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Home My WebLink About08-8542 CITY OF ZEPHYRHILLS 5335-8TH STREET (813)780-0020 8542 FIRE WORKS PERMIT Permit Number: 8542 Address: 7050 GALL BLVD Permit Type: FIRE WORKS ZEPHYRHILLS, FL. Class of Work: FIRE WORKS Township: Range: Book: Proposed Use: MEDICAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 35-25-21-0010-10500-0000 Improv. Cost: Date Issued: 11/18/2008 Name: FL HOSPITAL OF ZEPHYRHILLS Total Fees: 500.00 Address: 7050 GALL BLVD Amount Paid: 500.00 ZEPHYRHILLS, FL. 33542 Date Paid: 11/18/2008 Phone: Work Desc: FIRE WORKS DISPLAY SHOW- DEC 7TH 2008 PYROTECNICO OF FLORIDA INC FIRE PERMIT FEES 500.00 i2 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) CONT C OR 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 NOV/15/2007/THU 04: 59 PM ZEPHYRHILLS BUILDING FAX No, 813-780-0021 P. 002 Temporai y SSa1es iC?hec1iist •.City of Zelrhyirhills £335 80'Street • .Zophyrhflls,P1.83542 . • Phone:813-780-0020/Fax:813-780-0021 REQUJRENTS • review 1D �COnhBC�Dt in .Plot Plan showing setup of location. .,-rW review b rd d n Mle at Notarized•letter fromproperty owner stating their 1 the sebrn Lp 811S01� �i" SlI� ie1 codes •A-flanae retardant certificate is required 7F a ten x �e tothee- t $ O'or is erected and:pnor to opening for business. IOC ptdinaMeS. b!• reV'e8�are Approved certified fire extinguishers per NFPA JS � ' st titelt'tole expen� placed outside eatranc 'those no No Sn►Qking signs must be e 9 tr the conttaMes b be in= IF there-is a wire fence or chain link fencing must eaet�,, x Jlrldrl�0�1 ' 2 exits. IF tent has sides,the sides shall be in the up position unless there is inclement weather, then 2 sides must b e.in the up position... FIREWORK RBQ ENTS.-(in addition to the above) • ' Proof of State License. — ��'a Egsza Proof of Liability insurance. • List of items to be sold at site • Copy of Thivera License and Social Security Number of all personnel dealing 4— with the sale of f reworks at the tent location. S h4. (,jjs,i0b FEES $30.00 City Registration(if Regulated.by.DBPR—Fee is W lived) x $500.00—'Fireworks fee-Fire Department fee $ 5.00-Temporary Sales Fee for 1'two days S 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(35.00/BD, 15.00*/FD) Sb5Ay BEEN REv1EWED $ 35.00—Electrical Fee(if applicable) g Y ZEQHYRHILLS FIRE 'FFICE i)atc: Reviewer: Property Owner: • Florida Hospital Zephyrhills rhills Applicant: • Pyrotecnico • ' • Phone Contact: • Marsha LeFebvre - 800-854-4705 Address Site: • 7050 Gall Blvd Zephyrh'lls FL 354l • • Date of Sale: • Ordinance No.408 dated 1/26/1987(for additional requirements) ' 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 Building Department Date Received Phone Contact for Permitting Owner's Name_Florida Hospital Owner Phone Number Owner's Address 7050 Gall Blvd.Zephvrhills.FLI3305w41 Phone Number Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address JOB ADDRESS 7050 Gall Blvd. ,Zephyrhills, FL 33541 LOT# SUBDIVISION PARCEL ID# (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED B NEWCONSTR B ADD/ALT 0 SIGN Q MOVE Q DEMOLISH INSTALL REPAIR PROPOSED USE Q SFR COMM Q OTHER TYPE OF CONSTRUCTION Q BLOCK FRAME Q STEEL Q OTHER DESCRIPTION OF WORK Fireworks Display BUILDING SIZE SQ FOOTAGE HEIGHT BUILDING $ VALUATION OF TOTAL CONSTRUCTION ELECTRICAL $ AMP SERVICE PROGRESS ENERGY Q W.R.E.C. PLUMBING $ MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION Q GAS Q ROOFING SPECIALTY Q OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES QNO BUILDER COMPANY SIGNATURE REGISTERED I Y/ N FEE CURRENT IY/N N Address License# ELECTRICIAN COMPANY SIGNATURE REGISTERED Y 1 N I FEE CURRENT Y/N Address License# PLUMBER COMPANY SIGNATURE REGISTERED Y/ N FEE CURRENT Y/N Address License# MECHANICAL COMPANY SIGNATURE REGISTERED I Y/ N FEE CURRENT Y/N Address License# OTHER COMPANY SIGNATURE G Y/ N FEE CURRENT Y/N Address P0 Box 149. New Castle. PA 16101 License# RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction, Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans wl Silt Fence installed, Sanitary Facilities&1 dumpster;Site Work Permit for subdivisions/large projects COMMERCIAL Attach(3)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction. Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, Sanitary Facilities&1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance SIGN PERMIT Attach(2)sets of Engineered Plans. ****PROPERTY SURVEY required for all NEW construction. Directions: Fill out application completely. Owner&Contractor sign back of application,notarized If over$2500,a Notice of Commencement is required. (A/C upgrades over$5000) Agent(for the contractor)or Power of Attorney(for the owner)would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (Front of Application Only) Reroofs Sewers Service Upgrades A/C Fences(PloUSurvey/Footage) Driveways-Not over Counter if on public roadways..needs ROW NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed"restrictions" which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any applicable deed restrictions. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or contractors to undertake work,they may be required to be licensed in accordance with state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the intended work,they are advised to contact the Pasco County Building Inspection Division—Licensing Section at 727-847- 8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the"contractor Block"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 and is not entitled to permitting privileges in Pasco County. TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings,change of use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and 90-07, as amended. The undersigned also understands,that such fees, as may be due,will be identified at the time of permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to receiving a"certificate of occupancy"or final power release. If the project does not involve a certificate of occupancy or final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact fees are due,they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances. CONSTRUCTION LIEN LAW(Chapter 713,Florida Statutes,as amended): If valuation of work is$2,500.00 or more,I certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other than the"owner", I certify that I have obtained a copy of the above described document and promise in good faith to deliver it to the"owner"prior to commencement. CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work will be done in compliance with all applicable laws regulating construction,zoning and land development. Application is hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. 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 Bayheads, Wetland Areas and Environmentally Sensitive Lands,Water/Wastewater Treatment. Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses. Army Corps of Engineers-Seawalls,Docks,Navigable Waterways. Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment, Septic Tanks. US Environmental Protection Agency-Asbestos abatement. Federal Aviation Authority-Runways. I understand that the following restrictions apply to the use of fill: Use of fill is not allowed in Flood Zone"V'unless expressly permitted. If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a "compensating volume"will be submitted at time of permitting which is prepared by a professional engineer licensed by the State of Florida. If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall construction, I certify that fill will be used only to fill the area within the stem wall. If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent properties. If use of fill is found to adversely affect adjacent properties,the owner may be cited for violating the conditions of the building permit issued under the attached permit application, for lots less than one (1) acre which are elevated by fill,an engineered drainage plan is required. If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A permit issued shall be construed to be a license to proceed with the work and not as authority to violate,cancel,alter,or set aside any provisions of the technical codes,nor shall issuance of a permit prevent the Building Official from thereafter requiring a correction of errors in plans,construction or violations of any codes. Every permit issued shall become invalid unless the 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 commenced. An extension may be requested, in writing,from the Building Official for a period not to exceed ninety(90)days and will demonstrate justifiable cause for the extension. If work ceases for ninety(90)consecutive days,the job is considered abandoned. 