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HomeMy WebLinkAbout09-8883 CITY OFZEPHYRHILLS 5335-8TH STREET (813)780-0020 8883 BUILDING:PERMIT Permit Number: 8883 Address: 38116 5TH AVE Permit Type: SPECIAL EVENT ZEPHYRHILLS, FL. Class of Work: SPECIAL EVENT Township: Range: Book: Proposed Use: COMMERCIAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: Improv. Cost: Date Issued: 3/06/2009 Name: CITY OF.ZEPHYRHILLS Total Fees: 470.50 Address: 38116 5TH AVE Amount Paid: 470.50 ZEPHYRHILLS, FL. 33542 Date Paid: 3/06/2009 Phone: Work Desc: CELTIC FESTIVAL MAR 7 & 8/2009 2 DAYS 110.25 PER D - $250 DEPOSIT LUEL CELTIC HERITAGE SOCIETY OF FLORI SPECIAL EVENT 470.50 REINSPECiION'FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c)when extra inspection trips are necessary due to any one of the following reasons: a)wrong address b) condemned work resulting from faulty construction c) repairs or corrections not made when inspections called d)work not ready for inspection when called e) permit not posted on job site f) plans not at job site g)work not accessible. 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 permits required from other governmental entities such as water management, state agencies or federal agencies. The payment of inspection fees shall be made before any further permits will be issued to the person owning same "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." NT OR SIGNAT RE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER f 2ephyrhilis. _vt-! V r 947 000399 1367 liv V{n' 250.00 U.,00 urialli4E r {r a/ rCc�(;rT i �J.i.�is 1 Lf J�F� zr ': 220.50 ,r c,i PART II. APPLICANT INFORMATION Name of Organization: C—Q\ rte. 1 e C" u�-• ��s� Applicant must be a not-for-profit entity, register do busines 'n he State of Florida Contact person: Mailing address: ' Phone number(including area code): 1 1 . S y Alternate phone number ( ) Fax number(including area code): Email address: Sic Q ,,,�,�G{ ��, Date incorporated: '. ` ? c 4 Current corporate status:.(Circle One) Active Inactive Employer Identification Number(EIN: - i ' 1 PART II. . EVENT SPONSORSHIP Name of event: Ze jV,ç\. 6W 4 a L\ Do you have any co-sponsors for the event?: i/No Yes If yes, please list: Will an admission fee be charged to attend this event? Noes If yes,how much will the fee be? ' 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 fiscal year (October 1- September 30) APP! JE TTACHED CN^lTiONS J2sJ S1T€ PLAN APPROVAL EXPIRES OP ID PR DATE(MM/DD/YYYY) • ACORD O CERTIFICATE OF LIABILITY INSURANCE ID PR 03/03/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Gulfstream Insurance Group Inc HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P.O. Box 8908 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fort Lauderdale FL 33310-8908 Phone: 954-561-2220 Fax:954-566-0673 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Scottsdale Insurance Company INSURER B: Association of Scottish Games and Festivals, Inc. INSURER C. 1984 Valley Drive INSURER D: Dunedin FL 34698 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SR DW POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR TYPE OF INSURANCE DATE(MMIDD/YY DATE(MM/DD/YY) GENERAL LIABILITY EACH OCCURRENCE $ 1000000 UPJVIAUEIOKENIEU A X COMMERCIAL GENERAL LIABILITY CLS1577798 03/01/09 03/01/10 PREMISEs(Eaoccurence) $ 100000 CLAIMS MADE OCCUR MED EXP(Any one person) $5000 PERSONAL&ADVINJURY $ 1000000 GENERAL AGGREGATE $ 3000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1000000 X POLICY PRO T LOC JEC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY. AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND I TORY LIMITS ER EMPLOYERS LIABILITY E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? , E.L.DISEASE-EA EMPLOYEE $ If yes describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Insured: Zephyrhills Celtic Festival & Highland Games Event: Zephyrhills Celtic Festival & Highland Games, March 6-8, 2009 CERTIFICATE HOLDER CANCELLATION ZEPHYRH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL CIty of Zephyrhills IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 5335 8th St. REPRESENTATIVES. Zephyrhills FL 33542 A ORI REPRESE TIVE C_ 1O ACORD 25(2001108) ©ACORD CORPORATION 1988 PART III. EVENT INFORMATION Name of proposed event: S \\ 4L \ Date(s) and time(s) of proposed event: ;c � a�r�, l ` P IV - (/v1 Proposed event location: 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? �✓�No Yes. If yes, a separate request form for state road closure must be submittedwith this application. Will the event require closure of a City street/avenue?: `____No Yes Estimated number of vendors: IS Estimated number of food/beverage concessionaires: I Is it proposed that alcoholic beverages be sold, served or consumed at this event? No UxYes 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 activities associated wit�hp{ it: - S IaS Q� 14V G\d �i r•� �" 1C 'l�l r`%3 iG'. 'G:=�S J-%-`� 413 �1•a� . \ cam. n3 R y1�, n ce i vv :.ak\2.'✓VCS; f'\'A ��d31CN�nct C_ S J�•�y0,]�7w,��. "� '. c' .: �i1S t: i..f c.r- N- -: j Have you held this event before in Zephyrhills? No 7Yes If yes,when: `e �:y � 5 ,_ Estimate of anticipated number of spectators/participants attending the event: --çi , In the event of inclement or hazardous weather, do you have an alternate date selected? `/No _Yes If yes,what is the alternate date?: What electrical services will le required/provided for the event? (Please be as specific as possible): V > 1 n 5r r \� :� L� a.,:}� s ,s \≥ - .:`�\ �'� t� What other utilities will be required for the event? 3 Restrooms and garbage cans. 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 10'x 10' or larger will also require a fire rating certificate. tD� (\e iM e ' tv V y C i ' , L- Sz%'e o' ; -. x )� 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.): r Sew -s -' . y+Y C �. qS "` `f'ac,< c $ r o s• � Ycw�C S W"�>�Y' iCnGt �' 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? c- Attach proof of liability insurance in the amount of One Million Dollars ($1,000,000.00.) All policies shall name the City of Zephyrhills 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. 943-05 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. II II I By: Date: Title: Printed Name: 4-C sti's 1 5 y _ COVVfféJ SHOW EX Ffff' GE 'SHOW .4, EMERGENCY= ya 4 a / VEHICLE VVd V� Access= ACCF$5 V V VS. _,rS n 0CE VS 0 4 k, � r * ' MAI Sat1N CARs s STAG ' , + TENT� ATHLETICS .} s CLAN TENTS �X ��k FIELD , �awx,� r'_ `�.. j t eu JUbGE r T; -O CbI6ANDN . � SEER AND V V T AINML� E� TENTEER `}� }z sr �qr ' r Y 5 x 7i Y