The URL can be used to link to this page

Home My WebLink About09-9046 CITY OF ZEPHYRHILLS 5335 - 8TH'STREET (813)780 -0020 9046 FIRE WORKS PERMIT fi r, R 9 a 8 ° ,� * ,i ; :,1 D Y4I„, E ' f o " s �12 € a A ` " x ° s i < , ... ''. �... , �' .5 . Permit Number: 9046 Address: 5943 GALL BLVD Permit Type: FIRE WORKS ZEPHYRHILLS, FL. Class of Work: FIRE WORKS Township: Range: Book: Proposed Use: COMMERCIAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 10- 26 -21- 0020 - 0000 -0030 lmprov. Cost: iZ; %, . ..,..1 1.,i ,1, , sE Date Issued: 4/22/2009 Name: ZEPHYR LLC Total Fees: 526.00 Address: 5943 GALL BLVD Amount Paid: 526.00 ZEPHYRHILLS, FL. 33542 Date Paid: 4/22/2009 Phone: (813)927 -2426 Work Desc: TEMPORARY SALE FIREWORKS- JUNE 15TH- JULY 7TH 2009 _a= GALAXY FIREWORKS, INC FIRE PERMIT FEES 500.00 TEMPORARY SALES 26.00 n C (0 S/ed - n Ad 38( 1 vvv t 3 i. `$ `s�_° $x : ¢ E,• 7 e :'c r as €' -� 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. — r') / ACW (A- 6Ctiv CONTRACTOR SIGNATURE - • -4 I • IC R PERMI?I EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOURS NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813- 780 -0041 i _ZEPHYRHILLS FIRE DEPARTMENT • 6907 Dairy Road, Zephyrhills, FL 33542 Fire C l ief Keith Williams Bus (813)780 -0041 Fax (813)780 -0044 FIRE SERVICE USER FEES Occupancy INo.: Plan o.: 9 -4 • Contractor up it /' ��! S" Busin ss NaEne: 1.24- Billing Address: ter' G� # �' ii Busin ss Ad tress: �S 6 , - Busin ss Phone No.: Billing Phone No.: Busin ss F4 No.: Billing Fax No.: Conta : ! Contact: 1 _ PLAN REVI FEES _ INSPECTION FEES _ PERMIT FEE _ FALSE ALARM FEE — Site Flan I N/C — Annual N/C _ Sprinider $50 — 1st Alarm N/C _ Muni- amiy /C .06 sf — 1 st Re- inspection N/C _ Standpipes $50 _ 2nd Alarm N/C (Minimum Charge $25.00 _2nd Re- inspection $100 _ Fire Pump $50 — 3rd Alarm N/C El Plan Revisions DBL _ 3rd Re- inspection $250 _ Hoods $50 4th Alarm $100 — 4th Re- Inspection $500 _ Fire Alarm $50 _ 5th Alarm $150 _ SP NKLER SYSTEMS (Business closed until LP Gas $50 _ 6th Alarm $200 _ 0 - Heads; $50 violations corrected) — Natural Gas $50 _ NON COMPLIANCE $150 26 pl I Heads $100 SPRINKLER SYSTEMS _ Fuel Tanks - per tank $50 STANDPIPE SYSTEM Hydro Undergrounds $45 Sparklers $ '' EI Per Riser I $50 Hydrostatic Test $65 per system / Fire Works $500 IRE PUMP Acceptance Test $45 per system . Camp Fire . 0 Per P Jmp $100 Hydrant Flow $75 . _ Controlled Bum $100 _ FIRE 4LARM SYSTEM _ Hood/Duct $50 — 0 - 25 Devices $50 FIRE ALARM SYSTEM _ Place of Assembly $50 Annual _ 26 plus Devices $100 System Acceptance $50 _ Fire Protection $25 SUPPRESSION SYSTEMS _ Recall Acceptance $50 _ Flammable Application $50 Annual Wet i $50 — OTHER _ Waste Tire Storage $50 Annual Dry $50 — Fire WalUSmoke Wall $15 per wall Generator < KW $100 — CO2 $50 _ LP Gas $25 per tank Generator >30 KW 150 — Other $50 _ Natural Gas $25 per system _ Bio- Hazard Waste $100 Annual KITCHEN EKHAUST _ Fumigation Tenting $50 H ucts $50 . ent 10x10' or greater $15 percent _ Torch Pot/Applied $50 OTHER Fire Pump $45 _ Haz. Materials $100 Annual R LP I Ilation rer tank $50 Fire .Suppression $30 Fuel T nk Insialiation $50 System Acceptance Per T $50 _ Exhaust Hood/Duct $30 0 Nature Gas Insaliation $50 _ Re - inspection DBL ( er Sy (other than annual) _ El Spray Booth $50 Inspection scheduled DBL _ and cancelled Tess than _ _ 24 hours _ Construction Insp. N/C _ Emergency