HomeMy WebLinkAbout19-22135 CITY OF ZEPHYRHILLS
5335-8TH STREET
(813)780-0020 22135
FIRE WORKS PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 22135 Address: 7242 GALL BLVD
Permit Type: FIRE WORKS ZEPHYRHILLS, FL.
Class of Work: FIRE WORKS Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 35-25-21-0010-08800-0000
Improv. Cost: OWNER INFORMATION
Date Issued: 12/16/2019 Name: PROVEST TOWNVIEW LLC & MISSION H
Total Fees: 540.00 Address: PO BOX 515
Amount Paid: 540.00 HUDSON, NY 12534-0515
Date Paid: 12/16/2019 Phone:
Work Desc: TEMPORARY SALE FIREWORK DECEMBER 26, 2019- JANUARY 1, 2020
CONTRACTORS APPLICATION FEES
PHANTOM FIREWORKS FIRE PERMIT FEES 500.00 TEMPORARY SALES 10.00
CONTRACTOR CERTIFICATE 30.00
C)ro
Ins ecti s Required
FIRE R ITE INSPECTION
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.
&-, a7
CON TOR SIGNATURE PERMIT OFFICgA
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOURS NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT- 813-780-0041
Temporary Sales Checklist
City of Zephyrhills
5335 816 Street
Zephyrhills,Fl.33542
Phone:813-780-0020/Fag:813-7804021
REQUIREMENTS
Detailed Plot Plan showing setup of location. Refer to Ordinance 1038-09,Sec 4
Notarized letter from property owner stating their approval. -re
A flame retardant certificate is required'IF a tent is involved.Inspection required once tent
/ is erected and prior to opening,for business. ��` Zc �e T�k-
`/ Approved certified fire extinguishers per NFPA 10.
V 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.
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 fQe
$ 5.00—Temporary Sales Fee for 1"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 same property Ord#1038-09,Sec 6
$60.00—Tent Fee(45.00/1313, 15.00*/FD)--(*$]5.00 waived for Fireworks)
$45.00—Electrical Fee(if applicable)
Property Owner: �C1eS'( �0 u3tJ V�rCt�
P
Applicant: -oS
Phone Contact: l 3 �" 11
Address Site: 'ice Wx\W0 soj C `t 1 2— lo AlA t1! t�. Ze(\OA l; l`s, 51—
Date(s)of Sale: 3 r
It /a-v �l
Ordinance No. 1038-09(for additional requirements)
PHANTOM FiREWORK,S
TEMPORARY LEASE AGREEMENT
THIS FIREWORKS STANDJTENT AND LEASE AGREEMENT is made between
Piopert
y Owner(herein referred to as the"Landlord"),whose address is:
Landlord:Proves(Townview LLC Phone Number:5187719-0100
Email:cv@ rovestinvest.com
Address: 158 Union Turnpike Hudson,NY 12534 Contact:Charles Vita
Federal Tax ID or SSN:83-4353940 Check-Payable:Provest Towaview,LLC
Site Information
Property Name:Townview Square Phone Number:917-922=6794
Email:cy@ tovestinvest.corh
Address:7246-7422 Gall Blvd. Contact: Charles Vita
Ze h rliills,FL 33541
and,PHANTOM FIREWORKS EASTERN REGION,LLC dba Phantom Fireworks(herein referred to the"Tenant"),
whose address is:2445 Belmont Avenue,Youngstown,Ohio 44505-2405,330-746-1064.
LEASE OF PROPERTY. Landlord leases to Tenant the location space on property described above,detailed on
attached EXHIBIT A,which is made a part hereof:_ The lot,parking lot or common area is owned and/or controlled by the
Landlord, who warrants and certifies it has full right.and authority to lease the location space to the Tenant. The location
space is to be used for housing a temporary sales facility from which the sale of 'state-legal 1.4G (Class C) consumer
fireworks and novelty items will be conducted in accordance with applicable taw. Landlord specifically gives permission
and the exclusive right to Tenant to locate a temporary' stand,kiosk or tent and storage container on the location space to be
used for the purposes stated herein. Landlord will permit no other sales of I AG consumer fireworks on any of the property
not occupied by Tenant.
