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HomeMy WebLinkAbout20-1182 i m F eon gip: City Of ZephyrhillspERMITNUMBER 5335 Eighth Street _ ' Zephyrhills, FL 33542 FIRE-001182-2020 Phone: (813)780-0020 f1. Fax: (813)780-0021 Issue Date: 12/12/2020 Permit Type: Fire ,t Property Number=: : . .. Street:Addr`ess° 35 25 21 0010 07200 0011 7422 Gall Blvd :OwnePanf mation .Perrmt nformation Contractor Information `s Name: TNT FIREWORK RURAL KING Permit Type:Fire Contractor:TNT FIREWORKS RURAL Class of Work:Sparklers KING Address: 7422 Gall Blvd Building Valuation:$0.00 ZEPHYRHILLS,FL 33542 Electrical Valuation: Phone: (813)782-1957 Mechanical Valuation: Plumbing Valuation: Total Valuation:$0.00 Total Fees:$100.00 Amount Paid:$100.00 Date Paid: Project:Description SALE SPARKLER INSIDE RURAL KING pplication Fees e ; 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. CONTRACTOR SIGNATURE PE IT OFFICE PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER -&13-780-0020 City of Zephyrhills Fire Fax-81.3-780-0021 Permit Application Date Received_ Phone Contact for Permit, _F877 f 740 6180 Owners Name Rural King#0101 Owners Phone Number Owner's Address 7422 Gall Blvd,Zephyrhills, Florida 33541 Fee Simple Titleholder Name Titleholder Phone Number Fee Simple Titleholder Address Job Address 7422 Gall Blvd Lot# J5 2- Sub Division Parcel# ? 1 00/0 - 0 ........... Bio-Hazard Waste Storage-ANNUAL Hazardous Material(Tier 11 or RQ Facility)ANNUAL Comm Exhaust Kitchen Hood/Duct 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 A% Fire Protection Maintenance-ANNUAL Recreational Burn -1 try P—.m7 rA7n F9 FTI Sprinkler F 0 0 0 Sparklers Inside Retail Sales of State Approved Sparklers Fire Alarm 1:1 0 El 0 F Sprinkler System Installations Hood Cleaning 1:1 0 El 0 E] Standpipes(Sprinkler Sys) Hood Suppression 0 0 El 0 Torch Roofing/Tar Kettle Fire Alarm Installation Waste Tire Storage ANNUAL Fire Pumps r N7 Fire Works-SPARKLERS Flammable Application-ANNUAL Valuation of Project Fuel Tanks Other: Contractor Company Signature Registered Y/N Fee Current Y/N Address License# ELECTRICIANI Company Signature Registered Y/N Fee Current Y/N Address License# F_ PLUMBER Company Signature Registered Y/N I Fee Current Y/N Address License# MECHANICAL Company Signature Registered Y/N Fee Current Y/N Address License# OTHER Company TNT Fireworks Signature Registered Y/N Fee Current Y/N Address 6255 SE 78th Street,Ocala,FL 34474 License# E_ 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 } Jimmy Patronis Casio Silica CHIEF FINANCIAL OFFICER ` �� BUREAU CHIEF Julius 1-1111S k a p Keith\McCarthy DIVISION DIRECTOR SAFETY PROGRAM MANAGER :k FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF STATE FIRE MARSHAL 200 East Gaines Street -TallahassLe,Florida 32399-0342 '10.850-413-3644 Fax.850.410.2467 CERTIFICATE OF REGISTRATION RETAILER LOCATION PERMIT OFFICIAL COPY THIS CERTIFIES THAT: TNT Fireworks 6255 SE 78th St 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: RURAL KING#101 7422 GALL BLVD. 7EPHYRHILLS FL 33541 Pasco Issue Date: 02/01/2020 Type: 07 r Class: 66it'=� � County: License/Permit#: SR17-000467 ;���" ? Expiration Date: 01/31/2021 Chief Financial Officer MAY. 9. 2013 12.32RM TIT MAIN aFFICE NO. 3954 '_F 2' TNh FIREWORKS Sibs Plan Workshwt ADDRESS 1114"-r �!�/ ?�f ZZ G;�✓ AL vd CftYZr/.qszA STATE . ZIP —.PHONE AZI 76- STONE KAMEI LOCATION I - 1c mddr A 3?(tvi 2=ecOH- yt &4 s" TYPE OFF EVENV Itt!e sales of&—d a g te�at"edlm t m OWN 'o 'n REVIEW DATE -' CITY OF ZEPH ..