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. FLORIDA JURAT(F.S. 17.03) OWNER OR AGENT L "'V CONTRACTOR Subscribed and sword to(or affirmed) efore me this Subscribed and sworn to(or affirmed)before me this by by Who is/ar erson Ily kno o me or has/have produced Who is/are personally known to me or has/have produced q______________________________as __ "y _____ __ as identification, as identification. /I/-= ' �U�a.+ 7 ldotary Public Notary Public m Comission No. G- �/ .-- Commission No. Name o' otaty NW�_/�C I r1�S_F_VEN1SYLVANIA Name of Notary typed,printed or stamped NdtarlaI SDl Marsha L4 LafabVfM,Notary Public City of Now Castle,LdWranCo County I My CommisSibn Ex Irae Mr 1,,ao1_z. ---rte' Zephyrhills Fire Rescue 6907 Dairy Road,Zephyrhills,FL 33542 Fire Marshal Bus (813) 780-0041 Kerry Barnett Fax (813) 790-0044 E-mail: kbamettfire.zephyrhills.fl.us Plan Review#: 08-146 Project: Fireworks Display(Florida Hospital) Number of Pages: Fireworks Packet Date:November 17,2008 1 have reviewed the plans for the fireworks display located at 7050 Gall Blvd and will allow the project to move forward based on only life safety issues of NFPA 1123. Zephyrhills Fire Rescue is not responsible for any crowd control or parking issues that may reflect on a particular department within the City of Zephyrhills. 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 to be followed have been noted below and shall be followed. A. 4.2.1 Shells shall be kept in shipping cartons until setup for display. B. 4.2.2.2 A prep area shall be secured from the public 100' in all directions. C. 4.3.2 Mortars shall be spaced and separated so shells are propelled over the fallout area. D. Mortar racks shall be positioned and secured to withstand a shell exploding in the mortar. E. 4:6.3 All fireworks shall be secured and positioned using stakes, sandbags,racks, etc... to prevent tip over or hazardous movement during operation. F. 5.1.3 Minimum site requirement for fallout area shall be 350' diameter. G. 8.1.2 Crowd control shall be maintained by monitors located around the display and fallout site. This will not be completed by Zephyrhills Fire Rescue.Barricades,scene tape,etc...may be used to assist with crowd control.Monitors may be provided by the fireworks company or the hospital. H. 8.1.3.1 Ensure there is sufficient number of assistants available for the fireworks display. All assistants shall-be 18 years of age. I. 8.1.3.4 Protection for personnel during shoot shall consist of head, eye,hearing and foot protection.Long sleeves and long pants are 2 also required.Shorts,t-shirts and unprotected footwear will not be allowed therefore fireworks not be displayed. J. 8.1.6.1 No smoking,matches,lighters or any other open flame shall be within 50' of any fireworks. K Pressurized water extinguisher(minimum of 2—2A)shall be on site. L. Power sources for electronic firing shall be restricted to batteries or other isolated power supply. M. 7.6.4.1 Due to a portion of the hospital being located in the fallout area, approved personnel shall be positioned to watch and check the rooftop for any fallout debris. N. 8.2.6 This section refers to manually fired fireworks. This shall be followed. Inspections required: 1. On-site inspection required. This area shall be set up at least 1 hour prior to the display so all aspects of the display including setup of fireworks and firing system(s)can be checked. 2. Post display inspect. ICE 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. Nov. 14. 2008 2: 11PM Pyrotecnico No, 7436 P. 1 Headquarters U.S. Locations P.O.Box 149 I�AX Atlanta,GA 877.924.0102 New Castle,PA 16103 724. 652. 1288 Las Vegas,NV 800.9S6.7976 OFFICE nfor pytotecnico.com Montgomery.AL 800.255.1199 OT 1 724. 652.9555 wEl1 New Orleans,LA 800.783.2513 .,r..r r 800. 854.4705 www.pyrotecnico.com Tampa,FL 888.352.7976 Fax 813.780.0021 To: Jackie From: Marsha Date: 11/14/08 207:26 PM Pages: 2 including this page Dear Jackie: Please see attached W/C form. Please contact me if you need anything else. Thank you, Marsha Lefebvre Pyrotecnico The Information transmitted Is Intended only ror the person or entity to which It Is addressed,and may contain confidential and/or privileged material. Any review,retransmisslon,dissemination or other use of,or taking of any action In reliance upon,this Information oy persons or entities other than the intended recipient Is prohibited. If you received this In error,please contact the sender at Pyrotecnlco Immediately. CDL` , .350-116 j Shooter: Chris Reitano L°tvFroor, • •• T or«alw+T et.moor cv,.rt m.ny cohriwr t•u�:y by�,., 18405 Normandeau Street Sping Hill, FL 34610 SS#: 267-63-3577 DOB: 3/9/74 Chis .has worked for Pyrotecnico for 15+ years and has shot over 100+ shows Chris Reitano has shot the following shows this year: 9/27/08 Septemberfest in Shady Hill, FL 8/30/08 Spirit of the Suwanee in Live oak, FL 8/5/08 St. Lucie Mets in Port St. Lucie, FL 7/12/08 Yacht Starship in Tampa, FL • 7/5/08 SUVA in Suwanee, FL 7/4/08 DTAA in Tampa, FL You can call John Feigert at 770-842-3977 for confirmation. ;s k t g T = FRL-J :€4t yet, s (f2 5'( 2.