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HomeMy WebLinkAbout10-11163 CITY OF ZEPHYRHILLS / 5335 - 8TH STREET (813)780 -0020 11163 FIRE WORKS PERMIT Permit Number: 11163 Address: 7050 GALL BLVD Permit Type: FIRE WORKS ZEPHYRHILLS, FL. Class of Work: SPECIAL EVENT 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: 11/22/2010 Name: FL HOSPITAL OF ZEPHYRHILLS Total Fees: 530.00 Address: 7050 GALL BLVD Amount Paid: 530.00 ZEPHYRHILLS, FL. 33542 Date Paid: 11/22/2010 Phone: (813)783 -6189 Work Desc: SPECIAL EVENT FIRE WORKS SHOW - DECEMBER 5 , 2010 - - -. .. .- . • 1 - - -. ',.As .1 -7• .- - • 1.•1 - . y. -, gl 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 _ 1 %. y _ 1- _ / CONTRACTOR SIGNATURE r 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 ZEPHYAHILLS BUILDING FAX No. 813 1 ` a •i = 1113 . • Temporary Saks iCheckllst • • .cuy of zephyrhills r.. .. ed 5 . . 5395 8 Street - • _Zepbyrhilis, FL 33542 . gj • Phone: 813=780 -0020 /)Fax: 813'780 -0021 . REQUIREMENTS • • ' .Plot Plan showing setup of location. • • Notarized letter fromproperty owner stating their approval. • • A retardaint certificate is . required IF a tent is involved. Inspection is required one tent . • . • • is erected and :prior to opening for business. • • . • Approved certified fire extinguishers per NFPA 10. . • • No Smoking signs must be placed outside ancsiB /Mf * y . is Y ZEPy F LANts) AA A VE . E IF there is a wire fence or c1hain link fencing mud ve at 10 4 k ._'.'" , O � • 2 exits. e�`*'e- ,�. - 4 ...� • • IF tent has sides, the sides shall be in the up position unless there is cl ..-7 j P . • • then 2 sides must be.in the up position.. • . • . • • FIREWORK� QS -- (i. addition to the above) . • _ • : . ' Proof of State License. Proof of Liability insurance. • • V List of items/0 be sold at site. • Copy of Drivers License and Social Security Number of all personnel dealing • with the sale of fireworks at the tent location. . • FEES • • , of • • $ 30.00 -- City Registration (1f Regulated .by.DEPR —Fee is Waived) • X $500.00 —Fireworks fee - Fire Department fee • $ 5.00 — Sales Fee for 1 n two days • • • $ 1 — Temporary Sales Fec per day for each consecutive day thereafter, not to , • • • exceed duration of 30 consecutive days and ho more than one occurrence • . • per calendar year per Ordinance #408. . . $ — Tent Fec (35.00BD, 15.00 * /FD) ("115.00 waived for Fireworks) . ' . $ 35.00 Electrical Fee (if applicable) . ' . . . • Property Owner: • Florida Hosptial Zephyrhills Applicant: 'Pyrotecnico • • • Phone Contact: • Marsha LeFebvre — 800 - 854 -4705 • ' • . Address Site: 7050. Gall. Blvd. Ze • h rhills, FL `33541 • • • Date of Sale: • 12-' - 2 O' 1 b S • • Ordinance No. 408 dated 1/26/1987 (for additional requirements) • • ' . • Zephyrhills Fire Rescue 6907 Dairy Road. Zephyrhills, F1, 33542 Fire Marshal Bus (813) 780 -0041 Kerry Barnett Fax (813) 780 -0044 E -mail: kbarnett a,fire.zephyrhills.fl.us Plan Review #: 10 -136 Project: Fireworks Display Number of Pages: Packet November 17, 2010 I have received and reviewed the plans for the fireworks display located at 7050 Gall Blvd and will allow the project to move forward at this time. Paying for permit, contractor acknowledges complying with the items listed below. Permit must be on site with fireworks company. Should anyone have any questions, please do not hesitate to contact the Fire Marshal's office. 1. NFPA 1123 shall be followed to its entirety. Failure to follow the guidelines may 2. prohibit the show to be conducted. 