways, I understand that_the;fpllowing Yeslrlcllons:apply to,ihe usbpf fill: Use of:fillls not allow-ed.ln:FloodZon,p`V'unless.expressly permitted. If the fill material is to.,be used in Flood Zone.°A',It is.understood that a drainage plan addressing a "compensating volume"will.,00 submitted at time of permitting which Is prepared by a professional engineer licensed by Stale of Florida. if. nil material Is to be used in Flood Zone'A".In connection with a permitted building using stem wait constructions.I certify that fill waif be used only to fill the.areawithin the stem wall. If fill material Is to be used In any area. I certify that use of such iill will not adversely affect adjacent properties, If use of rill Is found to adversely affect adjacent properties,the owner may be cited for violating the conditions of the building permit Issued under the attached permit application,for tots less than one(1) acre which are:elevated by 011,an engineered drainage plan is,required. If I am the AGENT.FOR THE OWNER,I promise In good faith to Inform the owner of the permitting conditions set forth In this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work, plumbing,signs,wells,pools,air conditioning,gas,or other Installations not specifically Included In the application, A permit Issued shall be construed to be•a license to proceed with file work and not as alllliodly to violate,cancel,after,or set aside any provisions of the-technical codes,nor shall Issuance of a permit prevent(lie Building Official from thereafter requiring a.correction of errors In plans,construction or violations of any°codes,:Every permit issued shelf become Invalid unless(he work authorized by such permit Is commenced within six months of permit issuance;or if work authorized-by Ilia permit is suspended or abandoned for a perkod'of six(6)months after the.Ilme lhe.work Is commenced; An extension may be requested,In writing,from the Building Official fora period not to exceed ninety(90)days and will demonstrate justifiable cause for the extension. if work ceases for ninety(90)consecutive days,Ilia job Is considered abandoned, WARNING TO.OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR:PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,CO,RSU.LT WITH YOUR LENDEit OR AN ATTOl2tEY BEFORE t?ECORDiNG YOUR NOTICE OF COMMENCEMENT FLORIDAJURAT(F.S.117.03) OWNER OR'AGENT CONTRACTOR — Subscribed end s%u6(n to(or affirmed)before me this Sob abed r swum tt{epr (fir d)b l u rre th Ml rGr LCs sr wno Isfaro Pat onalyknown to rho or hasfiavo produced J o Word personal koavm to me or has/have produced asIdonillicaVon, �yyaassiidenlificalion. Notary Public ��C:(.IX.,K.C. /�r/� Notary Public Commission No. Commission No. s't T t I Name of Nolery typed,pdoled or stamped Name of Notary typed,printed or stomped i COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL Marsha Lee LeFebvre, Notary Public Union Twp., Lawrence County My Cornmission Expires May 1, 2020 MEMBER, PENNSYLVANIA ASSOCIATION OF NOTARIES • P 4 FLORIDA j � 1+`�Ill 5��� fir' [ SPIT dvent ealt SENT VIA EMAIL Subject:Letter of Permission November 26,2018 To: Fire Marshall,City of Zephyrhills RE. PYROTECHNICO Dear Zephyrhills Fire Marshal, Florida Hospital Zephyrhills gives Pyrotechnico and a representative of said company permission to shoot off fireworks on Sunday, December 2, 2018,at our property located at 7050 Gall Blvd.,Zephyrhills, at the end of our annual Christmas Tree Lighting Program that evening.Specifically,the fireworks will go off in a secured parking lot adjacent to our Simpson Breast Health Center. Sincerely, oul Amanda Maggard President and CEO Florida Hospital Zephyrhills