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HomeMy WebLinkAbout21-3147IMPOV.4 Address: 204 E Martin Luther King Blvd TAMPA, FL 33603 City of Zephyrhills 7� 5335 Eighth Street Zephyrhills, FL 33542 FIRE-003147-2021 Phone: (813) 780-0020 Fax: (813) 780-0021 Issue Date:_ Permit Type: Fire Class of Work: Fireworks Building Valuation: $0.00 Electrical Valuation: Mechanical Valuation: Plumbing-Taluation: Total Valuation: $0.00 Total Fees: $532.00 Amount Paid: $532.00 Date Paid: 12/1/2021 12:22:20PM 5953 Gall Boulevard 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, 23133#�� Tim= T1T7TT"T-'W;XT -7 accordance with City Codes and Ordinances. NO OCCUPANCY BEFORE C.O. NO OCCUPANCY BEFORE C.O. CONTRACTOR SIGNATURE PE IT OFFICEC) PERMIT EXPIRES IN "ONTHS WITHOUT APPROVED INSPECTION T-3 C1 Temporary Sales Checklist City of Zephyrhills 5335 81h Street Zephyritills, Ft. 33542 Phone: 813-780-0020 / Fax: 813-780-0021 Detailed Plot Plan showing setup of location, Refer to Ordinance 1038-09, See 4 Notarized letter from property owner stating their approval. A flame retardant certificate is required JE a tent is involved. Inspection required once tent is erected and pri :pr 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. jF 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. M= 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. 00-i-0-0 - City Registration (If Regulated by DBPR - Fee is Waived) $500.00 - Fireworks fee - Fire Department fee $ 5.00 --Temporary Sales Fee for I,' two days $ LOO - Temporary Sales Fee per day for each consecutive day thereafter, not to exceed duration of 7 consecutive days and no more than LwQ occurrences during a 12 month period on same property Ord #1038-09, See 6 $ 60.00 - Tent Fee (45.00/1313, 15.00*/FD) -(*$15.00 waived for Fireworks) $ 45.00 - Electrical Fee (if applicable) IM 0 Applicant: Gal�axFireworks, Inc. Phone Contact: ___L811_3) 234-?g64________---- Address Site: 5953 Gall Boulevard, Zephyrhills, Florida 33542 Date(s) of Sale: Temporary Tent sale of Fireworks December 10,2021 to January 8,2022 Ordinance No. 1038-09 (for additional requirements) No Fireworks Discharge L 0 Fire Extinguisher NO Fire Works Diafge t Exit,"' 0 Enig./Exit Light II No Fireworks Discharge Fire Extinguisher 10 E/Exit UT. 0 tight REVIEW DATE F %C ia arY O FIRE MO LIFE SAFE7y EXAMINEk.,e� (INo Fireworks Discharge L�_1 C� Erng.lExit tight Exit 44" QF➢re Extinguislaerm- L NO IIiI('�'II�I! Fire t_....1 Works No Discharge Fireworks Discharge Exit 44" Exit 44" 0 0 Emg /Exit Fire Extinguisher Emg./Ex➢t Light 0 Light No Fireworks Discharge �� �� ��\���� � \�� /�\ :ar.� :��.�.. .:... ..� � �� : © <� � � � ° �s «� ? d� �� : . .. �. . . `2 �� k }� \\\ ? y .� ~ \\k />� : � �:. � :m �� .�:arm>s, �� y� ©�- . . . � � © �� � � y: 2<\ w� « a:a . :a, » �.td��� ©+. x t�?ks ' s rtl r t r i S t 31 c F )- r s +rt 3 �� �� ;� ° .5•s r r �� i3JttP.,x t 3 fit} SAI st _ _ 1144 t �F 5 �y, . � '4 �W*f .: i � fi � : t ° [ � i it - yy y 5 ., t 'tt.