2. Ensure shells have required labeling. (description, size, type, warning statement) 3. Ensure shells are inspected by the operator following their delivery to the site. 4. Preparation area for display shall be secured from public by at least 100 feet in all directions. 5. The minimum secured site for the display shall be 140 feet in all directions from location of fireworks or 280 foot diameter around fireworks area. (2" shells) Being a health care facility the distances are doubled, 280 feet in all directions or 560 foot diameter. AHJ has ability to reduce distance when favorable conditions exist and added safety precautions taken. 6. Ensure mortar racks are secured to prevent movement during the display or if a shell explodes in the mortar. 7. Racks containing mortars shall be limited to 15 mortars per unit. 8. Discharge of shells shall not come within 25 feet of any overhead obstructions. 9. No spectator or spectator parking shall be within the secured site, including fallout area. This also include employees of Florida Hospital. 10. The secured site shall be taped off showing no access. Florida Hospital and/or Pyrotecnico shall post individuals around perimeter to ensure no admittance. 11. Parking of vehicle housing fireworks shall be on the outer perimeter of the fireworks area. 2 12. During the display, support personnel shall be positioned to visually observe roofs of any structure within the secured and fallout area. This can be done by either Florida Hospital Security personnel or fireworks personnel. One person shall be on the roof top area of Florida Hospital. These people shall have communication with fire service assigned to the display. 13. Operator is responsible to have a sufficient number of assistants for the display. Assistants shall be at least 18 years of age. 14. All personnel in discharge site WILL HAVE head, eye, hearing, and foot protection. Cotton, wool or flame resistant, long sleeve, long legged clothing will be worn. 15. No smoking materials shall be within 50 feet of any fireworks 16. At least 2 pressurized water extinguishers shall be on site for the display. 17. Following the display, the firing crew shall conduct an inspection of the discharge and fallout areas. Any unexploded shells found shall not be handled for a minimum of 15 minutes and then doused with water and sit an additional 5 minutes before handled. 18. The fire marshal or his designee reserves the right to stop the display if, in his/her opinion, feels a hazardous condition exists. Inspections Required: 1. Site inspection with operator and Florida Hospital staff. Display and fallout areas will be secured and fireworks will be in position for the display. This meeting shall be conducted under daylight conditions. Contact fire marshal with time. 2. Post site inspection. KERRY BA'4liV , 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. ZEPHYRHILLS FIRE DEPARTMENT 6907 Dairy Road, Zephyrhills, FL 33542 Fire Chief Keith Williams Bus (813)780 -0041 Fax (813)780 -0044 FIRE SERVICE USER FEES Occupancy No.: P / lan No.: Contractor: _ ® GO Business Name: AIIIIY % _ ,eir Billing Addres • 2 Business Address: "7, 2 I `AlGAT.'����1 Business Phone No.: Billing Phone No.: Business Fax No.: Billing Fax No.: Contact: Contact: PLAN REVIEW FEES _ INSPECTION FEES PERMIT FEE FALSE ALARM FEE ^ _ Site Plan N/C _ Annual N/C Sprinkler $50 i _ 1st Alarm N/C _ Multi Family /Commercial .06 sf 1st 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 0 Plan Revisions DBL _ 3rd Re- inspection $250 Hoods $50 — 4th Alarm $100 _ 4th Re- Inspection $500 Fire Alarm $50 5th Alarm $150 — — SPRINKLER SYSTEMS (Business closed until LP Gas $50 6th Alarm $200 — 0 - 25 Heads $50 violations