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Home My WebLink About22-5037City of Zephyrhilis�` ; 5335 Eighth Streeti°� g., Zephyrhills, FL 33542 SPCV-005037-2022 Phone: (813) 780-0020 Fax: (813) 780-0021 Issue Date: 11t02t2022 Permit TSpecial EvenVTem orar"�iale ,. s3:';at 1 ?..r ti 't �{. �r 11 r :E., a„r•\l `..t..,A1ti-.1 i. 1..k<, 1 `1b,tJ �i;� 34 25 21 0010 00100 0010 7921 Gall Boulevard \Uja` 1 tic 1 -.,lti rJ } ,t ,"��,. l,,C �,: ,..�E Asa r Name: LOWES HOME CENTER INC Permit Type: Special Event/Temporary Sales Contractor: D-EAGLE TENT RENTALS Address: 7921 Gall Blvd ZEPHYRHILLS, FL 33542 Class of Work: Special Event/Temporary Sale I INC Building Valuation: Electrical Valuation: Mechanical Valuation: Plumbing Valuation: Total Valuation: $0.00 Total • f1 + • ! i Date •. ♦ 1 REINSPECTION respect • Reinspection feescomply • • • ! • F: i .. • • • Complete Plans, Specifications add fee Must Accompany Application. All work shall be performed in accordance with City Codesand Ordinances. NO OCCUPANCY BEFOREC.O. NO OCCUPANCY BEFOREC.O. CONTRACTOR SIGNATURE PE If IT OFFICEU PROTECT !-::i CARD T TT y A D-Eagle Tent Rentals, Inc. 2766 Rifle Range Road Winter Haven, FL 33880 863-325-8553 To Whom It May Concern: 1, Tanya Baldwin, authorize Tanya Godwin to submit, sign and pick up any documents for this corporation associated with permits for tent events or any other permit needs in the state of Florida. If you have any questions, please call. State of Florida, the county of Polk. Sworn to (or affirmed) and subscribed before me via X physical presence OR __ online notarizations this October 6, 2022 by Tanya Baldwin, who is personally known to me or whom has produced FL Driver License B435-807-67-835.0 as identification and Who-- has, X has not, taken an oath. ISM A' W(il—ry Signature Elizabeth C. Davis o ,'jj"oELIZABETH C, DAVIS Notary Publlc, State of Florida ray `4z- MCOMM, axplros Sept, 111, 2025 Type, Print or Stamp Name Y Commission Number HH17I2313 4 Temporary Sales Checklist City of Zephyrhills 5335 8h Street Zephyrhills, Fl. 33542 Phone: 813-780-0020 / Fax: 813-780-0021 •Mfflmm�= Notarized letter from property owner stating their approval. flame retardant certificate is required IEF a tent is involved. Inspection required once tent iscrected and p.Lior 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, IF 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) ---I`—ro-6T-oT`Ste License. -- 00 'Lkp Proof of Liability insurance. co" List of plcras-torue sold at site. Copy of Drivcrs,,L�e�se and Social Security Number of all personnel dealing with the sale of Pr&works at the tent location. H= �--'$ 30.00 — City Registration (If Regulated by DBPR — Fee is Waived) MOM---Vireworks fee - Fire Department fee $ 5.00 — Temporary Sales Fee for 1 " two days $ 1.00 — Temporary Sales Fee per day for each consecutive day thereafter, not to exceed duration of 7 consecutive days and no more than two occurrences during a 12 month period on same property Ord #1038-09, Sec 6 $ 55.00 — Tent Fee (40.00/13D, 15.00*/FD) —(*$15.00 waived for Fireworks) $ 40.00 — Electrical Fee (if applicable) Property Owner: UM Date(s) of Sale: Ordinance No. 1038-09 (for additional requirements) M This letter sign for and pickup permits for etemporary portable tent on behalf of Lowe's Companies store locations for the purpose of selling Christmas trees. The location of these tentswill be determined by each store individually. The tents will be setup for the duration of longer than 45 days starting the month of November and ending in the month ofDecember. will also bmauthorized to install the tents on the Lowe's location, as specified by each store. In addition, all customers will have access to the restroom facilities located inside each Lowe'e store location. 