=.tx� ;;,, ,r y.r i s r'. y.. •. r y - - f��f I { v ' }�'$rtt ''�z-�5.s 'fil,� = 5���_. �}��. �� ��:t •.'c - -�`t �Si�`�r4J{$ � ��; 3 . . #s M AIR IN u �3e - < tt i t H T t t # t L � tfir t- .t , ABC,Tents Mark Chapter 16, verses Into aff the warld and preach the gospel to every cry .,.. ,6, Location Inventory for Permkffing GalaxAWM3MMj@M Locatior Inventory for Permitting Galaxy Fireworks, Inc. DATE (MMIDD CERTIFICATE OF LIABILITY INSURANCE F W1372OD21 I I I �Lm­ REAVAIM RAWL'i- PRODUCER ACRISURE LLC 1375 EAST 9TH STREET, 30TH FLOOR, SUITE 3000 ERIC TREEND I I --- ­­­­ --- - ----- ---- (800) 748-0351 FAX ERIC,TREEND@BRITTONGALLAGHER.COM CLEVELAND OH 44114 INSURER A: FWCJUA INSURED INSURER GALAXY FIREWORKS INC - -- ----------------- - INSURER C 204 E MARTIN LUTHER KING BLVD JNEYRERD' TAMPA FL 336030000 INSURER E: FEIN:593092878 INSURER F: COVERAGES CERTIFICATE NUMBER: 2102030026 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, ------- TYPE OF INSURANCE POLICY NUMBER 1 -- --- ------- -- ­ 1111, .__­ POLId Y tFF POLICY— 0 V�A 1"U1nnrVVyV1 LIMITS :i COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE !$ CLAIMS -MADE OCCUR qq MEp P (Any ono person) $ PERSONAL & ADV INJURY $ ------ --- --- -- -- 9EN1 AGGREGATE LIMIT APPLIES PER: GENERAL AGGRE $ POLICY PRO - Po LOU JECT PRODUCTS - COMP/OP AGO $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ JEAA 0'__ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTY DAMAGE_ AUTOS ONLY AUTOS ONLY UMBRELLA LIAR OCCUR EACH OCCURRENCE $ ESS LIAR M- GATE $ WORKERS COMPENSATION PER EOTTH ��_1'416TPTE, ER AND EMPLOYERS'LIABILITY AIVD YIN AN PROPRIETORIPARTNER/EXECUTIVE NIA' 2E637021 A OFFYICER/MEMBER EXCLUDED? --- --- EL CH ACCIDENT 1$ S00,000.00 1/19/2021 1/1912022 I (Mandatory In NH) E.L, DISEASE - EA EMPLOYEE! $ 500,000�00 ------------------- --- - if es, describe under E.L. DISEASE - POLICY LIMIT $ 500'000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedute, may be attached It more space to required) City of Zephyrhills SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 5335 8th Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN I ACCORDANCE MTH THE POLICY PROVISIONS. Zaphyrhills FL 33542 AUTHORIZED REPRESENTATIVE Phone Number: (813) 780-0000 1988-2015 AD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD • iii iu ilk ATE IDACOOR" CERTIFICATE OF LIABILITY INSURANCE li li 1 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 CERTIFICATEHOLDER. 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 • i 1PRODUCER CONTACT BrittonGallagherPHONEFAX ClevelandOne i♦ ♦ • i216-658-7101 1375 East* i•' INSURED INSURERB: Everest Indemnit Insurance Co. 10851 Galaxy Fireworks Inc. -- -� - - — _— -- 204 E. Martin Luther King Blvd INsu�ERe: Everest Denali Insurance Come - — -ra- - Tampa FL 33603 INSURER D INSURER E 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. T _----------------- WSRT iAUDL SUBR,,T POLICY EFF POLICY EXP - —- --- -----...._. i TYPE OF INSURANCE LTR ! POLICY NUMBER MM/DD/YYYY MM/DDlYYYY LIMITS B ,.. GENERAL LIABILITY ',, S18ML00324-211 j 6/10/2021 6/10/2022 EACH OCCURRENCE $ 1.000,000 X ' DAMAGE —TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ 500,000 _ CLAIMS -MADE X OCCURi MED EXP (Anyone person) $ ~� PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:PRODUCTS - COMP/OP AGO $ 2,000.000 POLICY -• PRO X LOC ---- -- $ - -- - — --- -- C AUTOMOBILE LIABILITY SIBCA00081-211 6/10/2021 i 6/10/2022 COMBINED SINGLE LIMIT accident $ 1D_00 000 X ANY AUTO ; :: BODILY INJURY (Per person) $ �— ALL OWNED SCHEDULED —_AUTOS AUTOS I BODILY INJURY (Per accident) $ X 'HIRED X NON -OWNED PROPERTY DAMAGE $ AUTOS '_ AUTOS Jeer accident -_ ---- -- - $ A UMBRELLA LIAR X OCCUR P-001-000142177-03 6/10/2021 6/10/2022 EACH OCCURRENCE $ 4,000.000 — -— .— .._.. ---- X ;EXCESS LIABCLAIMS-MADE: : CLAIMS MADE',. I AGGREGATE ! $ 4 000,000 DED RETENTION $ $ wORKERS COMPENSATION I I WC STATU- OTH-i AND EMPLOYERS' LIABILITY YtN , ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT ' $ OFFICER/MEMBER EXCLUDED? N / A - --------------"------"- "---- " (Mandatary in NH) % E.L. DISEASE - EA EMPLOYEE $ If yes, describe under :; .--- .....-- ---a. -. ---------- -- DESGRIP710N OF OPERATIONS below E,L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS i VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement. Location: 5953 Gall Blvd, Zephyrhills Additional Insureds: City of Zephyrhills, Mark Ayer and all his agents, representatives and subsidiaries (Workmen Comp) I # SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Zephyrhills 6907 Dairy Rd Zephyrhills FL 33542 AUTHORIZED REPRESENTATIVE @ 1988-2010 ACORD CORPORATION. All rights reserved. ! ' • i 1 1 i ' ! name and logo are registered marks of ! • t Jimmy Patronis yap Casia Sinco CMEFFTNANCIAL,OFFICER BUREAU Jullits Halas Keith McCarthy ErMSTON DIRECTOR ROGRANAGER SAFETY PMMA FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF STATE FIRE MARSHAL 200 East Games Street - Ti-allahmee, Florida 32399-0342 Tel. 850,413-5,644 Fax. 950410-2467. m aAl ul-aval'ug'all THIS CERTIFIES THAT: Galaxy Connection Inc. 204 E Martin Luther King Blvd Tampa FL 33603 wholesaler. Type: Class: County: License/Permit Expiration Date: 02/01/2021 07 61, Hillsborou.gh 2 ?. J M d, vi, t �, " 0, �t 777,9 FAM11.1 CUMKOAAR . . . . . . . . . . . IMMAU-1-MI(IFI2 WHOLESALER OF SPAWMERSI OFFICIAL COPY Issue Date: Type: Class: County: Expiration Date: Jimmy Patronis Casin Sinco — CIREF FINANCIAL OFFICER BUREAU CRW Julius Halas Keith McCarthy DIVISION DIRECTOR SAFETY PROGRAM MANAGEW FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF STATE I FIRE MARSHAL 200 Eas,t Giffies StrIcet - Ta,11aba'ssee, Florida.32399-0342 Tel. 850-413-3644 Fax. 850-410-2467 X WM -1 - A 1-0-IAXWO ".N_ OAV PW_ K"A TAIMI.P I RETAILER OFFICIAL COPY THIS CERTIFIES THAT: Galaxy Fireworks 204 E Martin Luther King Blvd Tampa FL 33603 Has registered pursuant to the provisions of Florida Statues to engage in the business of selling sparklers to consumers at retail at the following fixed place of business: 5953 Gall Blvd Issue Date: Type: Class: County: License/Permit #: Expiration Date: W1 02/01/2021 07 - 64 Pasco 186104-0008-2010 01/31/2022 39