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HomeMy WebLinkAbout08-8523 CITY OF ZEPHYRHILLS 5335-8TH STREET (813)780-0020 8523 FIRE WORKS PERMIT IIU Permit Number: 8523 Address: 4626 KRUSEN FIELD RD Permit Type: FIRE WORKS ZEPHYRHILLS, FL. Class of Work: FIRE WORKS Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 13-26-21-0080-00000-0010 Improv. Cost: Date Issued: 11/13/2008 Name: CITY OF ZEPHYRHILLS Total Fees: 500.00 Address: 4626 KRUSEN FIELD RD Amount Paid: 500.00 ZEPHYRHILLS, FL. 33542 Date Paid: 11/13/2008 Phone: Work Desc: FIREWORKS DISPLAY SHOW- NOVEMBER 15 , 2008-KRUSEN FIELD PYROTECNICO OF FLORIDA INC FIRE PERMIT FEES 500.00 ç1ct I � V l/ L I ` FIRE WORKS SITE INSPECTION Chapter 633, Florida Statutes,authorizes the City to charge and collect user fees to pay for the costs of fire prevention and protection related activities such as inspections, plan review,administrative fees,and other costs related to the aforementioned. Complete Plans, Specifications and Fee Must Accompany Application. Commencement of work without written approval of the Fire Department's Fire Marshal or required permits or opening up for commercial activity without an approved final inspection shall be charged double permit fee per day of operation or a minimum of$100.00, whichever is greater. All work shall be performed in accordance with City Codes and Ordinances. "FIREWORKS" per Section 791.01, Florida Statutes are considered as any combustible or explosive composition or substance or combination of substances or,except as hereinafter provided,any article prepared for the purpose of producing visible or audible effect by combustion,explosion,deflagration,or detonation. 4., L CONTRACTOR SIGNATURE I IC R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOURS NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE DEPT- Fire Marshal Office- 813-780-0041 N0V/27/2007/TUE02:22 PM ZEPHYRHILLS BUILDI G FAX No, 813-780-0021 P. 002 iaa px$1578000J, City of:Zephyrhitib'Permit Appltlon :F 815.780.0020 .auf Fng Department Data ReteMd 'Phone Con of Pe Yq ' 5 23 L ' MN OWrMt'.eName Ze h chills Pa co p owner PhoneNumber 813-7 414 own,? Addtcsa •O 3 3 3 9 . ' Wner phone Numbef pee StmpM T((ehoIder Nome Fee Simple'TnteholderAddr�e �oTS Zephyl~hi11s,FL•33542 46 6 r`s n t' JOE!ADDRQBS � :� PARCEL IDN tpbTet4WE0 PROM PPRTY WI itOTICB) SUBbIVIS(ON !— S ' [� MOVE CJoEMOLISH NEW OONBTR ADWALT [ J SIGN • WORK PROPOSED IN5YAU.. REPAIR • PROPOSED t)Sld Q 8FR J. COMM • STEEL (� •...Ohm Type of CONSTRUCTION BLOCK • Q FRAME ( j ..DHSORjwfl0NOFwORK Firework D1s la ' �� BUILPIN© VALUATION OP TOTAL OONSTRUOT1OIf . • pR00R as ENERGY [ J W. .C AMP SERVI (y) Ll6TRICAL 1 �] PLUMBN ; M "' O MECH/WICAI VALUATION OP MEO)1ANICAL IN8TALLATIb 5 ..]: :j jjjjjjjjc�AB [ ] ROOFINt3 Q SPECIALTY Q :OTHER YES ,• .i p • ROOD ZONR ARFA C� w to FINtSHBO FLOOR ffLEVAY10 S' ii AC a COMPANY• • . m BUILDER RHol*11P. PA, �: BIQNATURE • ucene "1r •• in Address {(, COMPANY P pflpNT ELENTRIOIAN IMCGIS aREP _.. Q b(GNATURS Lkeneti. t: Address •PLUMBER. . COMPANY YIN •• H ree:,an MJff s NAT B RtlolatEREo • UCen6y)i Address _� ?,s•�t MECHANIOAL• RSorsTANY Y p EN1 BIBNATUcOMPRt5 Ltoans tRG Address IS 0 •$tONA COMPANY C��O R$asrEReo 10NATURIR P O t cQ Address • Its RL°SIDENTIAL Attach f2)P101 Plans;(2)We of BufNflng Plane;(1)set of Energy Forms:R•0- ate♦♦• Mlrttmun Ian(10)wocn0 deys after submitl$i date.Requ'rod an fte. IR PJ 1 Smite PacWUse&1 dumpalerl SEa )"1 1I for R.aW rntit f ` COMM@RCIAL, tech e)sate of BOIlding Planer(1 Bubml n date• Req.red oil$C Conv�, • �1.