- 6907 Dairy Road, Ze hyr'z{s 33542 'e Chief a`` h Williams _'s J ) =?'} _i;: (O 7 o0 c FIRE SERVICE USER FEES Occupancy No.: Plan No.: Contractor. x% 9d Business Name: Billing Address: ti≤ i1 51O Business Address: Business Phone No.: Billing Phone No.: Business Fax No.: Billing Fax No.: Contact: Contact. PLAN REVIEW FEES INSPECTION FEES PERMIT FEE FALSE ALARM FEE ii 8 Sle Plan N/C Annual NIC Sprinkler $50 let Alarm WC 06 of 11 1st Rednmpsctlon NIC U Standpipes $50 2nd Alarm WC (Mtnlmlan Chugs$25.00 2nd R.. epectlon $100 U Fie Pump $50 3rd AI rm WC 0 Plan Revisions DBL LI 3rd RaInspection 3250 Hoods $50 4th Alarm $100 4th Re-Inspadbn $500 UFks Henn $660 5th Alm $150 SPRINKLER SYSTEMS (Business dosed urn U LP Gee $50 6th Alarm $200 80-25 Heads $50 vlofatlans ooneaed) Natural Gas $50 NON CONK NCE $150 26 plus Heads $100 SPRINKLER SYSTEMS Fuel Tanks- per to* $50 STANDPIPE SYSTEM Hydro ttndrgrotnds $45 Fisperkiers $100 Per Riser $50 HydroetaHo Test $65 per sys em Works FIRE PUMP Acceptenoe Test $45 per Camp Fire 0 Per Pump $100 Hydrant Flow $75 Cont olsd Bum $100 FIRE ALARM SYSTEM Hood/Duct $50 0-25 Detttces $50 FIRE ALARM SYSTEM Piece of Assembly $50 nmwd 28 plus Devices $100 8 Syalmn Acceptance $50 Fie Protection $25 SUPPRESSION SYSTEMS Rece1 Aooepfance $50 Fmnsnoble Appkedon $50 A,ee l Wet $50 OTHER Waste Tiro Storage $50 Annual Dry $50 Fire WaW8mohs Wal $15 perwd Generator<KW $100 LI CO2 $50 U LP Gas $25 per Generator>30 KW 150 Other $50 U Natural Gas $25 p.r.yr.m Bio-Hazard Waste $100 Annual KITCHEN EXHAUST Ftanipe ion Teter $50 Hood/Ducts $50 Tent 10'x1U or gralaw $15 pertwa Torch PotAppled $50 OTHER Fie Pump $45 H .Materials $100 Annul LP 6w"N ",n per mnk $50 UFlro Suppression $30 Fuel Tank i stelation $50 System Acceptance (Per Tank) $50 Exhaust Hood/Duct $30 9 Nagaal Gas McNtrl.aoa $50 Re•trwpectlon DBL (Per System) (~am a nusO 0 Spray Booth $W inspection scheduled DBL and canceled leas than 24 hours Construction map. NIC Emergency Vehicle Ac' $50 rJFALSE ALARM PLANS TOTAL= INSPECTION TOTAL= PERMIT TOTAL 1 A TOTAL GRAND TOTAL I Comments: Date: 11/f7/4( lnsRctor._ 2`/ Headquarters U.S. Locations P.O. Box 149 - Atlanta,GA 877.924.0102 New Castle, PA 16103 724. 652. 1288 Las Vegas,NV 800.956.7976 info@pyrotecnico.com Montgomery,AL 800.255.1199 *-- ,- OTECNICO*" 724. 652.9555 New Orleans,LA 800.783.2513 VITALE FAMILY FIREWORKS • 1 8 8 9 800. 8554. 4705 www.pyrotecnico.com Tampa,FL 888.352.7976 City of Zephyrhills 5335 8th Street Zephyrhills, FL 33542 Dear Sirs: This is a letter of authorization for Jerry Sterner of Florida Hospital Zephyrhills to pick up the permit for the December 7, 2008 display. Sincerely, Pyrotecnico Marsha LeFebvre Show Coordinator Headquarters U.S. Locations P.O. Box 149 I Atlanta,GA 877.924.0102 New Castle,PA 16103 724. 652. 1288 Las Vegas,NV 800.956.7976 7� "1 11 rOteCniCO.COm Montgomery,AL 800.255.1199 i PYROTECNICOM 724. 652.9555 New Orleans,LA 800.783.2513 VITALE FAMILY FIREWORKS * 1 8 8 9 800. 854. 4705 www.pyrotecnico.com Tampa,FL 888.352.7976 The Show on December 7, 2008 will be shot manually. Thank you Christopher Mele General Manager 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 CFR 1910.1200, Standard must be Form Approved consulted for specific requirements. OMB No. 1218-007•2 IDENTITY (As Used on Label and Ust) Note: Blank spaces are notany applicable, or r)o p permitted if Rom Is not Fireworks '1 3 g UN 0335, PG I I information is available, the space must be marked"to indicate that. Section I Manufacturer's Name Emergency Telephone Number S. Vitale-P. rotechnic Ind., Inc d/b/a,Pyro ecni•co 8-5PM 800-854-4705 5-8AM 1-800-255-3924 Address (Number, Street,Clty,•State, and ZIP Coda) 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 tl -- Hazardous Ingredients/identity Information ' Other Limits Hazardous Components(Specitic•Chemical Identity; Common Name(s)) OSHA PEL ACGIH TLV Recommended % (ope) Special