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HomeMy WebLinkAbout20-75 m City of Zephyrhills PERMIT NUMBER - 5335 Eighth Street Zephyrhills, FL 33542 FIRE-000076-2020 '`. Phone: (813)780-0020 1' Fax: (813)780-0021 Issue Date: 05/27/2020 Permit Type: Fire Property Number Street Address 35 25 21 0130 00000 0140 7838 Gall Boulevard Owner Information Permit Information Contractor Information Name: TNT FIREWORKS(PUBLIX) Permit Type:Fire Contractor: TNT FIREWORKS (PUBLIX) Class of Work:Sparklers Address: 1936 George Jenkins Blvd Building Valuation: C� LAKELAND 33815 Electrical Valuation: Phone: (800)868-9151 Mechanical Valuation: Plumbing Valuation: Total Valuation:$0.00 Total Fees:$100.00 Amount Paid:$100.00 / Date Paid:6/4/2020 4:22:58PM Project Description SPARKLER SALE(PUBLIX) Application Fees Sparklers Permit Fee $100.00 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 subsequent reinspection. Notice: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permit 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 add fee 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. 00 CONTRACTOR SIGNATURE PE IT OFFICE PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER e i TNr FIREWORKS Site Plan Worksheet ADDRESS_ 73-6 32 CC.t.I f iWl CITYY' STATE FL ZIP 9 PHONE STORE NAME/LOCATION# PW I X' A I z4q� TYPE OF EVENT: In-store sales of Fj.gdcle StaWapproved sRarklers NORTH REVIEW DATE �" �t �� CITY OF ZEI)Rv ILLS FIRE AND LIFE SAFETY EXAMINER, ALL WORK SHALL COMPLY WITH NFFA CODES AND STANDARDS SOUTH SPECIAL INSTURCTIONS located approximately 75ft from an exit ;13-780-0020 City of Zephyrhills Fire Fax-813-780-0021 Permit Application Date Received Phone Contact for Permit 800 868 _ 9151 Owners Name Publlx#1245 Owner's Phone Number 813 782 1957 Owners Address 7838 Gall Boulevard,Zephyrhills, FL 33541 Fee Simple Titleholder Name Titleholder Phone Number Fee Simple Titleholder Address Job Address 7838 Gall Boulevard Lot# Sub Division Parcel# Bio-Hazard Waste Storage-ANNUAL W Hazardous Material(Tier II 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 �� 0 Fire Protection Maintenance-ANNUAL Recreational Bum Fi5fry emi ® er Sprinkler ❑ ❑ ❑ B x Sparklers Inside Retail Sales of State Approved Sparklers Fire Alarm ❑ ❑ ❑ Sprinkler System Installations Hood Cleaning ❑ ❑ ❑ Standpipes(Sprinkler Sys) Hood Suppression ❑ ❑ ❑ = Torch Roofing/Tar Kettle Fire Alarm Installation Waste Tire Storage ANNUAL Fire Pumps © Fire Works -SPARKLERS Flammable Application-ANNUAL Valuation of Project Fuel Tanks Q Other: Contractor Company Signature Registered Y/N Fee Current Y/N Address License# ELECTRICIAN Company Signature Registered Y/N Fee Current Y/N Address License# PLUMBER Company Signature Registered Y/N Fee Current Address License# MECHANICAL Company Signature Registered Y/N Fee Current Y/N Address License# Vendor Company ITNT Fireworks Signature. Registered I Y/N Fee Current Y/N Address 6255 SE 78th Street, Ocala, FL 34474 License# 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(http://appraiser.pascogov.com) -Site plan at store-placement dictated by Fire Marshals office -State Sparkler Licence attached -Product List attached Y Jimmy Patronis Casia Sinco CHIEF FINANCIAL,OFFICER BUREAU CHIEF Julius Halas Keith McCarthy DIVISION DIRECTOR SAFETY PROGRAM MANAGER 40 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: Publix Supermarkets ' 6255 SE 78th Street Ocala FL 34472 Has registered pursuant to the provisions of Florida Statues to engage in the business of selling sparklers at the following fixed place of business: Publix#1245 7838 Gall Blvd Zephyrhills FL 33541 Pasco Issue Date: 02/01/2020 Type: 07 Class: 66 County: Marion License/Permit#: 118682-0014-2008 Expiration Date: 01/31/2021 Chief Financial Officer <02865378> 028653.78 - REPRINT - TNT FIREWORKS PACK LIST - REPRINT - 21362 Order #: 2865378-S3-00002 Chain Store Sales-FL Chains Order Date: 4/7/20 Terms: Net 30 Days CUST PO: SCAC: CENF PRO #: 886780857 SLSMN: Chain Stores - East SHIPMENT NBR: 543799 Sold To: 1420005 Ship To: 2056670 - PUB1245 PUBLIX - COMPANY 0002 PUBLIX 1245 PO BOX 32008 7838 GALL BOULEVARD LAKELAND, FL 33802 ZEPHYR COMMONS ZEPHYRHILLS, FL 33541 SFM #: Desc/Case Packing Item Quantity Selling Suggested CP # Ordered Units Sell Price - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - *************************** Novelties **************** ********** FDP 2 PAK SNAP 160 J19 320674 ' 2 CS 320 EA 1. 