� wi,�. mWraumten(10)WoddngaoIo jt�� :StwRfU ufps or codes aid Bamery recte0ee 61 oumpster.Site Worts Perrrtll for all new pro)ao(e.All s u SIGN PERMIT ""P OpGRTY SURVEY requlre0 for all NEW construction. R o roe ons: f:aOT .leelli re� U out$500,a complof Cu n notarized aa,,..e aieas no Owner a rgnbador alga back of ttpplka6o u 11rat if over$2500,a Nodce of Commencoment Is required. (A1C uppmdeo.over 55000) 'b�' � M in AVON(for the ERl PER or Power of tey(tor the owner)would be someone with no WA O iI"�e OVER TH8 COUNTER were TTIN(i (Front r AppllCaOon Only) coiuplaics Na • Fences(ptoV3uneylFoet� Remote ,Sewers Bervlca Upgrades • Drtvovieys•Not over Counter U on pvbUC roadwaYB-nods ROW 0 tt ai bJicMm ac*q to weivet aø barb*ed eel bebne1c t t a s1Mt vei n1 . xi yWw,� 4d T"a t� W t 0 .arty bsOmd R stt3 k isvmqq i s t, < #r+,.; me* rsq sill Aesllowen0!y rr 2a s k; txe btu2Sboa Ag3W iri4q dNw 'la t1 t6I*fl5x9)91tL :,111 t w ertt ni .a rltanib i ad ldo h,wfmwr$o - k w ai r ₹) arss of seneqxe s$oa I,y*idiwuoqes a10 tno 1t an snws V1K sillwns+igt w rw eee eao4t Dnnd mad of et aoinu #id, ii o v, .aeo.*nibo dpi bno seba3 Al sM ik w • NoTlce.6F:DEVD'RRSTRIOTIONs: The undersigned understands that this permit may bo•aubJect to'deed'.restrictlons' which may more restrictive than County regulations; The undersigned assumes•responsibility for compliant with any • appUoable deed reetrIstlons. •.UNLICENSE1•'OONTRACTORe AND CONTRACTOR RE8PON8lBiLITI�B: 'if-the:owner has hired a contractor or oonlraelofs to undertake work;they may be required to'be licensed in accordance with state arid local regulations. If the contractor is notItoersed as required by law, the owner and contractor may'bd cited for a misdemeanor violation' •under.alets law. If the owner or Intended,contraotor are uncertaln•as lo•What licensing requlramente'may apply for the Intended work,theyare advised to contact IlW Pasco County 8uillJlng Inspeotion•Otvision—t.kensind Section of727-841- '8009,,.'Furthermore, If the owner.has hired a contractor or oontragtors,•he is•advised to have the con(raolor(e)'sign portions of the''oontraotor Bfook'of this application for which they will be responsible. If you,as the owner sign as the contractor,that may be an indication that he Is not properly licensed end is'Rot entitled to permitting privileges In Pasco 'County.• .' ' TRANSPORTA110N IMPACTAT1IUTi IS IMPACT AND RESOURCE$11COVERY PEEt3: The undersigned understands• that Trensportatiorf impact fees and Recourse Regovary,Fees may apply to the construction of riew,buildings,than a of' use In existing buildings,or expansion of existing buildings,as specified In Pasco County Ordlnencd ntIrr{ber 88-07and• 90-07,as amended.•TM1•underaign d also understands,that such Peps,as may be due,will be tdentifled.at the time of- permitting. It te•fwrther understood that Transportation Impabt'Fees'epd Resource Recovery Fees must be paid prior td receiving a"oerUfloate of occupancy'or final power r6laase. If the pr�ect•does not involve•a Certtflcate of occupancy or final power release,the fees must 4e paid prior to permit issuance, urthermore,If Pasco County Water/Sewer Impact 'fees are due,they must be paid prior to permit issuance In aocordatcelwlth applicable Pasco County ordinances. 'CONSTRI1CTION LIEN LAW(Chapter 71;Fiorl~da•6tetutes,as amended): If valuation of Works$2,600,00 or more,I • oar>I* that 1, the applicant, have been provided with a'copy of the `Florida Construction Lien Law--Homeownees •Protection Guide'prepared by the Florida Department of Agriculture pnd,Consumer Affairs: If the apploant is someone otter then the'owner,l certify that I have obtained a copy of the abets desorlbsd document and promise in good faith to, deliver It to the'owner'prior to commencement, CONTRACTOR'SIOWNBR'S AFFIDAVIT: I certify that all the Information In this