Vehicle Act $50 � — FALSE ALARM PLANS TOTAL' INSPECTION TOTAL PERMIT TOTAL ti TOTAL GRAND TOTAL Comments: (J" Date: 472 / - i Insphactl r. I ` �� Apr 22 2009 12:40PM HP LASERJET FAX p.3 WO1UU KS U'I,iNZXNSATLUN AND ZtL' VXJSKti LlAB L.Tr 11VSU1(ANU]S rUL1UX INFORMATION PAGE 5 Insurer: PRODUCER: Agent# \ 1 T.H.B. Insurance Company / Allied Specialty Insurance Inc. 10451 Gulf Boulevard 10451 Gulf Boulevard Treasure Island. FL 33706 Treasure Island. FL 3706 (Carrier Code: 40851) _ Carrier Policy #: WC08945 Carr r Prior Policy #: NEW 1. The Insured: Galaxy Fireworks. In . Mailing Addrees: 204 E Martin Luther ,*ing Jr Blvd /' Tampa. FL 33603 Fein: 593092878 Policy #: 9''- Other workplaces not own above: Type of Business- 'rpora i•n SEE SCHEDULE OF OPERATIONS Risk +4: 1 2. The policy period is from 12:01 a.m. on 11/18/2008 to 12:01 a.T. on 1 1: 0 at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy appli to the Work -rs Compensation Law of the states 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 No are: Bodily Injury by Accident $ 1,000,000 each accident Bodily Injury by Disease $ 1.000.000 policy limit Bodily Injury by Disease $ 1.000.000 each employee C. Other States Insurance: All states except: ND. OH, WA. WV and WY D. This policy includes these endorsements and schedules: WC000000A(04 /92) WC000308(04/84) WC000402(04/84) WC000404(04/84) WC000414(07/90) WC000419(01/01) WC000422A(09/08) WC090303(08/05) WC090403A(01/08) WC090606(10/98) 4. The premium for this policy will be determined by our Manuals of Rules. Classifications. Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Code Premium Basis Rate Per Estimated No. Total Estimated $100 of Annual Annual Remuneration Remuneration Premium SEE SCHEDULE OF OPERATIONS Total Estimated Annual Premium $ 1,671.00 Minim= Premium $ 518.00 Expense Constant $ 200.00 WC 00 00 01 A Countersigned by v Apr 22 09 12:11p Galaxy Fireworks, Inc. 813- 234 -1516 p.2 CERTIFICATE OF INSURANCE ISSUE DATE • ACORD 0412V2009 PRODUCER This certificate is issued as a matter of information only and confers no rights MCGRIFF, SEIBELS 8 WILLIAMS, INC. upon the Certifigte Holder. This Certificate does not amend, extend or alter the P.O. Box 10265 coverage afforded by the policies below. Birmingham, AL 35202 800 -476 -2211 • COMPANIES AFFORDING COVERAGE • Company James River Insurance Company A INSURED Company Galaxy Fireworks, Inc. B 204 East Martin Luther King Drive Tampa, FL 33603 Company • 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 A GENERAL LIABILITY 000319120 06;10/2008 EACH OCCURRENCE $ 1,000,000 2:3 Commercial General Liability 06110/2009 FIRE DAMAGE S 50,000 ❑ Clams Made ® Occurrence ❑ Owners' and Contractors' Pnotecbon MEDICAL EXPENSE $ EXCLUDED Dr Deductible 52,500 PERS. AND ADVERTISING INJURY $ 1,000,000 l ❑ GENERAL AGGREGATE $ 2,000,000 General Aggregate Limil app ,es per. PRODUCTS AND COMP. OPER. AGG. $ 2,000,000 ❑ Policy ❑ Project Din location AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ❑ Any Aultomosile BODILY INJURY (Per person) $ ❑ All Owned Automobiles ❑ scheduled Automobiles BODILY INJURY (Per accident) ❑ flied Automobiles PROPERTY DAMAGE (Per accident) $ O Non -owned Automobiles COMPREHENSIVE I ❑ COLLISION WORKERS' COMPENSATION j WC Statutory Limit I 1 Other 1 1 AND EMPLOYERS' LIABILITY EL EACH ACCIDENT $ EL DISEASE (Each employee) $ EL DISEASE (Policy Limit) $ A EXCESS UABILrTY '000319130 