TERM. The term is for the lease period December 16,2019 through January 10;2020. If the Property is sold to
another party at least 90 days prior to the beginning of the lease period,this lease can be voided. Landlord must provide
written notice on or before 40 days prior to the be of the lease period,and all prepaid deposits and/or rent must be
returned within 10 days of termination of this lease. This lease cannot be voided due to the property being sold to another
consumer fireworks vendor.
RENT. Tenant agrees to pay rent to the Landlord in the amount of$2,000.00 for the location space on the
property named above and detailed on Exhibit A,which includes electricity and a space for a storage unit,which amount
shall be paid in full a week prior to the commencement date of the lease term.
TENANT'S PROPERTY. Tenant assumes the risk of its personal property.on the location space of the leased
Property.
OPERATORS. Landlord acknowledges that Tenant may sublet the sale of the fireworks to independent operators
and approves of all such arrangementsi and Tenant is not relieved from its obligations hereunder. However in the event
Tenant is not able to secure an independent operator for the property, Tenant may terminate this lease with at least TEN
(10)days written notice to Landlord,and Landlord shall refund to Tenant all prepaid rent amounts.
INSURANCE. Tenant shall provide liability insurance covering the Tenant's use and occupancy of the location
space,including product liability;bodily injury,personal injury and property damage coverage,on an occurrence basis,with
coverage in the aggregate amount of TEN MILLION DOLLARS($10,000,000,00). Landlord shall be named as"additional
insured"under the insurance"as Landlord's interest may appear,'" Prior to occupancy,Tenant shall provide Landlord with a i
t
Certificate of Insurance evidencing the required insurance. Landlord is not required to hold similar policies of insurance,
and Tenant's insurance shall be primary for the term of this lease relative to the location space.
INDEMNITY. Tenant shall indemnify,defend,and hold the Landlord harmless from any claims in connection
with any injury or damage caused to any person or property arising out of Tenant's use or occupancy of the leased location
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City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner: ��'G�
Date Received:
Site:
Permit Type:
Approved w/no comments: Approved w/the below comments: ❑ Denied w/the below comments: ❑
This comment sheet shall be kept with the permit and/or plans.
Gene Brown—Fire Safety Officer Date Contractor and/or Homeowner
(Required when comments are present)
DATE(MMIDDNYM
ACCOR" , CERTIFICATE OF LIABILITY INSURANCE 11151 m'
019
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 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 CONTACT
NAME:
Britton-Gallagher and Associates, Inc. PHONEIAIC.No _ Ne: _ _
One Cleveland Center, Floor 30 E-MAIL
1375 East 9th Street ADDRESS:
Cleveland OH 44114 INSURERS AFFORDING COVERAGE NAIC#
INSURER A:EVereSt Indemnity Insurance Co. 10851
INSURED INSURER B:AXIS Surplus Ins Company 26620
Phantom Fireworks Eastern Region,LLC INSURER C-Arch
2445 Belmont Avenue INSURER D:
Youngstown OH 44505
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER:2099500159 REVISION NUMBER:
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 TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP
LTR I SR WVD POLICY NUMBER MMIDD MMIDD LIMITS
A GENERAL LIABILITY S18GL00643-191 10/30/2019 10/30/2020 EACH OCCURRENCE $11000,000
DAMAGE TO
X COMMERCIAL GENERAL LIABILITY PREMISES EaENTED occurrence) $500,000
CLAIMS-MADE X OCCUR MED EXP(Any one person $
X Non-Owned Stand PERSONAL&ADV INJURY $1,000,000
End't Included GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000
POLICY PROJEC X LOC $
COMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY Ea accident)
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS Per accident
C UMBRELLA LIAR X I OCCUR UXP0057739-05 10/30/2019 10130/2020 EACH OCCURRENCE $4,000,000
PiED
XCESS LIAR fl CLAIMS-MADE AGGREGATE $4,000,000
RETENTION$ $
WORKERS COMPENSATION WG STATU- OTH-
AND EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE� N J A E.L.EACH ACCIDENT $
OFFICERtMEMBER EXCLUDED?