777 Lowe I Companies will assume all payment cnarges associateci witn applying tor, signed tor, and picked up tor permi s for a temporary tent forChristmas Trees. The foregoing instrument was acknowledged before mnethis day of August 2022 6vRichard Goodman, Vice Type of identification produced N/A Richard Goodman Lowe's Companies, Inc Mooresville, VC 28117 11 Lighted 5A Won No Smoking Signs 11 Lighted Exit Sign i. Am 7'x/ Landscapt Timber & Entrance IF Lighted Exit Sign No $mokinu Slues 40 1)(Al era 1 On or) inch and or Ion(, I, Iry Entrances and Exit$ on both onds extinguishers will Ws on smolt enter polo, Thwr* will Ue two 06fitoat Pol*3o In two (*w, Of tit) tommt, The rflcims aro lightoti. �v r ' � T r �1 { o ., riioiria�+us ■ I, f p ,I Certificate Flame Resistance Issued By Date MunWmwred abctentmak,.er@yahoo.com ° www.abdonts.com MIS 'is to certifythis fabric/ flume retardant. It Is Inherent and . .. renwved \}\\�. `^ C\./\< i State .: 2« NA PA .\\+\�. <<2�y»\2... ...... \\}%2§d\ ... .2 tests andcodes. The Flame Re.. :§*..<yz»<cs»< Used ..°IL.NOT y. » Removed . .. by `Washing, Mark Chapter 16,ver . 15 - 18Go ye . Into .all the world and . ?\\ch thegospel to every creature....... t Rentals, Inc. 27 6 Rif ;1e Ra ,fie Road v en,FL 338 -8 863-325 5 N To Whom It May Concern: If you have any questions, please call. State of Florida, the county of Polk. Sworn to (or affirmed) and subscribed before me via X physical presence OR _ online notarizations this October 6, 2022 by Tanya Baldwin, who is personally known to me or whom has produced FL Driver License B435-807.67-835-0 as identification and Who-- has, X has not, taken an oath. SEAL Notary ignature P ELIZABETH C, DAVIS Elizabeth C. Davis Notary Public, State of Florida M OF" MY Comm expires Sept, 16, 2025 Type, Print or Stamp Name 1 t"�" 141, COmfniss'ion Number HH 171238 0 JIMMY PATRONIS CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION EFFECTIVE DATE: 8/28/2022 *ERSON: TANYA G BALDWIN 020667636 D-EAGLE TENT RENTALS, INC. Door and Window Installation All Types Residential and Commercial i IMPORTANT: Pursuant to subsection 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to subsection 440.05(12), F.S., Certificates of election to be exempt issued under subsection (3) shall apply only to the corporate officer named on the notice of election to be exempt and apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to subsection 440,05(13), F.S., notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section, ir it ,;X ma�E! 9012 1211201ZIMIM I#) Z ff011!1JWAF2ki 61j=iTJ4,WMAF1XTH42I#MMI V 'I '�' �# '. ! low @04 wi I IME,i"llfi'ikoill7i' ' M' NOUN& — CA _LIC0B293_7_0________ 1-92B-798-3134 Samantha Stuart Edgewood Partners Insurance Center (EPIC) iPHONE IFAX aA&_ko_E_WL VC. No): 925.609.5531 (Concord Programs Group - Branch 15558) E-MAIL P.O. Box 5668 AqDRFSS� certificatesprorental@epicbrokere.com Concord, CA 94524 �NS6REDII D-Ragle Tent Rentals, Inc. Rvzl�� COVERAGES CERTIFICATE NUMBER: 66515622 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 T IS OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WH:ICHH] M I S 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, INISS Ali "L�NR LTR TYPE OF INSURANCE POLICY NUMBER POLICY POLICY FF_F_ POLICY E365-- LIMITS MMDD AMM20—My—yY1 M no yyy IYYYY1 CIAL L LIA �ERGENERA I ILITY X A 7X� PPPKGO058205 09/30/23 1,000,000 1 2 '0 00 �09130/22 EACH OCCURRENCE _7COMM 17 CLAIMS -MADE L,!, J OCCUR SES$ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 X PRO- L7 LOC POLICY JECT [7-1 PRODUCTS - COMP/OP AGO $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY C5—MB7NMSIN_G_LrL_1MIT Ea qqcide0jj_.._ ANY AUTO SCHEDULED BODILY INJURY (Per person) $ OWNED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per accident) $ _______T -DAMAG-E'_ PROPERT _LPer aqcfdqnt� $ UMBRELLALII OCCUR 09/30/23 1$ 1,000,000 EACH OCCURRENCE EXCESS LIAB I CLAIMSI��E)E AGGREGATE,—,,—,-.— $ 1,000,000 -, DED RETENTION $ WORKERS COMPENSATION PER CTH- AND EMPLOYERS' LIABILITY YIN E.L, EACH ACCIDENT $ ANYPROPRIETOR/PARTNERIEXECUTIVE NIA OFFICER/MEMBEReXCLUDEO? (Mandatory in NH)- E.L, DISEASE____ EA EMPLOYEE $ If describe I gas, under DESCRIPTION OF OPERATIONS be ovd E.L. DISEASE -POLICY LIMIT $ ( i � f � DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Sohaftte, may be attached If more space Is requited) The Certificate Holder is Additional Insured with respect to General Liability as per the attached endorsement. -1 a t I City of Zophyrhills ItIrTOITINILOW" 5335 8th Street AUTHORIZZED REPRESENTATIVE Zephyrhills, FL 33542 USA Q 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD SamStuart 66515622