06/10/2008 EACH OCCURRENCE $ 4,000,000 011 0cc4rence OClaims blade 06/10/2009 AGGREGATE 1$ 4,000,000 $ • $ $ Please Note, Exces retie Policy will extend •• o e and = - • • Au • • . ::. =' • Policy # M8VF9450. Limit $1,000,000 CSL,; 11/18!08 to 11/18/09; Insu ith T.H.E. Insurance • • -ny, Agent: Allied Specialty Ins.; easure Island. FL ( : 61- 237-3355) AND: Florida Worke Compensation Cove . • ge Pokcy# WC089451: Limit: $1,000,000; 1 /18/08 to 11/18/09 is pr • 'ded by T.H.E. Insurance Company, Agent Allied Specialty Ins.; reasure Island, FL (1 -80C- 237 - 3355); jcontinued next page) 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. City of Zephyrhills, Pasco County Board of County Commisioners and Zephyr Mark Rider Authorized Representative 5335 8th Street Zephyrhills, FL 33542 USA . , Page 1 of 2 l CenilicatelD• 7J35NHJY Apr 22 09 12:12p Galaxy Fireworks, Inc. 813- 234 -1516 p.3 ADDITIONAL INFORMATION -- 'SSE SATE 04122!2009 PRODUCER CERTIFICATE HOL \ MCGRIFF, SEIBELS & WILLIAMS, INC. City of Zephyrhi s, Pasco County Board of County Comrni ners and Zephyr Mark P.O. Box 10265 Ader Birmingham, AL 35202 5335 8th Street 800 -476 -2211 Zephyrhills, FL 33542 • I USA i �/, INSURED \ , / Galaxy Fireworks, Inc. \ 204 East Martin Luther King Drive ' Tampa, FL 33603 '\ TEXT (continued from previous page) Stand Location: 5943 -5953 Gall Boulevard, Zephyrhills, FL 33542 City of Zephy_hilis, Pasco County Board of County Ccauais_oners, Zephyr Hark Rider all their agents, representatives and subsidiaries The above listed are Additional Insured respects to General Liability policy as required by written contract subject to policy terms, conditions and exclusions. . E t Pane 2 of 2 1 Certificate 101 7J35NHJY Building Dept turent • G� G^f Date Received / j �,,, 676 f _ S95 _ (, 6 I Phone Contact or Permittin• f 0 ✓9 `� 16 Owner's Name `.\ \--..\—g....— Owner Phone Number t 49aki -c z Owner's Address t A\ 2.0 2 1'"" ' 1 1\ - Owner Phone Number Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address JOB ADDRESS 6 / Li 'J e \\- A v0 k. \ ' \LOT # SUBDIVISION PARCEL ID# (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR ADD /ALT I SIGN ( I MOVE I I DEMOLISH INSTALL REPAIR PROPOSED USE I I SFR 1 1 COMM I OTHER 1 I TYPE OF CONSTRUCTION I 1 BLOCK 1 1 FRAME I 1 STEEL 1 1 OTHER I I DESCRIPTION OF WORK ? (�' yC � BUILDING SIZE SQ FOOTAGE HEIGHT I BUILDING $ VALUATION OF TOTAL CONSTRUCTION I I ELECTRICAL $ AMP SERVICE 1 I PROGRESS ENERGY 11111 W.R.E.C. I I PLUMBING $ I I MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION I I GAS 1 1 ROOFING I 1 SPECIALTY I 1 OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA 1 1 YES 1 1NO • BUILDER COMPANY gliP\Q 1 ` .r N SIGNATURE U REGISTERED Y / N CURRENT Y / N i Address License # ELECTRICIAN N COMPANY SIGNATURE REGISTERED I Y / N I FEE CURRENT I Y/ N Address License # PLUMBER COMPANY SIGNATURE REGISTERED ( Y / N _I FEE CURRENT I Y / N Address License # MECHANICAL COMPANY SIGNATURE ' REGISTERED 1 Y/ N ' FEE CURRENT I Y/ N J Address ( License # OTHER t 1 COMPANY SIGNATURE REGISTERED 1 Y/ N I FEE CURRENT 1 Y/ N 1 Address 1 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 w/ Silt Fence installed, Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions /large projects COMMERCIAL Attach (3) 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 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 (Plot/Survey /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 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 JURp jt7.03 1 ` , OWNER OR AGENT ' 'k 4 ._ _ 4, - + CONTRACTOR �_- - .10... —...0. by eC� bed Q and swo 4. (or rmed e e m - this Su scn d and sworn to, • a o �;\ e t' is � by e i C' 44",1,(1/l i /are ppe ally known to a or has/have produced o is/ re person3HHv known to me V r has /have produced N� L ' as identification. / /`► as identification. k :-et i � . n �n�' c'- N o t a Public P . i Notary Public 7 1 ' - Notary Commission : -- Commission No. Vie-l.'s.'" t .14'1' . -. , e Name of Notary type , P Name of No : prin • • �A N DIANA LEMO>� E. MY COMMISSION # 00720914 � '* MY COMMISSION # 00720914 • '', • I_XPIRES October 01, 2011 - • '. .��t EXPIRES October 01, 2011 m • (407) 398 -0155 FlwldalloMrySgrvico.com (407) 398-0153 FlotldallotoryServico.com 813 -780 -0020 City of Zephyrhills Permit Application Fax- 8A3- 78C -PC2' Building Department Date Received Phone Contact for Permittin. -- 1ittttllltltlllt111► Owner's Name Owner Phone Number Owner's Address Owner Phone Number Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address JOB ADDRESS LOT # SUBDIVISION PARCEL ID# (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR I I ADD /ALT 1 SIGN 1 I MOVE 1 1 DEMOLISH INSTALL REPAIR PROPOSED USE I I SFR [ I COMM 1 1 OTHER 1 TYPE OF CONSTRUCTION I I BLOCK I I FRAME I 1 STEEL 1 1 OTHER 1 I DESCRIPTION OF WORK BUILDING SIZE SQ FOOTAGE HEIGHT I I BUILDING $ VALUATION OF TOTAL CONSTRUCTION 1 I ELECTRICAL $ AMP SERVICE 1 1 PROGRESS ENERGY 1 1 W.R.E.C. I I PLUMBING $ I 1 MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION 1 I GAS I 1 ROOFING 11 SPECIALTY 1 1 OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA 1 'YES 1 'NO BUILDER COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/ N 1 Address License # ELECTRICIAN COMPANY SIGNATURE REGISTERED L Y/ N I FEE CURRENT 1 Y/ N 1 Address I License # PLUMBER COMPANY SIGNATURE REGISTERED I Y / N I FEE CURRENT I Y/ N 1 Address License # (- MECHANICAL COMPANY SIGNATURE REGISTERED I Y/ N 1 FEE CURRENT I Y/ N I Address License # I OTHER COMPANY SIGNATURE REGISTERED I Y / N 1 FEE CURRENT I Y/ N 1 Address I License # F 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 w/ 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. (AIC 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 NC Fences (Plot/Survey /Footage) Driveways -Not over Counter if on public roadways..needs ROW LEASE AGREEMENT This Lease Agreement is entered into as of the _30 day of January , 20 19 by and between the undersigned Lessor and Galaxy Fireworks, Inc. a Florida Corporation, having its principal place of business at 204 East Dr. Martin Luther King, Jr. Boulevard, Tampa Florida 33603 ( "Lessee(s) ") for the purpose of establishing the terms and conditions by which Lessor leases certain property to Lessee. In consideration of the following covenants and conditions, and of other consideration the receipt and sufficiency of which are acknowledged, Lessor and Lessee agree as follows: 1. Premises Location: The property that is the subject of this Lease Agreement (the "Premises ") is located at the following address 5943 Gall Boulevard. Zephyrhills. FL 33542 . 