(Mandatory In NH) E.L.DISEASE-EA EMPLOYE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$
B Excess Liability#2 P-001-000046155-02 10130/2019 10130/2020 Each Occl Aggregate $5,000,000
Total Limits $10,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required)
The Certificate Holders are named as Additional Insureds with respect to General Liability as required by written contract subject to policy
terms,conditions and exclusions.
Tent Location:Townview Square-7246-7422 Gall Blvd.-Zephyrhills, FL 33541
Dates of Operation: December 16,2019 through January 10,2020
Provest Townview,LLC
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Provest Townview, LLC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
158 Union Turnpike ACCORDANCE WITH THE POLICY PROVISIONS.
Hudson NY 12534
AUTHORIZED REPRESENTATIVE
1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
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CERTIFICATE OF FLAME RETARDANT
BUYER CERTIFICATE NO. : 07-0720-001
ECONOMY TENT INTERNATIONAL
2995 N.W. 75TH STREET MIAMI.
FL 33147, USA ISSUE DATE : JULY 20th, 2007
We hereby certify the below products meet NFPA 701 & California Fire Marshal
for the fire retardant.
1. ITEM CODE : I-TENT TARP . 18oz WEIGHT. 62"width
2. DETAILED SPECIFICATION
PVC LAMINATED FABRIC
1100 Dtex(9X9/sq.inch)
WIDTH : 62"
WEIGHT : 18 OZ
F/R. UN.ANTI-MILDEW TREATED
COLOR: WHITE OPAQUE
3. TEST
1) FLAME RETARDANT TEST. NFPA 701
RESULT-PASS
2) FLAME RETARDANT TEST. CALIFORNIA FIRE N SIZE: 30 x 40 Frame
RESULT-PASS 10' WIDE FRAME AND POLE TENTS
12' " " 91 11 "
15' rr rr rr It is
20'
3.01 " rr If to It
ATHORIZED E 40' " " to
it "
Il`JI'],AST CORP i RATION 60' WIDE POLE TENTS
84 WIDE POLE TENTS
"� r
'item Item Ds_scriptton
t/P
45140 ; PHAidTOIVI'VALUEBAG;,S/4FE/Si4NEg
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4523M _ PFIANTQM=CELEBRATIQN;safelsa le �•0
45246 PIiANT0ltilf;MQ[iNSti2U.CIC.ASS7 ,safe,sane; .4
45291 PHANTOM.CLgUp PATROL'FUII Line,AEW: g
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A 44 RC>LIING.'tI UN[?E12"ASST:41" i
A=025 G13AND;FINALE ASSf(NE1!Ir):3-1 3
*W SUPREfVIE:FI[VA E;,4SSOR iN1EN L 2=1 2
A-029. NMAWA FALLS'ASS't`tr] g
A030 NEtttIYOFtItER:ASS'T.{filEVit}.
BE:AS,SORTNIENT
(DE
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i4-0 32A TU
A;034 NEUV,ROMAN GAtiIdLE.`AS$T 8=1; ;$
iA=476 f3ACK1'ARD,t3f RIkAGE:SAFELSANE 3
A500 PHANTOM BAGKYAR-P BP H SAFEtSANE'. 1.
A-510• FtHANTONi EL ITE'_ASSORTMENT 1=1.