display fireworks contain explosive and pyrotechnic compositions, and are classified as fireworks, 1.3G, UN 0335, PG .II by the U.S. Department of Transportation. No chemical composition is exposed during normal handling and storage. Section III •-- Physical/Chemical Characteristics Boiling Point Specific Gravity(142O - 1) n/a n/a Vapor Pressure(mm Hg.) Melting Point n/a n/a Vapor Density(AIR h 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) Flammable Limits LEL n/a UEL n/a n/a Extinguishing Media • �SpEvialc not attempt to fight fire in vicinity of 1.3G Fireworks UN 0335, Evacuate area F1re Fighifn Proceduresuate f re •'area immediately and seek shelter. Fallow established emergency action plan. Unusual Fire and Explosion Hazards Unusual fireworks may mass explode in a fire situation StYie CU—FP174 Labelmaster,Div.of American Labelmark Co.Inc,60646 9. OSHA 174,Sept. 1985 section V — Reactivity Data Stability Unstable Conditions to Av i No open names, smoking or moisture in vicinity of stored stable fireworks. Avoi X d .friction and impact. IncompaNbllity(Materials to Avolrl)• Do not allow fireworks to get soaking wet. Hazardous Decomposition or Byproducts Devices will explode in fire situation. Hazardous May Occur Conditions to Avoid - Polymerization Will Not Occur X Section VI -- Health Hazard Data - Route(s)of Entry. Inhalation? ND V Skin? NO ingestion? NO Health Hazards(Acute and Chronic) There is no exposed chemical composition. Carcinogenicity. NIP? iJ - IARC Monographs? NO OSHA Regulated? 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 -- Precautions for Safe Handling and Use Steps to Be Taken In Case Material Is Released or Spilled • Cautiously pick up spilled devices and place in cardboard cartons. Absolutely no smoking open flames, or sparking metal tools. in vicinity of spilled fireworks. Waste Disposal Method 'f Soak any explsed chemical composition with water: sweep up with a natural- fiber brush and dispose of by• burning compliances with state and'local •regulations. Precautions to Be Taken to Handling and Storing Keep fireworks cool and dry. Avoid impact with shipping cartons. Absolutely no smoking in vicinity of any special fireworks. Other Precautions i'tone • Section Vill --- Control Measures• V Respiratory Protection (Specify Type) None required when handlin finished fireworks. Ventilation Local Exhaust N/A Special . N/A Mechanical(General) N/A Other N/A Protective Gloves N/A Eye Protection N/A Other Protective Clothing or Equipment • N/A WorwHygienic Practices Absolutely no smoking near an.y fireworks Page 2 *U-s.GP.o:rasa-491.529/45775 L.. /.'.':.................. 1 �:•\ ems` ;'•�•:'::::•:::::::::::::?::�:=:�:�:�:�:�:�:aa. : f ti \.:.�,. r....:::..... �Sp M \ /1 cg a /. ,y r\'•\ .4 ?�• f2 / III \:�fe•PAW R• / J I J I I 2•PAW 'E-\IS-PAW — `9 y 1 , • < ✓y / i 1 I " I ��'• �.� ` f�ctt sr�San � � ! . I � � {I / /%112'PAW pA(J/0 \4. I II PAu� / =p�1 '. L3'� uJ• I I }P • \\ \ \ r ( i \ `\ \ `�� \\r1 J SPEW uwrr SOV / } Ia J : weuc srca I J \ `� \\\\\` `\ �� i2 P + PAW Q 1 zz / I IbI \\` io vi y�,z c i I r oif + �/ wc�'�t��3� / // •I•.•i'.I `/ I I 1 ! fir,/rJ2• . —.ftCn! .—a- — _ .i / HTF,RY PnAn — «.o s)Fiy V\ I„ PYROTECNICO 11A11 1 E F AMI I'v' FIREWORKS . 299 Special Entertainment Presentation Rec. Body 50 2.5-inch Shells 50 Total Body Shells Barrage Boxes 1 25 Shot, 2.5" Barrage 1 36 Shot, 2" Barrage 3 49 Shot Barrages 1 50 Shot Barrage 2 60 Shot Barrages 1 100 Shot Barrage 2 130 Shot Barrages 738 Total Barrage Shells Grand Finale 60 2.5-inch Shells 60 Total Finale Shells 848 TOTAL SHELLS Pyro Proposal 11/4/2008 Pg. 7 of 9 FHZ htl 12-7-08$3,025* Headquarters U.S. Locations P.O.Box 149 Atlanta,GA 877.924.0102 New Castle,PA 16103 724. 652. 1288 Las Vegas,NV 800.956.7976 �11, r•.•,.,.ii Montgomery,AL 800.255.1199 info@pyrotecnico.com PY ROTE(1 .N4 1(2(11) 724 652.9555 New Orleans,LA 800.783.2513 VITALE FAMILY FIREWORKS * 1 8 8 9 800. 