applloation Is acotipale and that all Work wlit.be done in compliance with all applicable laws regulating construction,zoning end land development, Apppiltiatton Is hereby made to obtain a permit to do work and Installation'as Iridloated. i certify that no'work or installation has commenced prior to Issuance*of a permit and that all work will be performed (6 meet standards of all laws regulating conatruollon, County and City codes, zoning regulations; and'land development regulations In the juriedlolion. I also • certify that I understand that the regulations of other government agencies may apply to the Intended work,and that It Is my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to: Department of Environmental Protection-Cypress 13eyheads,Wetland Areas and Environmentally Sensitive Lands,Water/WastewaterTteatmen6 Southwei;t Florida Water Manag''e rent Dtstrlct-Wells; Cypress' BBayheads, Weiland Areas, Alferin• d Watercourses.' • ,•Army Corps of Englneers-seawalls,Dookq,Navigable Waterways. ' Department of Health'& Rehabilitative.SdrviceslEnv[rohmental Health Unit-Wells, Wastewater Treatment, septlo Tanks. U8 Envl,otmient Protection Agency-Asbestos abatement. .. Federpl AviationAuthority-Runways. I understand that the following reetrietiorie'apply to the use of fill: , • ' Use offlit is not allowed In t9ood.Zone"NP unless expressly permltteed. If the'11k material is to'be:used in Flood Zone 'A', It Is understood that a drainage plan addressing a 'ootnpeitsalln volume'will be submitted at time of permitting which Is prepared by a professional engineer licensed by the f(ate'of Florida. • • : • if the fill•mgterlat is to be used in PIgod Zofe A In connection with a permitted building using stem well • construction,I eerily that till will be used only td fill the area within the stem wall, • - 11.1111 material 13•to be used in any area, I certify that use of such fill will not adversely alfeot adjacent properties. If use of fill is found to adversely affect adjacent'properties,the owner may be'cited for violating the cdndltlons of,the building permit Issued under the attached permit application,'for lots less than one(1) • acre which are elevated by fill,an engineered dialnage plan Is required. ill em the AGENT FOR T U OWNER,I promise In good faith to Intorm.the owner of the parmitiing conditions set forth In this affidavit prior to commencing construction. I understand that a pepar'ate permit may be required for'electrical work, plumbing, signs,wells,pools,sir conditioning,gas, or other installation's not speeiloally Included In the application. •A • permit lssued shall be construed to be a license to proceed with the work and not as authority to.violate,cancel,oiler,or • set eskle any provisions of the technical codes,nor shall issuance of a permit prevent the Building official from!hereafter ragUlriny a correction of drrora In plane,construction or violations of any codes. Every permit Issued shall become Invalid unless iha work authorized by such permit Is commenced within six months of permit-Issuance,or if work authorized by the permit is Suspended or abandoned for a period of six(6)months after the time the work is oommenced. An extension may be.requastgrd,in writing,from the Building Official for a pdrlod'not to exceed ninety(90)days and Will demonstrate' justifiable¢auee for the extension. If work ceases for,ningty(90)consecutive days,Id1gpb fs•consldered abandoned. • WARNING TO OWNER. YOUR FAILURE'TI REOdRD A NOTICE OF COttiliMENOEMENT MAY RESULT IN YOUR , PAYING YIiVICE FOR 1pwIøvE1aENTe TO YOUR PRoPEtt1Y.