B-09a, #3E.NiORNtt�(G GC ORY.BAG:36 6 36
C-007 JOAAWOiiA.6:ASST.CAkmtt,244 24
C-01,2A i;0 BALL;RO(uIAN'CANDLE(PH);246 24
C-0!'4A 'I,O,,*jpINIR'".GANpLE(PFi} 36 4 36
C-030 57f?OBING;,COMET;CANDLE":4PK 24
6646A; Fi ASFIING.THUWDER WISTARS 8 SH 24
d 0_.i MINI SARRAGE';CANDLE;20=1;NEW 20
G-045. PAR RAGE FIRE'CANDLE 1969H.16-1 IS
G046 BARRAGE FIRE GAND.L VU/REPORT 1.5
G-049 CRAZY BAIL:GANNON 192SHOT 15-1 15
G-056 5°gAL'L MIN11 i20MAN CANDLE NEW 60
F 012FF 8=10=200 WdK F�i?AG`f(CRPiGKERS Sit
F-022 2440.16�IR2ECRACKER THUNCIER6 24
0-04sA SiL.VEF2:satUTE";GR2AEKER 40-3640
,G-013UV lLq;HAPPY"E"' 36SHOT24'ml. 724
G=01.9" 96 S1 tOT GIQLOR2 P,F=ARt 40-4. 40
G=f12fi 10C1.SH0]'SATURN.'R3A17ERY 30-1 30
G-039 BURST'&StOOM 4-1 4
G-041 tdEW_YORKER_SALUTE=FINALE 4-1 4
G,042 PYROTECFINIC MOTIiFRLODE 44 4
G-044A S.EA_SPARROW MISSILES; 24
G�048 PFIANt?>_NIONtt!{VI 2:1 2
'G=050 ; SiCYFEST:PANORAMAiSHELLS 12-8 12
-�=051 ,; MIGHTY°:IUtt1'E'S:M+I3RTAR;KiT24,6 ;24
G fi52 00ACK;:i HE'SKy 4-1 4
G 055 SMALLFES1 tVfL:BALLS 15 6 15
062 STROBE SRECTAGULAR.- 6=1, 6
G-075A FIREBASEiALP.,-HA;�bSHOTS: _ t3
G-083.... SHAGADELLiG;MOJ.0:8=1, _ ,8
300CRACKL''ltdG.M1SSIGE;BASE-12-! 12
G-086. TROPIC 7NUIVQER; 43 4
G 088; CPiSGAi)E.OF CQI OEt10'SlifJ7 8
G-tZ98 1ioo=AH'!2=1-
„ G-099; ERED':VUHITE:AtVD 800M
G44p V}IPKgOL*;AWESt}tJlE r1.. 1
G 125 RAIt�.OF FiRE:8=1 ~
G;128, THE BEAS7-UNtEASHEO 98 SHOTS; 1
GA 34 3_'REI7;UiiHiTE&i3Lt1E.FtNALE 2-9 2
G�135 3 .GOLC3'B120Gi4t)EFtNALE 2-1 2
G-139C RAPT CiR: - 8-1 8
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G 155 HIGH:PE..RFQRMANCE DISPGY.33.SHOTS 3
G=159 PYRQTE,C NIG:PULVERIZER 34' 3
G-160. X,0AfVQRAMII,Q t INALE
GJi65 EMERALD CITY 1241 24
G486 CHERRY BO[UIB'MOR7AR:KIT 6-12 6 .