854.4705 www.pyrotecnico.com Tampa,FL 888.352.7976 November 7, 2008 FWCJUA c/o Travelers 2420 Lakemont Avenue P.O. Box 3556 Orlando, FL 32802-3556 Regarding: Certificate of Insurance To Whom It May Concern: Please accept this as notification for our request for a certificate of insurance. Policyholder: Pyrotecnico of Florida, LLC P.O. Box 149 New Castle, PA 16103 Policy Number: 6FR13UB 2840067 108 Effective Date: 06/22/08 Certificate Holder: Florida Hospital Zephyrhills 7050 Gall Boulevard Zephyrhills, FL 33541 (813) 783-6192 Fireworks Display Date: December 7, 2008 Attached, also, is a copy of the signed contract for the fireworks display. If any further information is needed, please contact me at 724-652-9555 or at bstone(cbpyrotecnico.com. Thank you for your assistance in this matter. Sincerely, Pyrotecnico Beth A. Stone Display Coordinator DEPARTMENT OF JUSTJCE 0 Bureau of Alcohol,Tobacco, Firearms and Explosives Martinsburg, WV 25401 September 3, 2008 Pyrotecnico of Florida LLC 901090:CR1i/SCC 30435 Commerce Drive Unit 102 Suites J&L 5340 San Antonio,FL 33576-8031 File Number_ 1-FL-00366 Premises Address:30435 Commerce Drive Unit 102 Suites J&L,San Antonio,FL 33576-8031 Dear Sir/Madam.: This letter acknowledges receipt of your timely application to renew your Federal explosives license/permit (1-FL-00366) as a Importer Of Low Explosives. The Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) is not able to process your application prior to the expiration date of your license/permit. However, Federal law allows you to continue operations under your current license/permit until such time as ATF completes processing your application. See 5 U.S.C. § 558. This letter, or as explained below, a follow-up letter., will serve as your license/permit until we complete action on your renewal. It is referred to as a Letter of Authorization (LOA). Since we have not completed processing your application,you may supply a copy of this letter to other licensees/permittees, e.g., your distributors, for the next six months (or until we complete action on your renewal, if that occurs in less than six months) as evidence of your licensed/permitted status. If we have not completed processing your application for renewal within six months of the date.of this letter, we will send you another letter, which will also be valid for six months (or until we complete action on your renewal, if that occurs in less than six months). This is of course contingent upon your remaining entitled to continue operations under your current license/permit. Please direct questions or concerns regarding this letter to Lydia Otalora at(304)616-4407. Sincerely, Christopher R. Reeves Chief,Federal Explosives Licensing Center ATF web address: www.atf.eov Nov. 14. 2008 2: 11PM Pyrotecnico No. 7436 P. 2 NOV 14 2008 9:07 AM FR TO 917246521288 P .02/02. t .:Ir4 '`� ii xz-os w I :.....v...-..a..,,..,.w�.l•,t�t•>Y•>: .,.. � Tg�7r:;t'.".'-. �Y.:.T........................-"...,.•...."°°•.:...>.'°':�'.`.:. .r THIS CERTIFICAT IS ISSUED AS A MATTER OF INFORMATION PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BRITTON GALLAGHER & ASSO HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR 6240 SOM CENTER RD ALTERTHE COVERAGE AFFORDED BY THE POLICIES BELOW. CLEVELAND OH 4Q139296S COMPANIES AFFORDING COVERAGE COMPANY 29XW3 A FLORIDA W.C. JUA INSURED COMPANY PYROTECNICO OF FLORIDA LLC B P.O. BOX 310 COMPANY NEW CASTLE PA 16103 C COMPANY D ...w.e••m.v..>.r....n� wa.."..-4w�^rN�a"1'aax• �.veeefa.��%xe»`'x4.5'wea::k..r • FF''��l C01+1'ER. .�. �, .° "'� ""a" ..... ........ wM• �*-t�- "s�+t"�4 i*r sue. . 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLIOY YXPIRATION LIMITS LTR DATI:(MM001YVI DATE IMMMDIYY) GENERAL LIAHILTTT GENERAL AGGREGATE S COMMERCIAL GENERAL LIABILITY PRODUCTS-COMPIOP AGO. $ CLAIMS MADE a OCCUR. PERSONAL&ADV.INJURY j OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE FIRE DAMAGE(Any one fire) s MED.EXPENSE(Any one person) s AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMB ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) HIRED AUTOS BODILY INJURY 5 NON•OwNtO AUTOS (Per A.oidene) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT s AGGREGATE 3 EXCESS LIABILITY EACH OCCURRENCE I UMBRELLA FORM AGGREGATE S OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION AND STATUTORY LIMITS � A 9MPLOYER'iLIABILITY (6FRl3Ub-2840C67-1-08) 06-22-08 06-22-09 EACH ACCIDENT S THE PROPRIETOR!PARTNERSIEXECUTIVEX INCL DISEASE-POLICY LNIT S i non nonOFFICERS ARE: EXCL DISEASE-EACH EMPLOYEE I OTHER i RIPTION OP OPERATIONSILOCATIONSNEHICLESIRESTRICTIONS!SPECIAL ITEMS THIS ZPZIAE ANY PRIOR CERTIFICATE ISSUED O 'rHE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE IC5UINO OOMPANY WLL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THY CERTIFICATE HOLDER NAMED TO THE FLORIDA HOSPITAL ZEPf1YRHILLS LEFT, BUT FAILURE TO MAIL OUCH NOTICE SMALL IMPOSE NO OBLIGATION OR 7050 GALL BOULEVARD UANILITY OP ANY