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Home My WebLink About20-77 a "q U City of Zephyrhills PERMIT NUMBER 5335 Eighth Street Zephyrhills, FL 33542 FIRE-000077-2020 Phone: (813)780-0020 Fax: (813)780-0021 Issue Date: 05/27/2020 Permit Type: Fire Property Number Street Address 34 25 210110 00000 0010 7631 Gall Blvd Owner Information Permit Information Contractor Information Name: TNT FIREWORKS WALMART Permit Type:Fire Contractor:TNT FIREWORKS WALMAR Class of Work:Sparklers Address: 7631 Gall Blvd Building Valuation: ZEPHYRHILLS,FL 33542 Electrical Valuation: Phone: (813)782-1957 Mechanical Valuation: Plumbing Valuation: Total Valuation:$0.00 Total Fees:$100.00 is Amount Paid:$100.00 Date Paid: 2p7-Z Project Description SPARKLER SALE WALMART Application Fees Sparklers Permit Fee $100.00 REINSPECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80(2)(c)the local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or first reinspection,whichever is greater,for each subsequent reinspection. Notice: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permit required from other governmental entities such as water management, state agencies or federal agencies. "Warning to owner:Your failure to record a notice of commencement may result in your paying twice for improvements to your property.If you intend to obtain financing,consult with your lender or an attorney before recording your notice of commencement." Complete Plans,Specifications add fee Must Accompany Application.All work shalt be performed in accordance with City Codes and Ordinances. NO OCCUPANCY BEFORE C.O. NO OCCUPANCY BEFORE C.O. CONTRA TOR SIGNAT RE PE IT OFFICE PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER TNT@ FIREWORKS Site Plan Worksheet STORE NAME/LOCATION#LAYOUT OF WAL-MART LOCATION'S TYPE OF EVENT: In-store sales of Consumer Fireworks Walmart 706 Zephyrhills,FL REAR OF BUILDING y 'f ��iiiiit"7 Fes,... — ---- Atdoa A1q tSft—d AWi) ; Firexork, � Register$ ° Lam,C[am 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 Allay)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 maylshould be dictated by Instruction of the Inspector depending on the individual locations needs and or store setup. REVIEW DA 14CITY Of ZEPHYMIL FIREAAµD LIFE SAFETY EXAMINER .i FF;A CODES ANC STANDARDS _ 813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 Permit Application Date Received Phone Contact for Permit 1 877 740 6180 Owners Name Wal-Mart#706 Owners Phone Number 813 782 1957 Owners Address 7631 Gall Blvd,Zephyrhills, FL 33541 Fee,Simple Titleholder Name Titleholder Phone Number Fee Simple Titleholder Address Job Address 7631 all Blvd Lot# Sub Division Parcel# Bio-Hazard Waste Storage-ANNUAL Hazardous Material(Tier II or RQ Facility)ANNUAL Comm Exhaust Kitchen Hood/Duct a Hood Installation Controlled Burn 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 Bum try P emi ®n er Sprinkler 1:1 ❑ ❑ ❑ X❑ Sparklers Inside Retail Sales of:at__� 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 I Registered Y/N Fee Current Y/N 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 16255 SE 78th Street, Ocala, FL 34474 License# ram---=-----s_-�.._._. _-___._..,..�...._._....�..�,....�._.._..4....w....._ - __.._.�.._._.�..._.......�.��,._.:.��..-.a..- ...._ ,_..