HomeMy WebLinkAbout19-21361 _ CITY OF ZEPHYRHILLS
r ' 5335-8TH STREET
(813)780-0020 213
FIRE WORKS PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 21361 Address: 38116 5TH AVE
Permit Type: FIRE WORKS ZEPHYRHILLS, FL.
Class of Work: FIRE WORKS Township: Range: Book:
Proposed Use: COMMERCIAL Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est.Value: Parcel Number: 1 1-26-21-001 0-1 61 00-0000
Improv. Cost: \\,, OWNER INFORMATION
Date Issued: 6/13/2019 Name: CITY OF ZEPHYRHILLS
Total Fees: 535.00 c ear Address: 38116 5TH AVE
Amount Paid: 535.00 ZEPHYRHILLS, FL. 33542
Date Paid: 6/13/2019 Phone:
Work Desc: SPECIAL EVENT FIREWORKS JUNE 22, 2019- FEE WAIVED
CONTRACTORS APPLICATION FEES
PATRIOTIC FIREWORKS FIRE PERMIT FEES 500.00 SPECIAL EVENT 5.00
CONTRACTOR CERTIFICATE 30.00
2
Ins ections Re uired
FIRE WORKSSITE PECTI 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 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.
"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.
&---
CONTRACTORSIGNArURE PERMIT OFFIC
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOURS NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT- 813-780-0041
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Jacqueline Boges
From: Steve Spina
Sent: Wednesday,June 12, 2019 4:16 PM
To: Andrew Cecere
Cc: Todd Vandeberg;Jacqueline Boges
Subject: Re: Patriotic Fireworks License
Jackie,
As the city is the sponsor of the fireworks display for Summerfest,please waive the permit fee.
Thanks,
Steve
Sent from my iPhone
Steven F. Spina, PhD
813 714 6292
On Jun 12,2019, at 4:11 PM,Andrew Cecere<drew@simplveventsfl.com>wrote:
EXTERNAL EMAIL
Hello,
Can you send something to Jackie in permitting that acknowledges the waiver of the$500
fireworks fee,please.
---------- Original Message----------
From: Jacqueline Boges<jboges@,ci.ze h�hills�.flus>
To: Andrew Cecere<drew@simplyeventsfl.com>
Date: June 12, 2019 at 3:24 PM
Subject: RE: Patriotic Fireworks License
Thank you received.
Again need that in writing from City manager.
From:Andrew Cecere<drew@simplyeventsfl.com>
Sent:Wednesday,June 12,2019 1:14 PM
To:Jacqueline Boges<iboges@ci.zephvrhills.fl.us>
Subject: RE: Patriotic Fireworks License
Temporary Sales Checklist t
City of�,phyrhifls
5335 8 h Street
Zephyrhills,Fl.33542
Phone:813-780-0020/Fax:813-780-0021
REQUIREMENTS
ADetailed Plot Plan showing setup of location. Refer to Ord 1038-09, Sec 5
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 prior 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.
FIREWORK REQUIREMENTS—(In addition to the above)
Proof of State License.
► Proof of Liability insurance.
List of items to be sold at site.
-4 Copy of Drivers License and Social Security Number 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
—V1 $ 5.00—Temporary Sales Fee for 1"two days
.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(40.00/BD, 15.00*/FD)—(*$15.00 waived for Fireworks)
40.00—Electrical Fee(if applicable)
Property Owner: '7-P
Applicant:
Phone Contact: —7 *7
Address Site:
Date(s)Of
Ordinance No. 1038-09(for additional requirements)
Rows HALLowax
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DON SURENKAMIP
Call.(727)243.4718
10919M.U.S.Highwaylil . 1026 U.S.Highwayl9 FORM'
Port Riche V,FL 34668 Holliday,FL 34681
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City of Zephyrhills
SPECIAL EVENT PERMIT Planning Department ., `•'
5335 8th Street,Zephyrhills,FL33542 . .. .
www.ci:zephyrhills.fl.us .0
813-780-0000
LTERIVIS.&'CONDITIONS'.'
._1. .Applications must be filed with the City of Zephyrhills Planning Department no less than 60 days and no more than
12`months prior td an event._P.ermits for recurring events-may be applied for and approved annually.
z. The grant of a permit shall constitute the issuance of.a limited license, and shall not create a property right,or
entitle the,applicant,to violate any general city rules,or."r"egulatioris applicable:to the use of public property adopted'
by.ordlnance: -
3. The.applicant shali'be responsible for the•payment of fees,deposits;or reimbursement of costs where a,request is.
made to,use City services,equipment,or'property for a special event:In addition,the applicant-shall be responsible
•for ail costs incurred should inspection services,be required in order ensure compliance with City-ordinances.Any
costs of fepairs to.or restoration of public faciiitid caused bythe.dvent shall_be charged'to the applicant.-
4, It is the.applicant's'-responsibility to-contact the"City of Zephyrhills Police Department irnmediateiy upon the
occurrence'of any crii.ninal activityor-medical incidents where.fre rescue is'called or treatment is given.In addition,;
the,applicant.shail,docuinent alf incidents in the Post-_Event-Report'to be provided.to the City of Zephyrhills.a.j
e minimum of 1 week after the event. I
5:. All forrris,cohtainedin:this packet are requited-ed-tei be'cornpleted.Please referto the checklist contained in this packet
for'additional documents required1or submittal.Incomplete applications Will not be accepted.