•1P YOU INThI�iD To ATTAIN PINANC riG,CONSULT • NOTICE OFOOMMENOEMENL • "F AUliAT( i 3 ' •• •OYVNSR OR AOR r ONTRAcio S d srltm a me thk subaMhed,epd acorn to or eatcYirare me a , to t S r me Ideniikatoat n• uec r are personll wn to ms or h9 lhuveas ldnUfiGarfol>r.roduced >`• ( A 11-//�►GI�IV.Y` FldteryPub0o CommloslonNo. CommtaalonWo t1• N"leNotary or mpoo ~— . ems o ry o ,p me or stamp r CARtA M.MANDEL. • Comrrw Dcaese� �y Expires 11112/2009 eonded taw(sce) 2.425.; N;,f;d Florida Naary Aun.. ne Temporary Sales Checklist City of Zephyrhills 5335 8'b Street Zephyrhills,Fl.33542 Phone:813-780-0020/Fax:813-780-0021 REQUIREMENTS Plot Plan showing setup of location. Notarized letter from property owner stating their approval. wt-A A flame retardant certificate is required IF a tent is involved. Inspection is required once tent is erected and inrior to opening for business. Approved certified fire extinguishers per NFPA l0. 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) V Proof of State License. ►A froce.ss UA V Proof of Liability insurance. oCopy st of items to be sold at site. ,par of Drivers License and Social Security Number of all personnel dealing with the sale of fireworks at the tent location. ( fr4Q . �eva�nn FEES $30.00—City Registration(If Regulated by DBPR—Fee is Waived) _L. $500.00—Fireworks fee- Fire Department fee $ 5.00—Temporary Sales Fee for I"two days $ 1.00—Temporary Sales Fee per day for each consecutive day thereafter, not to exceed duration of 30 consecutive days and no more than one occurrence per calendar year per Ordinance#408. $50.00—Tent Fee(35.00IBD, 15.00*/FD)-(*S15.00 waived for Fires j I `�! $35.00—Electrical Fee(if applicable) ale Property Owner: Zephyrhills Pasco Police Athletic League (ZPAL) �s �, Applicant: l �Ic Phone Contact: Chris Reitano — 727-364-1269 Address Site: Krusen Park, 4626 Krusen Field Rd. ,Zeplyrhilla, FI 333542 Date of Sale: Numb e,- 15, ca.c R3SU-116��r 'J Lsro1o (,• Shooter: Chris Reitano 18405 Normandeau Street Sping Hill, FL 34610 SS#: 267-63-3577 DOB: 3/9/74 Chis .has worked for Pyrotecnico for 1Q+ years and has shot over 100+ shows der. `rt'��rd,J Nov GO 04 1'2i3Gp Publio Relations 813-782 .6108 p.8 SITE INFORMATION FOR FIREWORKS DISPLAY Organi2adon sponsoring event: Zephyrhills Pasco Police Athletic League Date and time ofproduction: 11/15/08 - Post Game Locationofproductton: Krusen Park, 4626 Krusen Field Road, Zephyrhills, FL 33542 Name ofmaiuoperator: Chris Reitano Number and ages of nil assistants: Charles Flanagen - 39 Cor rmation of License held by operator: See at to heed Evidence of permitee's insurance carrier: Se. at�t,a -ham_ Number and types of pyrotechnic devices and materials to be used; See attached MSDS for pyrotechnics used! S�a+ Cached Extinguishers on site(pressurized water—at least 2): Diagram of where production to be conducted(to include point of firing,fall out radius, and audiencelooatlon); See attached Firing safeguards in place: • circuit testers no more than 25 mA e power for firing sources be restricted to batteries or isolated power supplies • firing systems ensures against accidental firing(2-step Interlock) • not to be left unattended rpI i • smoking prohibited within '"oft a firing/handlIng area • appropriate distance tl ont audience(not less than twice the • all access points are blocked off into firing/handling f# /?fl -11H rnTWn'a1n4A.-1 9b47b7.F.n11 TC:1 T /11e7./CT/TT Zephyrhills Pasco Police Athletic League High Level Fireworks Display Site Plan* Krusen Park 4626 Krusen Field Road Zephyrhills, Florida 33542 ,;�� y f V\\ PYROTECNICO " VITALE FAMILY FIREWORKS • 1889 G,Js • r w.