KIND UPON THE COMPANY.ITS AGENTS OR REPRESENTATIVBB. ZEPHYRHILLS FL 33541 AU7HORIBBp REPRESENTATIVE V '� ** TOTAL PAGE.02 ** F A FLORA WORKERS COMPENSATION EV JOINT uNOERWRiT>Nc AssacwTioN,iNc. WORKERS COMPENSATION JUN 2 6 ZOO$ AND EMPLOYERS LIABILITY POLICY BRiTtOH O -SOH $&ASS . ING INFORMATION PAGE WC 0000 01 ( A) POLICY NUMBER: (6FR1 3UB-2840067-1-08) RENEWAL OF (GFR13UB-2840C67-1-07) INSURER: FLORIDA W.C. JUA NCCI CO CODE: 80179 1. INSURED: PRODUCER: PYROTECNICO OF FLORIDA LLC BRITTON GALLAGHER & ASSO P 0 BOX 149 6240 SOM 'CENTER RD NEW CASTLE PA 16103 CLEVELAND OH 44139-2985 Insured is a A LIMITED LIABILITY COMPANY Other work places and identification numbers are shown In the schedule(s) attached. 2. The policy period is from 06-22-08 to 06-22-09 12:01 A.M. at the Insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Worker's Compensation Law of the state(s) listed here: FL B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work In each state listed In Item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 1000000 Each Accident Bodily Injury by Disease: $ i 000000 Policy Limit 0 Bodily Injury by Disease: $ 1000000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: ° SEE ENDORSEMENT FWCJUA 03 01 D. This policy includes these endorsements and schedules: SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 4. The premium for this policy will be determined by our Manual of Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit. ANNUALLY. DATE OF ISSUE: 06-23-08 KF ST ASSIGN: FL OFFICE: FLORIDA WC JUA 821 29KWJ Page I of 1 PRODUCER: BRITTON GALLAGHER & ASSO 022718 CERTIFICATE OF INSURANCE ISSUE DATE Aa >>fl,� 01/17/2008 PRODUCER This certificate Is Issued as smatter of information only and confers no rights MCGRIFF,SEIBELS&WILLIAMS,INC. upon the Certificate Holder.This Certificate does not amend,extend or alter the P.O.Box 10265 coverage afforded by the policies below Birmingham,AL 35202 205-252-9871 COMPANIES AFFORDING COVERAGE Company United States Fire Insurance INSURED Company James River Insurance Company S.Vitals Pyrotechnics B dba Pyrotecnico P.O.Box 149 Company Westchester Surplus Lines Ins New Castle,PA 16103 C Company D Company E This Is to certify that the policies of Insurance described herein have been issued to the Insured named herein for the policy period indicated. Notwithstanding any requirement,term or condition of contractor 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,conditions and exclusions of such policies. Limits shown may have been reduced by paid claims. CO TYPE OF INSURANCE POLICY NUMBER EFFECTIVE LIMITS OF LIABILITY LT EXPIRATION B GENERAL LIABILITY 00029260 01/14/2008 EACH OCCURRENCE $ 1,000,000 0S1 Commercial General Liability 01/14/2009 FIRE DAMAGE $ 100.000 ❑Clalms Made ®Occurrence MEDICAL EXPENSE $ ❑owners'and Convactors'Protection EXCLUDED ❑ PERS.AND ADVERTISING INJURY $ 1,000,000 ❑ GENERAL AGGREGATE Is 2,000,000 General Ag[ aIe umtt açPtlesper PRODUCTS AND COMP OPER.AGG. $ 2,000,000 Policy 0 Project ULocatial A AUTOMOBILE LIABILITY 1337251149 01/14/2008 COMBINED SINGLE LIMIT $ 1,000,000 0AnyAutomobile 01/14/2009 BODILY INJURY Per person) $ ❑Ali Owned Automobiles ❑SdteduledAutomobiles BODILY INJURY accident) $ ❑Hired Automobiles PROPERTY DAMAGE(Per accident) ❑Nonvwned Automotkxs COMPREHENSIVE $1000 deductible ❑ COLLISION 1000 deductible WORKERS'COMPENSATION WC StatutoryLimit I I Other AND EMPLOYERS'LIABILITY EL EACH ACCIDENT $ EL DISEASE I $ EL DISEASE ! Limit $ B EXCESS LIABILITY 00029262 01/14/2008 EACH OCCURRENCE $ 4,000,000 ($iOcounence ❑CtaimsMade 01/14/2009 AGGREGATE $ 4,000,000 C EXCESS UMBRELLA COVERAGE G22054752001 01/14/2008 Excess of Underlying$4,Million I$ 5,000,000 01/14/2009 Is $ CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 80 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Authorized Representative Proof of Coverage Papa 1 of 1 CertfcateID# OGR0G0T8 ISSUE DATE CERTIFICATE OF INSURANCE ACORDTM 10/14/2008 PRODUCER This certificate is issued as a matter of information only and confers no rights MCGRIFF,SEIBELS&WILLIAMS,INC. upon the Certificate Holder. This Certificate does not amend,extend or alter the coverage afforded by the policies below. P.O.Box 10265 Birmingham,AL 35202 COMPANIES AFFORDING COVERAGE 205-252-9871 Company United States Fire Insurance INSURED Company B James River Insurance Company Pyrotecnico of Florida,LLC P.O.Box 310 New Castle,PA 16103 Company Westchester Surplus