corrected) Natural Gas $50 _ NON COMPLIANCE $150 26 plus Heads $100 SPRINKLER SYSTEMS Fuel Tanks - per tank $50 STANDPIPE SYSTEM Hydro Undergrounds $45 Sparklers 0 Per Riser $50 Hydrostatic Test $65 per system Fire Works $500 FIRE PUMP Acceptance Test $45 per system Camp Fire Per Pump $100 Hydrant Flow $75 Controlled Bum $100 — FIRE ALARM 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 $50 _ OTHER Waste Tire Storage $50 Annual Dry $50 ^ Fire Wall /smoke 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 EXHAUST _ Fumigation Tenting $50 El Hood /Ducts $50 ,— Tent 10'x10' or greater $15 per tent Torch Pot/Applied $50 OTHER _ Fire Pump $45 Haz. Materials $100 Annual LP Installation per tank $50 v Fire Suppression $30 Fuel Tank Installation $50 .__. System Acceptance (Per Tank) $50 _ Exhaust Hood /Duct $30 0 Natural Gas Installation $50 _ Re - inspection DBL (Per System) (other than annual) — El Spray Booth $50 0 Inspection scheduled DBL and cancelled less than _ _ 24 hours Construction Insp. N/C — _ Emergency Vehicle Acs $50 It FALSE ALARM PLANS TOTAL II INSPECTION TOTAL PERMIT TOTAL IF I J TOTAL L I GRAND TOTAL El_ Comments: Date: r. i i Ins ctor: .. Y, ° /�o DEPARTMENT OF THE TREASURY - BUREAU OF ALCOHOL, TOBACCO AND FIREARMS e �� Y 'o LICENSE/PERMIT (18 U.S.C. CHAPTER 40, EXPLOSIVES) $ m I In accordance with the provisions of Title XI, Organized Crime Control Act of 1970, and the regulations issued thereunder (27 @. s/ CFR Part 555)you may engage in the activity specified in this license /permit within the limitations of Chapter 40, Title 18, United 'tee ,. s j States Code and the regulations issued thereunder, until the expiration date shown. See "WARNING" and "NOTICES" on back. 1 CENSfI Christopher R. Reeves pERfd[F 8-pA- 073 -23 -2J -12122 DIRECT ATF Chief, Federal Explosives Licensing Center lFELG) ::niuMSE13 ;' , CORRESPONDENCE Bureau of Alcohol, Tobacco - ;Fir earms and EXploSlvae :< :: To 244 Needy Road E7CPIRA Martinsburg, West Virginia 254 ©b 0AT� September 1, 2012 Telephone: 1-877-283-3352 F'_aX. 1 3Q k 6 44Fi1 . NAME Prem ises Address CHAt' ES? You must notify the FELC at least 10 days before the move PYROTECNICO .......-. 299 WILSON - NEW CASTL.a PA - 4101- TYPE OF UCENSE OR PERMIT H EXP 23- IMPORTER OF HIG IVES CHIEF, FEDERALEXPLO INGCE RjPELG.): ........................ . ..........................„.......... ............................."......... .•_•••_••••...•••••••••....... .•...•.•••_••.•..••.•. •••••.• .. .......... ................................. .................................„.......... ....... .................... .............................._...,....... ......................,................................ .................................................„....................... C rtstdion8r R. Reeves PURCH • • ING CERTIFICATION .MaiiiiittAddtbk ' CHANGES*Y.du must notify the FELC at least 10 days before the change I - - I • - t this ' - e copy of a censelperr[ttt , ii issued to - t.: gag = the the acfivlty,Decified: S VITAL PYROTH E CNIC INDUSTRIES INC •PYROTECNICO PO 1RGX 149 (SIGNATURE OF LlcENSEE/PERAiMrrt l_ ,: NEW_lATLE PA 1 61 03 -01 49 The licensee /permittee named herein shall use reprodu of t license /permit to assist a transferor of explosives to vertt)y the identity and status of the licensee /permittee as provided in 27 'GFFt Part;:55 The signature on each reproduction must be an ORIGINAL signature ;: ATF F 5400.14/5400.15, Part 1 (8/89) • Nov 30 04 12i381* Public Relations 813- /ea -si09 p.6 SITE INFORMATION FOR FIREWORKS DISPLAY Organization sponsoring event: Florida Hospital Zephyrhills, 7050 Gall Blvd. , Zephyrhills, FL 33541 - Pjte.1A3 Wei —e...11 Date Etnd time of production: 12/5/10- approx. 