� 4 _____ • 4 ____ xy IIM� I.F. � f•. The White Circle Represents a 560 Foot in Diametefl a *Site Plan above is drawn to an �' �p approximate scale using: NFPA 1123, Code for Rrewo fcg Display,2006 Edition,Part Page I of I Material Safety Data Sheet U.S. Department of.Labor May be used to comply with Occupational Safety and Health Administration OSHA's Hazard Communication Standard, (Non-Mandatory Form) 29 CFA 1910.1200. Standard must be Form Approved consulted for specific requirements. OMB No. 1218-0072 IDENTITY (As Used on Label and List) Note: Blank spaces are not permitted if any item Is not applicable, or no 'Fireworks, '1.3g UN 0335, PG II Information is available, the space must be marked_to Indicate that:, Section I Manufacturer's Name Emergency Telephone Number •. S. Vitale• Pyrotechnic Ind. , Inc .d/b/a .-Pyro ecnico 8-5PM 800-854-4705 5-8AM 1-800-255-39,' Address (Number, Street, City, State, and ZIP Code) Telephone Number for Information- 302 Wilson Rd New Castle; PA 16101 800-854-4705 800-255-3924 Date Prepared April 1998 Signature of Preparer(optional) - Section If — Hazardous ingredients/identity Information Other Limits Hazardous Components (Specific.Chemical Identity;Common Name(s)) OSHA PEL ACGIH TLV Recommended � (optional) Special display fireworks contain explosive and pyrotechnic compositions, and are classified as fireworks, 1.30, UN 0335, PG II by the U.S. Department of Transportation. No chemical composition is exposed during. normal handling and storage. Section 111 -- Physical/Chemical Characteristics Boiling Point Specific Gravity(H2O - 1) n/a n/a Vapor Pressure (mm Hg.) Melting Point n/a n/a . Vapor Density(AIR- 1) Evaporation Rate n/a (Butyl Acetate - 1) n/a Solubility in Water Slight Appearance and Odor All chemical composition is contained in cardboard or plastic casing' Section iV — Fire and Explosion Hazard Data Flash Point(Method Used) n/a Flammable Limits L.EL n/a UEL n/a Extinguishing Media Do not attempt to fight fire in vicinity of 1.30 Fireworks UN 0335, Evacuate area Special Fire Fighting Procedures Evacuate fire -area immediately and seek shelter. Follow established emergency action plat Unusual Fire and Explosion Hazards Unusual fireworks may mass explode in a fire situation section V — Reactivity Data Unstable CoNo ons to enf smoking or moisture in Vicipity of stored itability NO o en flames,Wes, Stable X fireworks. Avoid •friction and impact. Do not allow fireworks to get soaking wet. ncompatibllity(Materials to Avoid -{ Devices will explode in fire situation. azakdous Decomposition or Byproducts Ma Occur Conditions to Avoid Hazardous y Polymerization Wilt Not Occur X Section V1 -- Health Hazard Data Skin? Ingestion? NO Route(s) of Entry: Inhalation? NO - NO Health Hazards (Acute and Chronic) There is no ex osed chemical corn OSitl 0.n. IARc Monographs? NO. OSHA Regulated? NO Carcinogenicity: NTPT NO Signs and Symptoms of Exposure N/A Medical Conditions Generally Aggravated by Exposure N/A Emergency and First Aid Procedures N/A Section Vii -- Precautio�fQcSafe Handling and Use spilled devices and pl�acei�nc dbo a' Steps to Be Taken In Case MateraReleased or Spilled Cautiously pick up o en flames, or sparking metal tools- in vicinity of spilled cartons. Absolutely no smoking P fireworks. with anatural Waste°isposalMethod Soak any ex lsed chemical composition with water: sweep up ose of by' burning compliances with state and�local 'regulations. fiber brush and dis act with shipping precautions to Be Taken In Handling and Storing Kee fireworks cool and dry. Avoid imp cartons. Absolutely no smoking in vicinity of any special fireworks. Other Precautions None •r Section Viii -- Control Measures. Respiratory Protection(SP�YY7YPO) None re wired when handlin •finished fireworks. Special N/A Ventilation Local Exhaust N/A Other N/A Mechanical(Genera!) N/A Eye Protection N/A Protective