2. Occupancy: Lessor represents and warrants that it owns the Premises, and Lessor hereby grants Lessee the exclusive right to occupy and use the Premises undisturbed during each Term (as hereinafter defined), access thereto (including the right to cross surrounding property belonging to Lessor, if any), along with all other rights provided to a tenant under the laws of the state of Florida. 3. Term: . The periods during which Lessee will be entitled to occupy the Premises ( "Terms ") are as follows: Term 1 is from June 15. 2009_ until _ July 10.2009 s;”us�... .: • * . (`Initial Lease Period "). - - ' . • - . - - • - ' - , , , • .. • . - • • • • .... • ' •. .. - - - • ' • . • 4. Use: Lessee may use the Premises to sell seasonal products, including but not limited to fireworks and items incidental thereto. 5. Rent: Lessee will pay Lessor the sum of $2.000.00 for term 1 • '..:..._e - -- ' • • • • ... • • • day of the applicable Term. 6. Permits: Lessee agrees to acquire any and all permits required by governing authorities for Lessee's intended use of the Premises. if the permits are not approved for any reason, this Agreement will be null and void, and all deposits will be refunded to Lessee. lf, after any necessary permits have been issued to Lessee, Lessee is prevented from using the Premises for the intended purpose of selling fireworks during any part of a Tenn because of an act of God, war, executive order, ordinance, change in law, or other reason beyond Lessor's or Lessee's control, Lessee will be relieved of its obligation to pay rent for that Term, and any rent paid for that Term will either be refunded to Lessee or applied to the next Term, as Lessor chooses. Lessor shall make that choice and notify Lessee within ten days of being informed by Lessee that it has been prevented from using the Premises. 7. Indemnification: Lessee shall indemnify and hold Lessor harmless from any and all actions and claims resulting directly and solely from Lessee's use of the Premises, including but not limited to claims by Lessee's licensees, or invitee, and trespassers. 8. Fixtures: All structures (including tents) shall be placed on the Premises under the approval of Lessor. Any placement shall not interfere with Lessor's use of property surrounding the Premises. Any installation shall not damage any of the Lessor's improvements on the Premises. 9. Insurance: Lessee shall provide Lessor with proof of liability insurance before the Term begins. Liability insurance shall be in an amount of not less than $1,000,000. for each occurrence. 10. Maintenance: Lessee shall maintain the Premises in an orderly manner and will haul away any and all trash made by Lessee, its customers, and vendors prior to vacating the Premises. notifies Lessor 30 days in advance of a particular year during the Option Period that Lessee elects to not exercise its option for t . - , essee will not be required to pay rent for that year, and Lessor will be free to rent the Premises to someo, - - - - . . • - ar, su •Ject to Lessee's right of first refusal set forth below. Such election will not affect s • - • - • . • . la essee elects to not exercise its option for a particular year, Lessee has the exclusive right o - . : . • a c any and all offers to lease the Premises during that year. Lessor shall notify Lessee in writing of any such offer and the 12. Non - compete: Lessor agrees to not sell or permit the sale of fireworks by anyone other than Lessee on any property owned or leased by Lessor within 2 miles of the Premises. 