6 : 30PM Location of production: Florida Hospital Zephyrhills Name of mainoperator: Chris Reitano Number and ages of all assistants: 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 attadled MSDS for pyrotechnics used: See attached Extinguishers on site (pressurized water — at least 2): , 2 Diagram of where production to be conducted (to include point or firing, fall out radius, and audience location): See attached Firing safeguards in place: • circuit testers no more than 25 mA A 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 • smoking prohibited within 25' of the firing/handling area • appropriate distance from audience (not less than twice the fallout radius) • all access points are blocked off into firing/handling area CERTIFICATE OF INSURANCE ISSUE DATE ACORD 10/12/2010 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 P.O. Box 10265 coverage afforded by the policies below. Birmingham, AL 35202 PHONE: 800 - 476 -2211 COMPANIES AFFORDING COVERAGE Company United States Fire Insurance INSURED company James River Insurance Company Pyrotecnico of Florida, LLC P.O. Box 310 New Castle, PA 16103 Company Westchester Surplus Lines Ins Company See Attachment 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 000292602 01/14/2010 EACH OCCURRENCE $ 1,000,000 ® Commercial General Liability 01/14/2011 FIRE DAMAGE $ 100,000 ❑ Claims Made ® Occurrence ❑ Owners' and Contractors' Protection MEDICAL EXPENSE $ EXCLUDED ® Per Project Cap $2,000,000 Gen Agg PERS. AND ADVERTISING INJURY $ 1,000,000 ❑ GENERAL AGGREGATE $ 5,000,000 General Aggregate Limit applies per: PRODUCTS AND COMP. OPER. AGG. $ 2,000,000 ® Policy ❑ Project ❑Location A AUTOMOBILE LIABILITY 1337289354 01/14/2010 COMBINED SINGLE LIMIT $ 1,000,000 ® Any Automobile 01/14/2011 BODILY INJURY (Per person) $ ❑ All Owned Automobiles 12 Scheduled Automobiles BODILY INJURY (Per accident) ❑ Hired Automobiles PROPERTY DAMAGE (Per accident) $ ❑ Non -owned Automobiles COMPREHENSIVE $1000 deductible ❑ COLLISION $1000 deductible D WORKERS' COMPENSATION 6FR13U80668N01409 06/22/2009 WC Statutory Limit I X1 Other 1 AND EMPLOYERS' LIABILITY 06/22/2010 EL EACH ACCIDENT $ EL DISEASE fEach employee) $ EL DISEASE (Policy Limit) $ B EXCESS LIABILITY 000296262 01/14/2010 EACH OCCURRENCE $ 4,000,000 ® Occurrence El Claims Made 01/14/2011 AGGREGATE $ 4,000,000 C EXCESS UMBRELLA COVERAGE G22054752003 01/14/2010 Excess of Underlying $4, Million $ 5,000,000 01/14/2011 $ Fireworks Display Date: December 5, 2010 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 2 Certificate 10 # 3MV4D538 ADDITIONAL INFORMATION ISSUE DATE 10/12/2010 PRODUCER CERTIFICATE HOLDER MCGRIFF, SEIBELS & WILLIAMS, INC. Florida Hospital Zephyrhills P.O. Box 10265 7050 Gall Boulevard Birmingham, AL 35202 Zephyrhills, FL 33541 PHONE: 800- 476 -2211 INSURED Pyrotecnico of Florida, LLC P.O. Box 310 New Castle, PA 16103 Workers Compensation and Employers Liability ** *Proof of Insurance Only * * ** Insurance Carrier: Travlers Insurance Company, issued through: Florida Workers Compensation Joint Underwrting Association, Inc. 2420 Lakemont Ave. Sutie 100; Orlando, FL 32814 States Insured: Florida Policy Number: 6FR13UB0668N01410 Policy Period: 6/22/2010 to 6/22/2011 Employers Liability Limits: 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 Page 2 of 2 Certificate ID # 3MV4D538 DEPARTMENT OF JUSTICE Bureau of Alcohol, Tobacco, Firearms and Explosives Warrinsburk WI/ 2.5463 August 23. 