Gloves. N/A Other Protective Clothing or Equipment N/A WorkiHygienic Practices Absolutel no smokin near any fireworks *o c�pj79ne-49j-529/45775 Zephyrhills Fire Rescue 6907 Dairy Road,Zephyrhills, FL 33542 Fire Marshal Bus (813)780-0041 Kerry Barnett Fax (813) 780-0044 E-mail: kbamett(ajfire.aephyrhills.fl.us Plan Review#: 08-144 Project: Fireworks Display (Zephyrhills Pasco Police Athletic League) Number of Pages: Fireworks Packet Date: November 10,2008 I have reviewed the plans for the high level fireworks display located at4626 Kruesen Field Road and will allow the project to move forward based on only the life safety issues of NFPA 1123. Zephyrhills Fire Rescue is not responsible for any crowd control or parking issues or any other codes that may reflect on a particular department such as Parks and Recreation or the Airport.Paying for permits acknowledges the contractor agrees to the items required below. Should anyone have any questions, please do not hesitate to contact the Fire Marshal's office. 1. The fireworks display shall follow NFPA 1123. Some of the more important sections have been listed below. A. 4.1.7.2 t Shells shal be individually supported separated from other mortars by 10 times the inside diameter of the mortar. B. 4.2.1 Shells shall be kept in shipping cartons until set up for display. C. 4.2.2.2 A prep area shall be secured from the public by at least 100 feet in all directions. D. 4.3.2 Mortars shall be spaced and positioned so shells are propelled over the fallout area. E. 4.2.4 If ready boxes are used follow the applicable requirements. F. 4.6 Mortar racks shall be positioned and secured to withstand a shell exploding in the mortar. G. 4.6.2.1 Racks containing 3"mortars shall be limited to 15 per unit. 4" shells shall be limited to 12 per unit. H. 4.6.3 All other firework devices shall be secured and positioned using stakes, sandbags,racks,etc... to prevent tip over or hazardous movement during operation. I. 4.4 If mortars are to be buried follow applicable guidelines. J. 5.1.3 Minimum site requirement for fallout area of 560' is acceptable. K. 8.1.2 Crowd control shall be maintained by monitors located around the display and fallout site. This will not be completed by Z FR. Barricades may be used to assist with crowd control. 2 L. 8.1.3.1 Ensure there is sufficient number of assistants available for the fireworks display. All assistants shall be trained and 18 years of age. M. 8.1.3.4 Protection for personnel during shoot shall be: head, eye, hearing and foot protection. Long sleeve(consisting of cotton, wool or other flame resistant material)and long legged pants. Shorts,t-shirts, unprotected footwear will not be allowed. N. 8.1.6.1 No smoking,matches,lighters or any open n flame shall be within 50' of any fireworks. O. Chapter 9 Follow all guidelines for electrical ignition. P. Follow all additional guidelines noted on check sheets within fireworks package that was submitted. Inspections required: 1. On-site inspection required. The area shall be set up at least 2 hours prior to the display so all aspects of the display including setup of fireworks and firing system(s)can be checked. 2. After display inspect. Areas(display&fallout)shall be checked by fireworks personnel for any unexploded shells, spot fires, etc... KERRY B TT, FIRE MARSHAL •'•Please be advised this review of plans submitted is a cursory review to assist the contractor in compliance with applicable fire safety codes.This review is not intended to be a final approval of the submitted plans.It is the contractor's sole responsibility to ensure that the plans are in complete compliance with all applicable NFPA codes and local ordinances.In the event that further examination or site inspection reveals areas of non-compliance,it shall be the contractor's sole responsibility,at their sole expense to bring those areas in compliance.The City assumes no responsibility for the contractor's failure to be in compliance with all applicable NFPA codes and local ordinances. RRE 6907 Dairy Road. Zepsiy ,iK5, '- . 