*Event Contact Person *Phone *Email
*Organization Name *Date Incorporated *Employer ID#i(EI_N) k ACTIVE
y�4� }! ✓�.'► �,y�,c • l .�}a)� 3 7 �d g3rkO ❑INACTIVE
*Event Name *Event Date *Event Times Entry Fee
�JM Mer Fes e hpi-1 ' 13cpr► �J
Co-Sponsor *Type of Event
[]Run/Walk ❑ Parade Festival ❑Other
*Has this event taken place In Zephyrhills before?
XYes—AnnualEvent ❑Yes—Once ❑ No
*Requested City Facility—Mark All that Apply($$symbol indicates associated fees).
IX Zephyr Park ❑Downtown 5th Ave. ❑Krusen Park ❑Airport Venue$$
❑Alice Hall @ Zephyr Park$$ ❑Clock Plaza on 5ih Ave. ❑Skate Park ❑Veteran's Memorial Park
❑Wickstrom Stage @ Zephyr Park ❑Gunner Paw Park ❑Shepard Park
*Estimated Attendance Estimated Number of Vendors Number of Parade or Run/Walk Entries(if applicable)
City of Zephyrhills Special Event Permit Page 11' 2018
City of Zephyrhills ;
SPECIAL EVENT PERMIT Planning Department
5335 8th Street,Zephyrhills;FL 33542
www.ci.zephyrhil Is.fl.tis
813-180-0000
*City Street or Avenue Closure Request? *State Highway Closure(FDOT Larne Closure Permit Required)
❑Yes(indicate location below) CN�Nb C1 Yes(indicate location below) P(No
*Equipment to be brought on City property(mark all that apply) *Requested City equipment/utilities for event(mark all that apply)
Tents(smaller than 10'x 10') Oki Bathroom Facilities
11 Tents(larger than 10'x 10'—requires fire rating certificate) ❑Electricity(51h Avenue Median)
QS Vehicles - SezF-�� Electricity(Stage Areas)
0 Stage GXGarbage Cans
❑Start/Finish Line ❑Cones/Barricades
El Signs ❑Other(please list below)
(,Tables
kPorta lets
Bounce=House/Inflatabies(requires own COI)
Sound Equipment
❑People Barricades(City does not own or provide)
❑other(please list below)
*Brief Description of Event
14er �25fi`�x �'r, :^� tJ:44
Zook) �J5 r nQ5y 9 9 1Yirl n'A r+iic>'Kit. lCl��rv+- ap.^v"► $J ti t'1�
i/We agree to obtain and maintain the required liability insurance and secure all necessary local,state and federal permits and to comply
with all terms and conditions applicable to the conduct of special events,as set forth in ordinance No.943.06,as amended.
I/We certify that the information contained in this application is complete,true and accurate to the best of my/our knowledge.As applicant
for the event,fte agree to release and hold harmless the City of Zephyrhills from liability of any kind for any and all damages arising out
of any loss or injury resulting from the conduct of this event and for any and all losses or injury arising while conducting the event using
City of Zephyrhills facilities or property and for any and all losses or injury to persons attending this special event.
I/We certify that individuals will not be barred from participation in this event due to race,creed,color,national origin,sex,age or physical
impairment.
I/We fully understand,acknowledge and agree to all terms and conditions of this form and that failure to meet the terms and conditions
shall result in cancelation of the event.
Signature: Date: + 1ls
Print Name:
City of Zephyrhills Special Event Permit Page 12 2018
My of Zephyrhills, xy,
ALCOHOLIC BEVERAGE
Planning Department
5335 8t'Streeti Zephyrhills,Fl.33542
CONSUMPTION PERMIT ivvuw.ci.zeph-780-0000
813-78o-OOOt}
TERMS&:CO.NDITIONS
i. Applications forConsumption of Alcoholic Beverages in conjunction with Special Events must be approved by City
Council:Applications must be filed with the City Manager not less thari:2 tnonths price to-an event..
2. Events including thd,consumotion of alcohofic beverages must attach,proof of lia it' insurance in the,amount of'
$2,006,000{Two Million Dollars)"naming the City,of�ephyrhil€s as an additio "insured{certificate Holder).
3:' No a licant shall be,issued.more than,3.(th'ree)perinits`per year,and n" ermined events may exceed.fwo days_',
) ' �ini3tira ' n. -
"Required Supportiv aterials =
1. `Diagram/map {cling specific,'cleatly:idenfifiable;deli ted;and secure areas within the event venue where-
Beverage sales,an onsumption a'reto occur.
2., bocumentation:ofapp priate applications-for Stat : Icoholic Beverage licensing for the event.
*Event Name *Event Date(s) *Event.Time(s)
r ! 9.3drY1
*Please provide a general description of how t /,efohol will be incorporated into the proposed event.Attach extra sheets if
necessary.