0000 160/2/50 27736040377 *************************** Sparklers ******** *** ************** FDP #8 SPARKLER ASST (90) J19 380325 2 CS 180 EA 2. 0000 90/6/5 27736040346 ************************** Counter Cases *************************** DSP ALTMASS HALF SS J20 FL 673.939 1 CS 1 EA 1273 . 6200 1/1 Containing: SUPER VALUE PACK REV J09 200722 8 EA 8 EA 10.00 12/3 912288 STORM SHOCK USA PDQ SS J10 102023 9 EA 9 EA 9 .99 24/1 939667 SMOKE BALLS BOX OF 8 J12 351052 24 EA 24 EA 2 .00 4/24/8 807590 THUNDER BOOM USA SS J12 WO 102024B 16 EA 16 EA 19 .99 10/1 939666 SIGN NFPA SM FRWKS NO SMOK 730644E 1 EA 1 EA 0 .00 1/1 GROUND BLOOM FLOWER 20 CT 290157A ' 20 EA 20 EA 5 .00 2/20/20 958450 JALAPENO POPPER YP PDQ 201183 16 EA 16 EA 2 . 00 3/16 973644 SHORT STACK 200924F 28 EA 28 EA 1. 00 4/28 27736028054 MAD TROLLS 201247 14 EA 14 EA 5 . 00 24/1 27736039005 HAPPY TROLLS J18 201251 6 EA 6 EA 10 .00 15/1 27736039074 KOOL KAT 201253 28 EA 28 EA 2 . 00 72/1 27736039081 Page No 1 REPRINT - TNT FIREWORKS PACK LIST - REPRINT - Order #: 2865378-53-00002 Desc/Case Packing Item Quantity Selling Suggested CP # Ordered Units Sell Price - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - LIGHTNING BLAST BOX SS USA 102646 ' 13 EA 13 EA 19 .99 12/1 27736023745 PALLET WRAP RED J13 730659 1 EA 1 EA 0 .00 1/1 Case Totals: 5 CS Page No 2 ATE CERTIFICATE OF LIABILITY INSURANCE Ilil/2020 D10/31/2019 10/31/2019 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). PRODUCER Lockton Companies CONTACT P NAME: 3280 Peachtree Road NE,Suite#250 PHONE FAX A/C o Ext: A/C No): Atlanta GA 30305 E-MAIL (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 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 12067055 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/DIDY MM/DNM LIMITS A X COMMERCIAL GENERAL LIABILITY y N SI8GL00242-191 11/1/2019 11/l/2020 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FxI OCCUR PREMISES Ea occurrence $ 500,000 MED EXP(Any one person) $ $000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 2,000,000 POLICY PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ 21000,000 OTHER: $ AUTOMOBILE LIABILITY NOT APPLICABLE COMBINED SINGLE LIMIT $ Ea accident XXXXXXX ANY AUTO BODILY INJURY(Per person) $ XYX3{XXX OWNED AUTOS ONLY AUTOSULED BODILY INJURY(Per accident) $ XXXXXXX HIRED NON-OWNED PROPERTY DAMAGE $ �{�{�{�{ AUTOS ONLY AUTOS ONLY Per accident XXX $ XXXXXXX UMBRELLA LIAR OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX EXCESS LIAB CLAIMS-MADE AGGREGATE $ XXXXXXX DED I I RETENTION$ $ }{XX}{}{XX WORKERS COMPENSATION NOT APPLICABLE PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ XXXXXXX OFFICER/MEMBER EXCLUDED? N!A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ XXXXXXX If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ XXXXXXX _EE DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) 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 12067055 Publix SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE #1245 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7838 GALL BOULEVARD ACCORDANCE WITH THE POLICY PROVISIONS. ZEPHYRHILLS FL 33541 AUTHORIZED REPRESENTE ©1986-201 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD TNT'o FIREWORKS Sjte.Plan worksheet ADDRESS *3 V IV CITY Zf 126-A-1 IS STATE FL ZIP. 3�511 PHONE 13 STORE NAME I LOCATION#, PUbl'iX I Z!i TYPE OF EVENT: In-store sales of aqft Statowa RRLoved sparklers NORTH REVIEW DATE—<64 tL- CITY OF ZEPHYR ILLS FIRE AND LIFE SAFETY EXAMINERg ALL WORK SHALL COMPLY WITH NFFA CODES AND STANDARDS El SOUTH SPECIAL INSTURCTIONS - located approximately 75ft from an g1L