Lines Ins Company D Company E This is to certify that the policies of insurance described herein have been issued to the Insured named herein for the policy period indicated. Notwithstanding any requirement,term or condition of 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,conditions and exclusions of such policies. Limits shown may have been reduced by paid claims. CO TYPE OF INSURANCE POLICY NUMBER EFFECTIVE LIMITS OF LIABILITY LT EXPIRATION B GENERAL LIABILITY 000292600 01/14/2008 EACH OCCURRENCE $ 1,000,000 IM Commercial General Liability 01/14/2009 FIRE DAMAGE $ 100,000 ❑Claims Made ®occurrence MEDICAL EXPENSE $ EXCLUDED ❑owners'and Contractors'Protection PERS.AND ADVERTISING INJURY $ 1,000,000 ❑ GENERAL AGGREGATE $ 2,000,000 General Aggregate Limit applies per: PRODUCTS AND COMP.OPER.AGG. $ 2,000,000 XI Policy 0 Project 0 Location A AUTOMOBILE LIABILITY 1337251149 01/14/2008 COMBINED SINGLE LIMIT $ 1,000,000 XI Any Automobile 01/14/2009 BODILY INJURY(Perperson) $ ❑All Owned Automobiles BODILY INJURY(Per accident $ ❑Scheduled Automobiles ❑Hired Automobiles PROPERTY DAMAGE(Per accident) $ ❑Non-owned Automobiles COMPREHENSIVE $1000 deductible ❑ COLLISION $1000 deductible WORKERS'COMPENSATION WC tatu r Limit I Other AND EMPLOYERS'LIABILITY EL EACH ACCIDENT $ EL DISEASE(Each em to ee $ EL DISEASE(Policy Limit) $ B EXCESS LIABILITY 00029262 01/14/2008 EACH OCCURRENCE $ 4,000,000 Igl Occurrence ❑claims Made 01/14/2009 AGGREGATE $ 4,000,000 C EXCESS UMBRELLA COVERAGE G22054752001 01/14/2008 Excess of Underlying$4,Million $ 5,000,000 01/14/2009 $ Fireworks Display Date: December 7,2008 Location: Florida Hospital Zephyrhills City of Zephyrhills,FL The above listed are Additional Insured respects to General Liability policy as required by written contract subject to policy terms,conditions and exclusions. The Certificate Holder is named as Additional Insured with respect to General Liability as required by written contract subject to policy terms,conditions,and exclusions. CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Authorized Representative Florida Hospital Zephyrhills 7050 Gall Boulevard _ _ -. Zephyrhills, FL 33541 Page 1 of 1 CertihcateID# 17ADYRUG Nov 30 04 12s3Gp Public Relations ei3-7Q2- 108 p.S SITE INFORMATION FOR FIREWORKS DISPLAY Organization sponsoring event: Florida Hospital Zephvrhills, 7050 Gall Blvd. , Zephyrhills, FL 33541 - Jerry Sterner 813-235-3150 Date rind time of production: 12/7/08 -approx. 6:30PM Location ofproduction: Florida Hospital Zephyrhills Name o£main operator: Chris Reitano Number and ages of all assistants: Joe Pendola - 27 Yrs ; Charles Flanagan - 39 Yrs. Scott Lee - 95 Yrs Confirmation of License held by operator: See attached Evidence ofpermitee's insurance carrier: See attached Number and types of pyrotechnic devices and materials to be used: See attached MSDS for pyrotechnics used: See attached Extinguishers on site(presswi2ed water—at least 2): 2 Diagram of where production to be conducted(to include point of firing,fall out radius, and audience location): See attached Firing; safeguards in place: • circuit testers no more than 25 mA e power£or firing sources be restricted to batteries or isolated power supplies • firing systems ensures against accidental firing(2-step Interlock) • not to be left unattended • smoking prohibited within 25' of the firing/handling area • appropriate distance from audience(not less than twice the fallout radius) • all access points arc blocked off into firing/handling area 80/Z0 3E d 11d 00IN0310eIAd 9V9ZVZ60LL 19:VT L00Z/5T/TT Headquarters U.S. Locations P.O.Box 149 Atlanta,GA 877.924.0102 New Castle,PA 16103 724. 652. 1288 Las Vegas,NV 800.956.7976 Montgomery,AL 800.255.1199 info®pyrotecnico.corn *YR 0 T E C N I C 0 724. 652.9555 New Orleans,LA 800,783.2513 V I T A L E FAMILY FIREWORKS + 1 8 8 9 800. 854, 4705 www.pyrotecnico.com Tampa,FL 888.352.7976 November 11, 2008 City of Zephyrhills Attn: Jackie Please see enclosed the application for permit for Florida Hospital Zephyrhills on December 7, 2008. I am be sending the originals and checks to you so processing can get started while we wait for the license from FWCJUA. I have enclosed the letter to them and I will email the license as soon as we receive it. Please contact me if you have any questions or concerns at 800-854-4705 or email the address below. Thank you Pyrotecnico Marsha LeFebvre mlefebvre@pyrotecnico.com J -L __#ct� ALP