*Provide a description of how securi and beverage law com iance will be provided,including hours of sale and consumption during the
event.Attach extra sheets if necess ry.
*Provide a description f the types(s)of beverages(s)and beverage containers to b used in conjunction with the event.Attach extra
sheets if necessary.
By signing Blow,the applicant fully understands,acknowledges and agrees to all terms and conditions X-t -nthis farm.failure to
meet the terms and conditions stated above shall result in a void of permit for alcoholic beverages.
*Event holder signature *Date
..CITY USE.ONLY
'sub ittal Dat6i A 0-roval D tel Si naturel
Alcoholic Beverage Consumption Permit , 2018
. ^ .
'
City of Zephyrmlls
U��UK�� ��� ��o��U��������� Planning Department
oU�~���nn��o�v~m_ REQUIREMENTS
���su�Street,Zephyr U|s,pL33542
'813'780-0000
Applicants are required to provide proof of insurance in the amount of One Million Dollars ($1,000,000) per
occurrence.For events With alcoholic beverage consumption,liability insurance coverage requirements increase to
Two Million Dollars($2,000,000)per occurrence.The City of Zephyrhills shall be named as an additional insured on
coverage for all events. Please note that itis also the applicant's responsibility mv ensure that all food/beverage
vendors and attraction vendors involved in the event provide valid proof ofinsurance meeting the minimum
requirements stated above,-.Proof of coverage shall be submitted to the city no less than one week priortotheevent
or the event runs the risk of cancellation.An example Certificate of General Liability Insurance form is provided in
this packet for informational purposes only.
'
\ 44� /
���y z�~*�Tz���^��— . here on known as the APPLICANT shall, its� sole cos and
«
expense,procure and maintain throughout the term bf this contract, Comprehensive General Liability insurance,
with the minimum policy amounts of$1,000,000 Combined Single Limits for passive events or,$2,000,000 Combined
Single Limits for events with alcoholic beverage consumption,orto the extent and|nsuchamoun¢sasrepuiredand
authorized by Florida law,and will provide endorsed certificates of Insurance generated and executed by a licensed
insurance broker, brokerage nrsimilar licensed insurance professional evidencing such coverage, and naming the
CITY OF ZEPHYRHILLS as 0 named,additional insured,as well as furnishing the CITY OF ZEPHYRHILLS with a certified
copy,nrcnpie�o[said insurance policies.Ce�|Ocatescf insurance and ce�ifiedcopies of these insurances policies
must ao�mpanythis signed contract.Said insurance coverages procured 6v the APPLICANT os required herein shall
be considered, and the APPLICANT agrees that said insurance coverages |t procures asrequired herein shall be
considered,as primary insurance over and above any other insurance,or self-insurance,available u,the CITY oF
Z£PHYRH|LLS, and that any other insurance, or se|Ansv^ance available to the c|Tv OF ZEPHvu*|uS shall be
considered secondary to,or in excess of,the insurance coverage(s)procured by the APPLICANT as required herein.
Nothing herein shall be construed toextend the CITY OFZEPMYDH|LUS' liability beyond that provided in section
768.Z8,Florida Statutes.
Applicant Signature Date
Printed Name
Representative Capacity of Person Signing
Insurance 2018
. ^
^
City of Zenhyrhills
INDEMU��K����K�U�� ����������U�~� Planning Department
NITY ����x�u—u—V'muK—n� U
533SOm Street,Zephyr i|b,FL33S42
Hold H@[m|eSS
813-780-0000
' here on known as the APPLICANT shall indemnify and hold
harm|esmthoC|7YOFZEPHYRH|ii3andaUoftheC|TY0FZ[PHYRH|L0'uf8oeo,6gent4anden?p|uyeeshomand
against all claims, liability, loss and enpeny� including reasonable costs,collection expenses,atto,neys'fees,and
court costs which may arise because of the negligence (wheth&active or passive), misconduct, or other fault, in
whole orinpart(whether joint,co.r1cu'rrent,or contributing),of the APPLICANT,its officers,agents or employees in
performance or non-performance of its obligations under the Agreement.The APPLICANT recognizes the broad
nature of this indemnification and hold harmless clause,as well as the provision of a'legal defense to the CITY OF
ZEPHvRH|LLS When necessary,arid voluntarily makes this covenant and expressly acknowledges the receipt of such
good and valuable consideration provided by the COY OF Z[PHYRH|LiS in suppdrt of this indemnification, legal
ddenseandho|dhann|escuntractua\ubVgatipnsinaccondanceviththe|amsoftheStatecfHohda.Thbc\ause.
shall survive the termination of this Agreement.Compliance with any insurance requirements required elsewhere
within this Agreement.shall not relieve the APPLICANT of its liability and obligation to defend, hold harmless and
indemnifytheC>TYOFZEPHYRH|LLSussetfurthinthisarti6euftheA8neement.
Nothing herein shall be-construed to extend the CITY OF ZEP14YRHILLS' liability beyond that provided in Section
z6o.a8,Florida Statutes.
Applicant Signature oa*a
Printed Name
Name,of Affiliated Entity
Rep,exentotive,Capacityof Person Signing