13. Cancellation: If the Premises is sold, master leased on a long term basis other than for the sale of fireworks, or the law is changed to prohibit the sale of fireworks for all remaining Terms, this Agreement may be canceled by either party providing thirty days written notice to the other party. IN WITNESS WHEREOF, Lessor and Lessee have each caused this Agreement to be executed and to take effect as of the date first above written, as evidenced by the signatures of their respective duly authorized representatives appearing below. Galaxy Fireworks, Incorporated (Lessee) Zephyr LLC (Lessor) By: h0A yr .L "W By: Signature 1 Signature _ Sharon Hunnewell- Johnson. President / . N' // : AK:- P a 7 / ' R Name an t\ Title Name and Title q —1, O /.�0 /RC / ie 200 / Date Signed , D l ate Signed / 1 Before me, the undersigned Notary Public, personally appearetf?r •s. __ /'1 J.,.... 4 j,6, —S o ----, known to me to be the person who executed the foregoing Lease Agreement, and she/he acknowledged to and before me that she/he executed such instrument and agrees to fully comply therewith. n .....• IN WITNESS H R ave s y hand and seal this T day of �z 20 O F i Notary Public, State of Iorid PATRICK D COOK � / 3 J( 2- Colhmia,Ilan . DD 745420 D My Commission Expires { (� A ,t ril 3, 2012 ,• • SondM fMU Tro No roma a00-306706 • . , : . • ' . . . . . . - . . • . .. - ' - .- - " . ''. . . . - ".•• • • . . • ... ... ; . . . : . , . . ..,,app„„,,....„„„..............., . . _ . . , . . . - - - - - . „...,.. . - - ,--- - ,__ ----..„_,. - .. . . . . . - - - - - "N. _ .." ' - - -...../'"---/ - ''--/ -- N- - - - - • ' " " ' , . . . . _ „. - - - - . . „ -,•___'.."-,-". •,....--„--:"... 'F' • • . •.• : : .,, a. t • ; • (7. o :-. -, -0 1r :_l . . . N .• - , . . r 1 . c..'" n -, - .0 - `/■.,qtr. 1 , - 4 ..,, . 7 ...; ,• ,...,:•-, -- i ..../jA ,) ,.; , IA.... ,-, _ - - 0 . • . - :.1 0 . P) ("") 0 , T-5 n • 2 , -.I - r ";.>. ./,' j' I . - • 2 (f) • — 11 • 71 0 fl) — — 0, - z3- . .- 4.i.'r . ..., - .,r. o .- --s • . .-._., -. ,..... -- w 03' .:. --. c .,, •IAer c'' u .- .• - "'' (cp r (I) , ,_ El - E - •--' • 0: -'<r) ci ti D a a;.- -.. L u. Ett n ; I - :, .-- • -. .- ---7 t- - ,-, (... 70 I -- z_- ) - - -= (n _2 -d g CD - 6 ru ca p) 0 - lu P1 0-- t7 ; -': • : : , 5 a_i .. 3 — — 2- __o ,--3 0 0 ..... !:. . ... 0 . (D . : m - '13 , -- .... cr. - T 0 :-..r.(0•• -. -, (0 •:... ..4 : .V .. .- ..: - Zi • . -::, cp C2- 0 RI 0 ' Z fr. (t) ` - < ' Z : " - .. - -0 C - e ;;',..-.• --:: • Ff a ',.....- 0: 7-p. ."..-.- 7 .1 S — (.,, -- .--. — -, ,,, n :. P- . c:.i"-:: —: -1 w- --: =•-• '''' a' DI 0 ' g.p - ,:,....? .,-, • , . ..,T, .c.,), • : t-- - • .,... *- . • . 0 :: .... • --t. = 0 - p.., co .....,.. • .-- :, - . z (3 . :.:,. ..- - . __., - fL CI al --. cb P z 13 • -:,,i . 0 c_1 ni n ---- : . 7, • , ::- . 1-- - - •-•--- .. •,--,'' 0 • •-, Z .11. Q. o 1/4 !-, . .........-: -, - - - - 2-4 . .... - al - I - • •'.... • - ,„ - (I) . 0 (j : oti . - . ::.... .... • 1-.1 ; ' .. . k L.V . ; Cr) . 0 ..., ,...., 0 • a •••••. ' . 1 an Cr; pi as . . . • c - 7. co -. o ni .-.. 13) .-I - -s. , *--1 - . , ;-4 - r < 0 . Cr. - C Zr - — CD : , r r 5 i• nl di CL ? • 0 ( 1...) a ... k'D : (li ..., ,---1 *".: . " Q_ 'V -1 - - r''' : • - :-.-. ;,. 1.1. .- -- i CD CD • ..... (r) 01 CO =" R .--1 -. .. l P1 . - al (I) 7 = • _ ,..._, • • t.,Li O. ci.. a ____-, • a , -- a _.1 0 . -4 0- GI rb -,.: 4 ,....,.. 6 ::-. • - ..5 = ,L__ ar.4. -, : - co c 1 :"" Z- 0: j."