�,�...,......._... �--w�---- 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 Jimmy Patronie Casia Sinco CHIEF FINANCIAL OFFICER BUREAU CHIEF Julius Halas Keith McCarthy DIVISION DIRECTOR SAFETY PROGRAM MANAGER A 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 F134472 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: 02/01/2020 Type: 07 Class: 66 County: Marion License/Permit#: 565026-0018-2005 Expiration Date: 01/31/2021 ' G'a Chief Financial Officer <02867415> 02867415 - REPRINT - TNT FIREWORKS PACK LIST - REPRINT - 21362 _ Order #: 2867415-53-00002 Chain Store Sales-FL Chains Order Date: 4/8/20 Terms: Net 60 Days CUST PO: 4105996486 SCAC: EXLA PRO #: 0469201778 SLSMN: Chain Stores - East SHIPMENT NBR: 545840 v 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 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - **,t******* ,t***,************ Assortments *************************** PPK BLAST ZONE USA SS J20 102648PI 1 CS 48 EA 29 .9700 48/1 *************************** Counter Cases * **************** ******** PPK BCKYRDSHW BLSTZON SS J19F 673636J ' 1 CS 1 EA 1548. 0500 1/1 Containing: BACKYARD SHOW COM SS J18 102555 40 EA 40 EA 19 .97 16/1 27736025565 BLAST ZONE USA SS J18 102550 25 EA 25 EA 29 .97 10/1 27736007677 i *************************** Promotional Supplies *************************** SIGN SPARKLERS NO SMOKING 730643E ' 2 CS 2-'EA 0. 0000 1/1 Case 'Totals: 2 CS Page No 1 AC o® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) CF11/1/2020 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 NAME:CONTACT 3280 Peachtree Road NE,Suite#250 PHOIAICNE FAX Atlanta GA 30305 E-MAIL Ex A/C No (404)460-3600 ADDRESS: INSURER(S)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 INSURER E Florence AL 35630 INSURER F: i 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMBS LTR POLICY NUMBER MMIDD MM/DD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000 000 A X Y N SI8GL00242-191 ll/1/2019 11/1/2020 CLAIMS-MADE FX]OCCUR PREMISES Ea occurrence $ 500,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 21000,000 POLICY PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ 2000,000 OTHER: $ AUTOMOBILE LIABILITY NOT APPLICABLE COMBINED SINGLE LIMIT $ Ea accident XXXXXXX ANY AUTO BODILY INJURY(Per person) $ XXXXXXX SCHEDAUTOS ONLY AUTOSOWNED BODILY INJURY(Per accident) $ XXXXXXX 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 I I RETENTION$ $ XXXXXXX WORKERS COMPENSATION NOT APPLICABLE PER OTH- AND EMPLOYERS'LIABILITY STATUTE Y/N 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 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 12067057 Wal-Mart SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE #0706 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7631 GALL BOULEVARD ACCORDANCE WITH THE POLICY PROVISIONS. ZEPHYRHILLS FL 33541 AUTHORIZED REPRESENT 7 VE 01988--20011 ACORD CORPO TION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 4 TNT(R) FIREWORKS Site Plan Worksheet STORE NAME t LOCATION#LAYOUT OF WAL-MART LOCATION'S TYPE OF EVENT: In-store sales of Consumer Fireworks Walmart 706 Zephyrhills,FL REAR OF BUILDING r'4^;+P.t&77 7. a 1;.,'7"77'„ '71-.'"" ,� "''`" .'.r;ry,«.., t::�,y; '4.777�C7 i Fi.F.,y f.�.'-7 7 +�+i'L !`T�' w f<i:�:777 I;r„F-7 3�s^?�';'s_. ,max.7- (�+y-ry+�..n+: '.'�:"'+,+•� It":""'e'-..""°'•''�"�z.',.a�i�'.''_�'.`, fH �ifeyk,`�'v� lrri''dz_ .6li+J¢ ^�`ji4:l,,.•'wC.a`Ii 7 .k^e..�:."k+...`R t,"u. '�',K.`::. I�abl^'.fl`N1^.+. .t.. -- Action Alq(&awnO Aisle) FITefY07{tl ^fit Registers ,:..a 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 maytshould be dictated U instruction of the Inspector depending on the individual locations needs and or store setup. REVIEW DA s'ar ,�'° CITY OF ZEPHY FIRE A14D LIFE SAFETY EXAMINER---P ANFFA CODES AND STANDARDS