2010 Pyrotecnico of Florida LLC 901090:CRR/KCL- 30435 Commerce Drive Unit 102 Suites .J & L 5400 San Antonio, FL 33576-8031 File Number: 1-FL-00366 Premises Addre.ss 30435 Commerce Drive Unit 102 Suites J & L, San Antonio, FL 335764031 Dear Sir/Madam: This letter acknowledges receipt of your timely application to renew your Federal explosives license/permit. The Bureau of Alcohol, Tobacco, Firearms and Explosives (A11-) 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 US.C § 558. This letter, or as explained below, a follow-up letter, will serve as your license/perrnit 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 Shannon Siviero at 877-283-3352. Sincerel y, 4:1444.e Christopher R. Reeves Chief, Federal Explosives Licensing Center ATF web address: www,atfga &fa-780-0320 City of Zephyrhills Permit Application Fax -813- 780 -0O21 Building Department Late Received Phone Canted for Permitting Owner's Name __Florida HQ pit a Zephyrhills Owner Phone Number _ � I 3 - 9 -� Owners Address L7050 Gall B1.v ,Zephyrh 11 s,T�1,� 33 1 owner Phone Number ( ... Fee Simple Titleholder Narno Owner Phone Number Fee Simple Titleholder Address JOB ADDRESS 7050 Gall Blvd.,Zephyrhills, FL 33541 LOT# SUBDIVISION PARCEL ID # ._ IO0TAl7r'ED FROM PROPERTY TAX NOTICE) WORK PROPOSED [ NEW CONSTR ADD /ALT I I SIGN ( 1 MOVE 1 I DEMOU.USH E INSTALL REPAIR PROPOSED USE I I SFR COMM I I OTHER I I TYPE OF CONSTRUCTION I I BLOCK I I FRAME I I STEEL I I OTHER I DESCRIPTION OF WORK Fireworks Display BUILDING SIZE SO FOOTAGE HEIGHT , .. - _:,- :w- .. °. —_ •r : si- �raz7. n,..;.� " ^�. ;t�> : 3:v . :,.t .:. �;?�::tr der =� _;�___ ,mot : :.,x -r. r:s a .. , v:: - :: ,�:rir n BUILDING $ VALUATION OF TOTAL CONSTRUCTION [ ELECTRICAL $ AMP SERVICE 1 1 PROGRESS ENERGY 1 1 WRE I I PLUMBING $ I I MECHANICAL $ - VALUATION OF MECHANICAL INSTALLATION r� GAS 1 1 ROOFING I I SPECIALTY r OTHER FINISHED FLOOR ELEVATIONS r FLOOD ZONE AREA =YES I 'NO .c: 'R '��' ?is- F•'_t- 7': ='-.3' n?I.yT' BUILDER COMPANY SIGNATURE REGISTERED V / N FEE CURRENT r Y! N Address License # ELECTRICIAN COMPANY SIGNATURE REGISTERED I Y/ N 1 FEE CURRENT l Y! N 1 Address License # _ PLUMBER COMPANY SIGNATURE REGISTERED I Y/ Td I FEE CURRENT Y 1 N Address - 1 License # MECHANICAL COMPANY 1 SIGNATURE REGISTERED } Y/ N 1 FEE CURRENT 1 Y/ N I Address License # OTHER / / • / r l, . COMPANY SIGNATURE . sit FEE CURRENT I Y I L � �i �� J Address FO Box 14 • e x % ' o • $ License* €:., s .d.. t1T ?ap trer a titi sisekast _ .. .. - -- - - - ,*€.;sEs. s± ?-,- .9tlSMI RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R -0 -W Permit for new COTT stnrcilon, Minimum len (10) walking days after submittal date. Required onsite, Construction Plans. Stormwater Plans vr/ S/( Fence installed, Sanitary Facilities & 1 dumuster; Site Work Permit for subdivisions,arge projects COMMERCIAL Ailed) (3) complete sets of Building Pions plus a Life Safety Page; (1) sot of Energy Forms. R -O -W Permit for new cons;ructicn. Minimum len (10) working days after submittal date. Required onsila, Construction Piars, Stormvater Plans vri Silt Fence installed. Sanitary Facilities & i dumpstar. Site Work Permit for all new pro;ects. All commercial requirements must meet compliance SIGN PERMIT Attach (2) sets of Engineered Plans. " "PROPERTY SURVEY required for aft NEW construction. ti�n MMi,EIREA ( t` ' °NI '1 MA,mC ,.......TR M.« ...,......_: a i'c�F s D { rtrs:;: Directions: Fill 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 sane 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.,noeds 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. 