- > (" i") - ;: -. )c, •ti r . - . 3 .... : .. i-L4.- , _ F..' ...:? -4 '-:•;;; 1 ":-:"." i. , -.: - • = :•:•••• — -• z ( i P__ = • 1 71 11) Cr' LI - 1<' , C -t ' co s_... - . .: _. :,...-:...'..- * .,.... Z ' - • * " ' 113 (D CI- CL Z P c (i_ '''. II': 74,- ,;:- .:•:,;:' ,t- : ..... 1-.- ,---,....-: ..- . •-: . .-.. cv- ,::-:-...:".-- Pa T : 0 .• ."- : . • 0 f 0 t ' i t.1 g k .: - to. - .. ...: ...-i..1 ,.... '... 0 - ... ''-''. I.: • - -:, • • i• • .._ tl.:.: ■ .Z. fa • : '': . .:-- • -: :• 7 1,1 IQ --, t.it 0. :1,.. ,....., . . ,. --L.,) --,... •....k.,„ :2 ..., ..•.! ...■ :;. - - ..:-i-o- - : ' 0 - -. cy.3 :.:,-:-- .n1,1 t 0 CI 1 ... 1 _, cu ....,_-•- ._,. ..,.. ....: . :•:;fr (- I ' ... r i .":: ..:- ay-. tri, .• n i = o o 2- ( J 4 or '-' ri . . fg . • -1'. ' .. ' . s '' • • ' 1 1 CI 27,3* ' . . • .....:•:. . " Ttl . - S • • , ...:-. ." 2 - • (. — ‘...3 -1 (13 ' ..1- c .-.4 ,..:i ,. .... (-I ..---.-.,..':- ,.— -- j.- : 0 u 11 .: 5- n - fn. z • 0 = •-.4. 1. • - a to n Irk -::: . - 0 - .."I "- - -: • : .. -.,.....t.."1 0 ., = • -4 - = ri ' (JJ t• 1 CI 2' 4 • . 4.„, • . .........„..:_--....-...o ... ,.. ... m C) -- .. . .... p - - :. . . : . ' 0 : < 6 D fll .. •• , ... p • T ; a) , - 7 - • . r...7- --. -a 11; ..-, a ID 'OF( - • • D CU i I • Gs a- 2 ,,. , s co cL a) • ., _ . . • .- ID . • . c - =-. - 6 t..7- - ro CD ri . • (13 . -,- . , • (n f. J . ) •-• fij ' (1) d ; - ru =T . 0 0 • Ca- a - ru - • ft/ < - c r i fp — (1 ' `P • - ..---- . Map - Pasco County Property A , raiser Page 1 of 1 Pasco County, Florida 0.9 miles NNW of Zephyrhills Mike Wells / • -- . , .1,1 - ,:lisii via a t l[ -r. y 1 � � ., . .ga t- , ,, — 4 When I click on the map: !� +G ` ■ :� s s Quick Info : , Full Info* . .m' ' . r•r u,W X ', Q. Zoom In 1.5x . " a # . Choose Layers: ` o r E 110, -- Parcel Lines (Default) 4 - - Parcel Labels (Automatic) F "1 , s - Street Names (Automatic) r , _ r . A, ? 2007 1 ft - Color a s 1" ` -.1 61 -.,-, II ._, . 1t s -- Select Additional Layer -- Select Grouping ® Dr,�w F i , �Ip P rint a 1 Image Size / Quality: ,_ $ . ' ,- A 1,* -.A. ir...,,... - ut 1. - (Q uaGt y applies it imagery is selected) � r ' _ a 1 vy i � .. '� Low Quality (Fast / JPEG) ac a< .. , a LL il► I Links of Interest: ■ 4 Recent Sales m this area Search tor property in Pasco 11 P1 Map Search 1,468 Feet Map1D= 4P84 Street name information is maintained by the Pasco County BOCC GIS Department. http: / /maps.pascogov.com /maps /showmap.asp ?Name = PascoMap_New &mdi = 4684315 &o... 12/8/2008 p i ---->W-3e, * I N :: ,i. 0 STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES k DIVISION OF STATE FIRE MARSHAL TALLAHASSEE, FLORIDA > -." CERTIFICATE OF REGISTRATION WHOLESALER OF SPARKLERS THIS CERTIFIES THAT: GALAXY FIREWORKS INC 204 E MARTIN LUTHER KING BLVD TAMPA, FL 33603- HAS REGISTERED PURSUANT TO THE PROVISIONS OF FLORIDA STATUTES TO ENGAGE IN THE BUSINESS OF SELLING SPARKLERS TO A RETAILER. al Chief Financial Officer 02101 2009 07 62 Hillsborough 72584000012006 1278410001 1000.00 01131 2010 Issue Date Type Class County License/Permit Number Application # Taxes & Fees Expire Date • CITY On ?EPHYRHILLS BUILDING DEPAT 'LENT OWNER ' C ��X V \v1.1°A...')(:)� JOB LOCATIO \ N PARCEL 1. D .. # - ‘2._`Q- cp_ ( -ncy•cyj - co SHOW ALL EXISTING & PROPOSED STRUCTURES GIVING DIMENSIONS & SETBACKS. '\`SCOOA ).