G-200A. fIUQ!_FPAC}t.lilGN%P,EF2F(2RMA1\10E''12-6 32
G;212 SILVER_GLITTEFf CONUT RACK 2
G 215. RADICALREOOI :SHEt1S:6=12 6
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1tO G:217 VFPACK:GANiSTER SNE1LS.4- 4. 4
G223 GOD QF FIRE 4.;!. 4
G224C .SINARIVIING SKEE i ERS;8 A.. 8
G-225 RYP}100N'SHELt-i{IT6.24 6
G•-238t1 . HOOTENANNY'10,;3HOT 8
G-246A 'E3{TERgilNATOR§HLL Kit 4-18 4
G-249, MT:fJLymptt5,Ti1UNaER 4-9 4
G�277 WQLFPAGK_COLdR GHANGIDtGStiEi:L. '12
G47_: SPEi1B bER 12'SHO7rS 2
0-285 NIiNESHELL MAY-HEM PREMIER 4A-NEW 4
G407 PULSATING SUPERCLUSTER'4-1 4
6
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G-309 GOLDEN FQX 16 S(10T16-1 18
G=315 STEdAft:STOF211A 12'SH0T.44 A
G=325 SI RILLER`16 SH6t 24.1 24
SUSPENDED ANIMATION 25_SHOT 12
k
G-392 BOL'D,COLORS 20 SHOTS' 4
G=393 DREAM`TEAM 12,SHEit j<IT 6
G=39.4 CONTINUUtU!_24 STIFLE KIT 4
G-404A SO
Lib',GQ[D 30'SHOT-4-1. 4
PARR- .
G 4•t!, . OT,S;PRATTLE 36 SHOT -1 NEW 4 .
6-415 SLINKING BOMBS MORTAR'KIT 12-12 NEW 12
G74.16; DE)fi Vi!24;SHOT'.12 1: 72
G A`1$ ECt lO'IN EAR i6 SHELL, 12t6 12
G-430A : CRACKUNG.AR"T'LEF2Y SHELL 12-6 12
G=461, RELI WHITE&.,BLUE CANISTER. 12
G=465 EWI411SHAKALOGKA'12-12
G 733 SEE-DAZ2LED;12,1'NEW 12,
G-474- WOLFPACK DOUBLESTAR:9-P24 4
TOP=NOTCH 19 SHOT'REPEATER :NEW
G 613: " METEOR FLASH' 16 SHOTS NEW' 12
G 614 PINT SIZE:POWERHOUSE;9,SHOTtNEW 36
G-641 SKULL;GRUSHER2"-1;0'SHOT.RACK NEW 4
G-675 ; GRUGGI•PALM'TO;WIILOW,2=1 2
G-702 LOCK AND:COAD KIT 4=24 4 -
G=752 TWISTEtl MI IES'24.'SHOTS:NEW 4
G-735. SKY,SH6OOTER 100 SHOTS 1?
t?801: IVIIN1-BOMB'4RTILLERY"SHELL"i2=6 12
G-820. ARTILLERY SHELL 12>6 1z
G' 28 RIDING.SHOTGUN 25�SNOT 6 1 6
4--929' ; BIG T6P:42 SHOTS•6A' 6
G-932 T[-.W"OLE,SHEBANG T"S,SHOT 2-1 2
G;949 "RAGTIME 20 SHOT 4
G=953 MASTERMIND 12 SHOT.41 4
G-960 GOOD TO GO-23.SHOTS 8=1 NEW g
G-667 HELL:ItN A HANDBASKET 15 SHOT 8-1' NEW' g
H-057 LUMINESCENCE FOUNTAIN.24=1 24
N-065 PE6GOCKTAiL•FAN:FOUNTAIi.4$-1 :8
H<238 BLACKBEAR'S bUTLASS 6fl
N-316 PHANTOM:FUNNIES NEW 16
1=408 WQLFPACK 200 GT;(4BX)-6" 60
1-01.7A CHINATOWN OEcY sNAi�i CRACKER,. 06 366
j-037 LADYBUG GROUND SPINNER 3PK NEW Sp
M-053Q FIERY Fk.OGS(12;COUNT PDQ)1-1 12
Nw.ObT8. #5 RED WHITE&BLUE PARACHUTE-36 36
N-020 SMALL MILITARY PARR 36-3 36
N-037 LOOK,;SPIDER SKY 36-4 NEW 36
O-D37W . 6 OX WOLFPAGC ASST.ROCKETS 36
0-043 WHISTLING B-R W R 20 GROSS 20
O 044 WHISTLING gdTTLE R<)CKS WIS&WR 20