117.03 OWNER OR AGENT__ CONTRACTOR Subxribtdj nd swom to or affirmed) befor me this Subscribed and sworn to (or affirmed) before me this :itr) —by n R fi c 1 b by Who is/are ersonally known to mtor has/have produced Who is /are personally known to me or has/have produced € h ' ' as identification. as identification. y� 1 m e c- e- .4otary Public Notary Public Commission No. .61/ / / Commission No. MR rLf) 11l . I. p t.:birz. Name of Notary typed, printed or stamped Name of Notary typed, printed or stamped ' 1 (y (i Q COMMONWEALTH OF PENNSYLVANIA Notarial Seal Marsha Lee Lefebvre, Notary Public City of New Castle, Lawrence County My Commission Expires May,1,,7012_ Headquarters U.S. Locations l °� �� t U . PO. Box 149 i nx Atlanta, GA 877. 924. 0102 ��� N Castle, PA 16103 724. 652. 1288 Las Vegas, NV 800. 956. 7976 • iii ��� � � IM vII Montgomery, AL 800 255 1199 info@pyrotecnico.com P Y RO �T' 1 E C N 1(, O 724. 652 9555 New Orleans, LA 800 783 2513 9' T A L E F A M I L Y FIREWORKS 1 8 8 9 800. 854. 4705 www.pyrotecnico.com Tampa, FL 888. 352. 7976 October 30, 2010 City of Zephyrhills Attn: Jackie This is a letter of authorization for Brenda Welcher of Florida Hospital Zephyrhills or Chris Reitano of Pyrotecnico to pick up the permit for the December 5, 2010 display. Thank you Christopher Mele General Manager COMMONWEALTH OF PENNSYLVANIA Notarial Seal Marsha Lee Lefebvre, Notary Public City of New Castle, Lawrence County My Commission Expires May 1, 2012 • TIPA P Y ROT E C N I CO November 4, 2010 City of Zephyrhills Attn: Jackie The show on December 5, 2010 will be shot electronically. Thank you Christopher Mele General Manager • 1 A4S 11'S Material Safety Data Sheet DATE PREPARED: January 18, 2006 PYROTECNIC0 VITALF FAMILY EIAEWOIL%L • 1111 From: PYROTECNICO 299 Wilson Rd Telephone Number: 800 - 854 -475 M -F 8AM -5 PM New Castle, PA 16101 Emergency : CHEM.TEL INC – 800- 255 -3924 - 24 HR FIREWORKS 1.3G un 0335 Section II — Hazardous Ingredients / Identity Information Contains Pyrotechnic Compositions that are mixtures of solid oxidizers and fuels that contained in paper and cardboard containers. No Hazard exist during normal handling and storage. OSHA PEL – N/A ACGIH T LV –N/A OTHER LIMITS – N/A Section III — Physical / Chemical Characteristics Boiling Point: - N/A Specific Gravity: - N/A Vapor Pressure: - N/A Melting Point : - N/A Vapor Density: - N/A Evaporation Rate: - N/A Solubility in Water: - N/A Appearance and Odor: - Pyrotechnic Composition is contained in paper or cardboard casings that may be shaped as cylinders, balls or tubes. Odor is not apparent. Section IV — Fire and Explosion Hazard Data Flash Point: - N/A Flammable Limits: - N/A LEL: -N /A UEL: -NIA Extinguishing Media: Deluge with large quantities of water as quickly as possible by FIRE HOSE from a PROTECTED location. Materials are self - oxidizing. Special Fire Fighting Procedures: Do not attempt to fight afire in the immediate area of 1.3G Fireworks- EVACUATE THE AREA. 1 2 Section IV — Fire and Explosion Hazard Data- Continued Unusual Fire and Explosion Hazards: Fireworks 1.3G MAY MASS EXPLODE IN A FIRE. DO NOT ALLOW FIREWORKS TO GET WET- Hazardous Decomposition May Result in a FIRE or EXPLOSION. EXPLOSION MAY OCCUR IF EXPOSED TO SPARKS OR FLAME. Section V — Reactivity Data Stability: - Stable Conditions to Avoid: - Open Flames, Sparks, High Temperatures, Friction or Impact. Incompatibility (Materia /s to Avoid): - Do Not Allow Fireworks to Get Wet. Hazardous Decomposition or Byproducts: - Decomposition does not occur under normal circumstances. Smoke Generated by Fireworks may contain gasses that are irritating to the eyes or mucous membranes. Prolonged Exposure and Inhalation of smoke may cause