\ - /o -- a' C 0 6; I V '4\ - c s o � UTILITY BUILDINGS MUST SHOW SIZE & FOUNDATION INFOR- MATION. FRONT PROPERTY LINE (NOTE EXAMPLES 1 & 2) STREET 1. SETBACKS FOR R1, R2 ZONING 2. SETBACKS FOR R3 ZONING 60' 60' 10' 10' - R X O I 10' P S 10' 10' EXISTING 10' O. T S I - E N D G PROPOSED 20' 20'SGL FAM 30'DUPLEX FRONT PROPERTY LINE FRONT PROPERTY LINE 4 14, ALLIED April 22, 2009 City of Zephyrhills 5335 8th Street Zephyrhills, FL 33542 RE: Galaxy Fireworks, Inc. - Insurance Policy: WC089451 Effective: 11/18/2008 to 11/18/2008 Type of Insurance: Workers' Compensation Dear Sir /Madam: Enclosed please find a copy of the declarations page for our insured Galaxy Fireworks, Inc. as requested. Galaxy Fireworks, Inc. is in good standing with our company and has always been very professional. We are pleased to have the privilege of representing them. Thank you for the opportunity to serve you. If you have any questions please feel free to contact me anytime. Sincerely, 6-evz -ola— Shelly Godde Account Representative Enclosure ALLIED SPECIALTY INSURANCE, INC. 10451 Gulf Boulevard, Treasure Island, Florida 33706. 727 367 -6900 • 1 800 237 -3355 • FAX 727 367 - 5695/1407 85 N.E. Loop 410, Suite 600, San Antonio, Texas 78216.210 341 -1321 • 1 800 235 -8774 • FAX 210 341 -2050 WURQS.ERS UUMYENSAT1UN AND . MYLUYERb LJAbILITX INSUKANUM YULlUX INFORMATION PAGE Insurer: PRODUCER: Agent# 1 T.H.E. Insurance Company Allied Specialty Insurance Inc. 10451 Gulf Boulevard 10451 Gulf Boulevard Treasure Island, FL 33706 Treasure Island, FL 33706 (Carrier Code: 40851) Carrier Policy #: WC089451 Carrier Prior Policy #: NEW 1. The Insured: Galaxy Fireworks, Inc. Mailing Address: 204 E Martin Luther King Jr Blvd Tampa, FL 33603 Fein: 593092878 Policy #: 900000000419008 Other workplaces not shown above: Type of Business: Corporation SEE SCHEDULE OF OPERATIONS Risk ID: 2. The policy period is from 12:01 a.m. on 11/18/2008 to 12:01 a.m. on 11/18/2009 at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states 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 $ 1,000,000 each accident Bodily Injury by Disease $ 1,000,000 policy limit Bodily Injury by Disease $ 1.000,000 each employee C. Other States Insurance: All states except: ND, OH, WA, WV and WY D. This policy includes these endorsements and schedules: WC000000A(04 /92) WC000308(04/84) WC000402(04/84) WC000404(04/84) WC000414(07/90) WC000419(01 /01) WC000422A(09/08) WC090303(08/05) WC090403A(01/08) WC090606(10/98) 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Code Premium Basis Rate Per Estimated No. Total Estimated $100 of Annual Annual Remuneration Remuneration Premium SEE SCHEDULE OF OPERATIONS Total Estimated Annual Premium $ 1,671.00 Minimum Premium $ 518.00 Expense Constant $ 200.00 WC 00 00 01 A Countersigned by -------4/Q1jildlis.3(1-- SCHEDULE OF OPERATIONS FOR: PAGE: 1 Galaxy Fireworks, Inc. Carrier Policy #: WC089451 204 E Martin Luther King Jr Blvd Fein: 593092878 Tampa, FL 33603 OTHER WORKPLACES: Galaxy Connection, Inc. 204 E Martin Luther King Jr Blvd Tampa, FL 33603 Fein: 562362766 NAICS code: 13990 Galaxy Fireworks, Inc. 9908 North Dale Mabry Tampa, FL 33618 SIC code: 2892SC NAICS code: 13990 Galaxy Fireworks, Inc. 12600 Palm Beach Blvd Fort Myers, FL 33905 SIC code: 2892SC NAICS code: 13990 Galaxy Fireworks, Inc. 4001 N Florida Ave Tampa, FL 33603 SIC code: 2892SC NAICS code: 13990 Galaxy Fireworks, Inc. 9005 Ridge Rd New Port Richey, FL 34654 SIC code: 2892SC NAICS code: 13990 WC 00 00 01 A