3i4 Chief₹(eith WiUUiams Blis 813)73? O0- :{ (G"ia T) s_.. FIRE SERVICE USER FEES Occupancy No.: Plan No: contractor Business Name: Billing Addred_?eN3r Business Address: Li. A2 $ i c e' Business Phone No.: Billing Phone No.: /AL Business Fax No.: Billing Fax No.: Contact: Contact: PLAN REVEW FEES INSPECTION FEES PERMIT FEE FALSE ALARM FEE 8 SNe Plan N/C Amua WC Sprhtder $60 fl let Alum WC 06 sf let R"Upeclion N/C Sdncpfpee $60 2nd Alum N/C (Mk nam Charge$25.00 2nd Redrrapeclion $100 Fim Pump $50 3rd Alum NIC Plan Rw Mons DBL 3rd R--Nnpecdon $25D Hooch $50 4th Alarm $100 4th Re-kwpaulorr $600 Fire Alarm 360 51h Alarm $150 SPRNwcLER SYSTEMS (Bueinsas dosed iii LP Gee 650 SIh Alarm $200 8 0-25 Heeds $50 dions coerecad) Natural Gee $50 nod oorpr w E $150 26p Heeds $100 SPRNO.ER SYSTEMS Fuel Tu*s-psr * $60 STANDPr+E SYSTEM Hydro Undergroiaics $45 Sparlde m Per Riser $50 Hydrodalb Test $65 a.r.fmm Woks FIRE PUMP Acceplairm Test $45 per.yebm Camp Flu ❑Per Pimp $100 Hydrant Fbw $75 Conkdled Bum $100 FIRE ALARM SYSTEM HoodlDuct 350 0-25 De Ices 350 FRE ALARM SYSTEM Place of Assembly $50 Annum 26 pies Devices $100 8 Syslem Aooeptanc a $60 Fire Proleotlon 25$ SUPPRESSION SYSTEMS Raced Acceptance 350 FlenaneW Appowdon $50 Anmw wet $50 OTTER Weds Tire Storage $50 Ammm Dry $5D JJ Fire WalV8mols Wad $15 perwee G.rw dw<ION $100 CO2 $50 LI LP Gee $2s pens.* G.rwrabr X30 ION 150 Other 360U Natural Gas $25 per.ya m Bb.Heo'ard Waste $100 Aswan KflrCl1.B4 EXHAUST FurNgelbn Terd t g $50 HoodiDuds $60 Tait 10'k1O oryr.eler $15 parfait Torah Pot/Applied $50 OTHER Flo Pimp $45 Ha .Meeeriela $100 Annual LP Mttlade9ort per mik $50 Fire Suppression $30 Fuel Tank kw1JJlon $50 System Acoeptauwe (Per Tank) $50 Eidisust HoodlDuct $30 flMa uie Oft kteledetion $50 U Re-kwpedfru DSL (Per System) (other then annual) oS�� � oDBL end canceled Nee than 24 hours Corwtrudion Map. NIC PLANS TOTAL INSPECTION TOTAL JI PERMIT TOTAL „FALSE TOTAL GRAND TOTAL I Comments: Date: r �,.�..o,.r... C�..i✓ate.o /Y. e -�A PART H. APPLICANT INFORMATION Name of Organization: ZEPIJ yky/as [?o / oLl C LIi4ri,t L &o�; Applicant must be a not-for-profit entity,register to do business in the State of Florida Contact person: rn n RS A A 1C€AJn Mailing address: ) (3 0 X 573 Phone number(including area code): (8 /3 ) 7J1/ _ J (per Alternate phone number 813 779 -6'-/83 Fax number(including area code): ( Email address:. Z b is I (d-6 s -- r r p cz b Qy , r(',cc,rr Date incorporated: A PP\,I L' I j„h aoc Current corporate status:.(Circle One)(Active Inactive. Employer Identification Number(EIN):. oZ(0- 1c1 PART IL EVENT SPONSORSHIP Do you have any co-sponsors for the event?: o Yes If yes,please list:. Will an admission fee be charged to attend this event?: No pes If yes,how much will the fee be?:_(V 5 _ 00 Please note, an application for any level of City subsidy of a special event must be filed with the City Manager by June 1 for events occurring during the following jfscal year (October I- September 30} 2 PART III. EVENT INFORMATION Name of proposed event: P F4L U PEP tad cu c— Date(s) and time(s)of proposed event: fJd U , 1 S h O CO Ff 8 33 H 8 Bo P Proposed event locatio . ku s� Pr If the proposed event is a parade,please list the point of origin,path, and the termination point as well as estimated number of entries (Attach maps as needed to clarify the parade route): Will the event require the closure of a state highway?:_o Yes If yes, a separate request form for state road closure must be submitted with this application. Will the event require closure of a City street/avenue?: No Yes Estimated number of vendors: L Estimated number of food/beverage concessionaires: Is it proposed that alcoholic beverages be sold, served or consumed at this event? !