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Home My WebLink About21-3265City of Zephyrhills �v 5335 Eighth Street iizo Will Zephyrhills, FL 33542 FIRE-003265-2021 Phone: (813) 780-0020 Fax: (813) 780-0021 Issue Date: 12/13/2021 Permit i e: sire 34 25 210110 00000 0010 77777 7 Name: TNT FIREWORKS WALMART Permit Type: Fire Class of Work: Sparklers Address: Po Box 1318 Building Valuation: $0.00 FLORENCE, AL 35631 Electrical Valuation: Phone: (813) 782-1957 Mechanical Valuation: Plumbing Valuation: Total Valuation: $0.00 Total Fees: $100.00 Amount Paid: $100.00 Date Paid: 12/13/2021 9:26:14AM TEMPORARY SALE - SPARKLERS - WALMART Sparklers Permit Fee $100.00 7631 Gall Boulevard Contractor: TNT FIREWO KS WALMAR' C- AM ITU entities such as water management, state agencies or federal agencies. !I WIRIMP11 1111 11111 111 . . . I a = = �� 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. KL4- ZL*y*-r- Vd-ONTRACTOR SIGNATURE PE?AIT OFFICEC) PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION 813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 Permit Application Date Received Phone Contact for Permit E 877 ��'0111 J�740 F6180 �A XMR "'00—A"'k, Owner's Name I Wal-Mart #706 Owner's Address 17631 Gall Blvd, Zephyrhills, FL 33541 Fee Simple Titleholder Name Fee Simple Titleholder Address E 0 Z Job Address 7631 Gall Blvd Sub Division E] Bio-Hazard Waste Storage - ANNUAL DComm Exhaust Kitchen Hood/Duct El Controlled Burn 1:1 Emergency Generator < 30 kw, ElEmergency Generator > 30 kw Fire Protection Maintenance - ANNUAL MFe-71 Sprinkler Fire Alarm 00 0 0 Hood Cleaning E] 0 0 0 Titleholder Phone Number = ]ME Parcel # Hazardous Material (Tier 11 or RQ Facility) ANNUAL Hood Installation LP/Natural Gas -installation LP/Natural Gas -ANNUAL Sale Places of Assembly -ANNUAL Recreational Burn EKISparklers Inside Retail Sales of State Approved Sparklers Sprinkler System Installations Standpipes (Sprinkler Sys) Hood Suppression L__J 11 0 0 Lj L__J Torch Roofing/Tar Kettle El E] Fire Alarm Installation Fire Pumps E::] Waste Tire Storage ANNUAL H] Fire Works -SPARKLERS ElFlammable Application- ANNUAL Valuation of Project El Fuel Tanks Other: Contractor F Company Signature Registered Y I N I Address License # ELECTRICIAN Company Signature Registered Y 1 N Fee Current �/N Address License # PLUMBER Company Signature Registered Y/N Fee Current /N Address License # F_ MECHANICAL Company Signature Registered Y/N Fee Current Y/N Address License # Vendor Company TNT Fireworks Signature Registered YIN Fee Current Y / N Address ]6255 SE 78th Street, Ocala, FL 34474 License I . 77-7-777 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 Fatronis John Gatlin CHIEF FINANCIAL OFFICER BUREAU CHIEF Julius Halas Keith McCarthy DIVISION DIRECTOR SAFETY PROGRAM MANAGER FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF STATE FIRE MARSIIAL 200 EAST GAMES STREET - TallaWsm Florida 32399-0342 Tel. 950-413-3644 EE Z I ► I "M►if X"31 ta 110A "I V I 112 aL 05 1 THIS CERTIFIES THAT: Vial -Mart Stores Inc. 6255 SE 78th Street Ocala FI 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: Wal-Mart #706 7631 Gall Blvd Zen�vtltills FL 33541 Pasco Issue Date: Type: Class: County: License/Pennit #: Expiration Date: 02/01/2021 07 66 Marion 565026-0018-2005 01/31/2022 ® 1 ' INSURANCECATE OF LIABILITY DATE (MM/DDIYYYY) 1 L/t/2022 10/29/2021 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 NACT NA PHONE IFAX A/C N_ oLExt— 3280 Peachtree Road NE, Suite #250 Atlanta GA 30305 E-MAIL (404) 460-3600 ADDRESS:______ INSURER S AFFORDING COVERAGE NAIC # INSURER A: Everest IT1CleLTllltt Insurance CO111 all 1 0851 _ INSURED American Promotional Events, Inc. INSURER B : INSURER C : 1359629 DBA TNT Fireworks, Inc. INSURER D : P.O. Box 1318 4511 Helton Drive Florence AL, 35630 I" INSURER E : � INSURER F : 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. _ ITYPE OF INSURANCE LTR LTR ,IN0 SUBR POLICY NUMBER MM/DI/YYYY D MMDIYYYY D LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR GENT. AGGREGATE LIMIT APPLIES PER: PO ICY L _ JECT D LOC C 'OTHER. Y N S18GL00242-211 1 UI/2021 11/1/2022 EACH OCCURRENCE $ 1 000000 DAMAGE TO RENTED PREMISES Ea occurrence --- $ 500,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY _ $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY .ANY AUTO OWNED SCHEDULED AUTOS ONLY EAUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY j NOT APPLICABLE COMBINED SINGLE LIMIT Ea accident $ XXXXXXX BODILY INJURY (Per person) $ XXXXXXX BODILY INJURY (Per accident) $ XXXXXXX PROPERTY DAMAGE Per accident $ XXXXXXX $XXXXXXX UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMSMADEAGGREGATE DED RETENTION $ NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX _ $ XXXXXXX _ $ XXXXXXX WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) If y s, describe under DESCRIPTION OF OPERATIONS below N A NOT APPLICABLE PER OTH- STATUTE ER E.L. EACH ACCIDENT $ XXXXXXX E.L. DISEASE - EA EMPLOYEE $ XXXXXXX E.L, DISEASE - POLICY LIMIT $ XXXXXXX i I I DESCRIPTION OF OPERATIONS I LOCATIONS t 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&T VE a Q i 1 i + ' • i • • ! ' + • s i, } w 1 11 • _ M REVIEW DATE CITY OF al4,w „ Consumer,TYPE OF EVENT: In-sigrg sales of ., 06 oSTANDARDS