�. YF2Hlt-i-S S. FIRE AND LIFE SAFETY EXAMINER ALL WORK SHALL COMPLY WITH NFFA CODES AND STANDARDS . � k � K' X x Y. t30tlfli ePfiCtAL.t to SIGNATURE =MMWGERtTXMRsp Wt*m DATE(MM/DDNYYY) ,aco CERTIFICATE OF LIABILITY INSURANCE 11w2021 11/2/2020 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). CONTACT PRODUCER Lockton Companies NAME: 3280 Peachtree Road NE,Suite#250 PHONE TFAX Atlanta GA 30305 E-MAILo Ext: 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: COVERAGES CERTIFICATE NUMBER: 12067058 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 PO ICY EFF• POLICY EXP LIMBS LTR S D POLICY NUMBER MMIDD/YYYY MMIDD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X Y N SI8GL00242-201 Il/1/2020 I1/1/2021 DAMAGE O N D CLAIMS-MADE Ex_] 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 $ 2,000,000 POLICY❑ PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY NOT APPLICABLE COMBINED SINGLE LIMIT $ Ea accident XXXXXXX ANY AUTO BODILY INJURY(Per person) $ XXXXXXX OWNED AUTOS ONLY SCHEDULED BODILY INJURY(Per accident) $ XXXXXXX AUTOS 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 RETENTION$ $ XXXXXXX WORKERS COMPENSATION NOT APPLICABLE PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N 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,maybe 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 12067058 Rural King SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE #0101 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7422 GALL BOULEVARD ACCORDANCE WITH THE POLICY PROVISIONS. ZEPHYRHILLS FL 33541 AUTHORIZED REPRESENTED ©1988-201 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 50299,5865> 02995865 - REPRINT - TNT FIREWORKS PACK LIST - REPRINT - 21362 Order # : 2995865-53-00002 Chain Store Sales-FL Chains Order Date: 10/30/20 ' Terms : Net 30 Days OUST PO: NEED PO SCAC: UPSN PRO # : 1ZR3A1830394629694 SLSMN: Chain Stores - East SHIPMENT NBR: 641170 Sold To: 2670049 Ship To: 2718761 - RK 0101 RURAL KING RURAL KING #101 4216 DEWITT AVE 7422 GALL BLVD. MATTOON, IL ZEPHYRHILLS, FL 33541 SFM # : Desc/Case Packing Item Quantity Selling Suggested CP # Ordered Units Sell Price --------------------------------------------------------------------------------- *************************** Novelties *********************** FDP 2 PAK SNAP 160 J19 320679 2 CS 320 EA 1 . 0000 160/2/50 27736040377 *************************** Sparklers *********************** FDP #8 SPARKLER. ASST (90) J19 380325 1 CS 90 EA 2 . 0000 90/6/5 33900023 *************************** Counter Cases *********************** FDP YLW (CCTKLPNKLTSCEL) X20 673997 1 CS 1 EA 170 . 0000 1/1 Containing: TICKLED PINK BAG' PS NY 102195B 10 EA 10 EA 5 . 00 36/1 27736021949 LET' S CELEBRATE BAG 102468 10 EA 10 EA 5 . 00 36/1 27736036639 2PK CONFETTI CANNON28X18 P 320651 14 EA 14 EA 5 . 00 3/6/2 27736039937 Case Totals : 4 CS Page No 1 <53-2995865> <1ZR3A1830394629694> N 53-2995865 TNT Fireworks 1ZR3A1830394629694 Bill of Lading - REPRINT SCAC: UPSN PRO # : 1ZR3A1830394629694 Shipment # : 641170 Shipper: Sales Assoc : Chain Stores - East TNT WAREHOUSE - OCALA, FL Cust PO # : NEED PO 6255 SE 78TH STREET Order # : 2995865 OCALA, FL 34472 RBU: 21362 WLSL Lic # : Transfer: Sold To: Ship To: 2718761 RURAL KING RURAL KING #101 4216 DEWITT AVE 7422 GALL BLVD. MATTOON, IL ZEPHYRHILLS, FL 33541 SFM #: ****** DELIVER DATE: 11/30/20****** ******************************************************************************** Emergency Response Nbr: (800) 255-3924 Payment Terms : Collect Contract Number: MIS0006877 ******************************************************************************** HM Description of Articles Weight Shipping # of Cases Class Pieces NOVELTIES - NMFC 56290-4 91 LBS 175 4 [X] Totals : 91 LBS 4 ******************************************************************************** Net Explosive Mass : 0 LBS ******************************************************************************** Checked By: Received By: Received Date: Delivered By: Placards Tendered By: Delivery Instructions Order: Ship To. Sold To: Page No 1-