/ No Yes If yes, an application for a permit for consumption of alcoholic beverages must also be submitted and approved Briefly describe the proposed event and the specific activitie associated with it: FO6Tr3A C�c_ PeOG- m Q &QJ3ow L (,y d /i irewor/c i s )a e-nctl h � 3 Have you held this event before in Zephyrhills? f/ No Yes If yes,when: Estimate of anticipated number of spectators/participants attending the event: d(7 In the event of inclement or hazardous weather, do you have an alternate date selected? VNo Yes If yes,what is the alternate date?: What electrical services will be required/provided for the event? (Please be as specific as possible): Un 31J1T/0A) 7� c. What other utilities will be required for the event? Please list all equipment, e.g. stage, tents, vehicles, etc. that you propose to use in the event or bring onto City property, streets or parks areas (All subject to approval)Note that tents 20'x 20'or larger wTOP lso require afire rating certificate. Up ( o9lupel E.S 1)&n Sew Tip u e K' Please provide/attach a description including a map and location and number of public facilities to be provided for the event(e.g., toilets, garbage cans, etc.): fZU5f� FtELi CLiYi Please attach documentation of the appropriate application for Pasco County Health Department permitting for public facilities. 4 PART IV. REQUIRED FACILITIES AND INSURANCE INFORMATION Who is your liability carrier for this event? 6 ,U Af L . LU I PA f2 Attach proof of liability insurance in the amount of One Million Dollars ($1,000,000.00), or Two Million Dollars ($2,000,000.00) if the event will include the consumption of alcoholic beverages. All policies shall name the City ofZephyrhills as an additional insured for the event. I/we agree to obtain and maintain the required liability insurance and to secure all necessary local, state and federal permits and to comply with all terms and conditions applicable to the conduct of special events, as set forth in Ordinance No. 2005- , as amended. Uwe certify that the information contained in this application is true and accurate to the best of my/our knowledge. As applicant for the event,I/we agree to release and hold harmless the City of Zephyrhills from liability of any kind for any and all damages arising out of any loss or injury resulting from the conduct of this event. This release includes a release for any and all losses or injury arising while conducting an event using City of Zephyrhills facilities or property and for any and all losses or injury to persons attending this special event. I/we certify that individuals will not be barred from participation in this event due to race, creed,color, national origin,sex,age,or physical impairment. Date: Q Title: ( 2 T?M' yy� Printed Name: f ' IAKs 1-1-/ A- 5 Page 1 of 1 Todd Vandeberg �� i r h p-� From: Ann Conley Sent: Thursday, November 13, 2008 8:31 AM To: Todd Vandeberg Subject: Thurs. Meeting Todd, Trina asked me to contact you and let you know that she will not be at this mornings meeting. The airport has not problem with the proposed Fireworks display at Krusen Field. Staff would need to know specific details of the event to notify pilots of flight restrictions during the event. I will be here at the office if you have any questions. -Ann 11/13/2008