shortness of breath or more serious problems when a chronic respiratory condition exist. Hazardous Polymerization: Will Not Occur Conditions to Avoid: - Storage in High Temperatures, Moist or Wet Conditions, Keep away From Open Flame or Sparks. Section VI — Health Hazard Data Route(s) of Entry: - N/A Inhalation: -N /A Skin: - N/A Ingestion: - N/A Health Hazards (Acute and Chronic) : - N/A Carcinogenicity: N/A NTP ?: - N/A IARC Monographs ?: -N /A OSHA Regulated: - NO Signs and Symptoms of Exposure: - Prolonged Exposure to Smoke that is Generated during Normal use of Fireworks may cause Irritation to Eyes and to Mucous Membranes. Medical Conditions Generally Aggravated by Exposure: - Eye Sensitivity, Respiratory Conditions. Emergency and First Aid Procedure: - EYES Should be flushed with Water. Move to Fresh Air and avoid additional Inhalation of Smoke. 3 [Section VII — Precautions for Safe Handling and Use Steps to Be Taken in Case Material is Released or Spilled: - If Fireworks are spilled, carefully pick up the material and place in a Cardboard Carton. Keep OPEN FLAMES and Sparks AWAY and NO SMOKING. Waste Disposal Method: - Fireworks that fail to go off should be soaked in a bucket of water and returned to the source where it was obtained. Dry components or powder should be carefully swept up and placed in a cardboard container then soaked with water. Burning of Fireworks Waste must be performed in compliance with local and state laws. Precautions in Handling and Storing: - Keep from OPEN FLAMES, NO SMOKING, AVOID IMPACT of MATERIALS and CONTAINERS of MATERIALS, STORE FIREWORKS IN A COOL AND DRY ENVIORMENT. FIREWORKS 1.3G MUST BE STORED AND TRANSPORTED IN COMPLIANCE WITH FEDERAL, STATE AND LOCAL LAWS. Other Precautions: - Fireworks 1.3G un 0335 can cause SERIOUS INJURY or DEATH. They Should only be Handled by Properly Trained and Qualified Personnel. When Shooting these Fireworks; PERSONNEL SHOULD WEAR PROPER EYE PROTECTION, HEAD PROTECTION AND NON- SYNTHETIC CLOTHING. Section VIII — Control Measures Respiratory Protection : N/A Ventilation: - N/A Local Exhaust: - N/A Special: - N/A Mechanical: -N /A Other: - N/A Protective Gloves : - N/A Eye Protection: - When Shooting Fireworks 1.3G Other Protective Clothing or Equipment: - Protective Head Gear and Non - Synthetic Clothing when Shooting Fireworks 1.3G. Work / Hygienic Practices: - Store Fireworks in a Cool Dry and Well Ventilated area. Protect Against Physical Damage and Moisture. Fireworks should be Isolated from all Heat Sources, Sparks and Open Flame. No Smoking. • 3 • , .....', .:- : ::' :A 9 ilk ..........., .....Z....,.• ..:. . , tTic) TIP ... .. _ . .. .. . . .. . .. .. . .. .. . . 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"....:"'". - -1 :-"a --- - - ' -'" _,...-...._____,, -.... *-- - )■ — ,,i.A- ...... .., --. :IITRPY Pne 71 ■ 1 X 11 1 pq l�r:. ///11'‘‘‘.. PYROTECNICO`" 9I1A.r 1 I.Y 1- 18 1- WORKS • IAA 9 Special Entertainment Presentation Recar Opening 1 315 Shot Barrage 315 Total Opening Shells Body - Special Effects Barrages 1 36 Shot 2" Barrage 3 49 Shot Barrages 4 130 Shot Barrages 1 150 Shot Barrage 817 Barrages Total Grand Finale 2 2 ", 36 Shot Shells 1 300 Shot Barrage 372 Total Finale Shells 1,504 TOTAL SHELLS • • A 'r "Rock 'n Roll energy took center stage at the world's most prestigious fireworks venue: LaRonde in Ro L oues... Montreal, Canada. Pyrotecnico's design team developed "Rock Loves... ", a five -act thriller that brought the international crowd to its feet and were awarded the coveted Gold Jupiter. rockloves.com L 4 ^ � L ��. -_ Ph- DEC. 1. 2009 2:14PM FL HOSP ZEPHYRHILLS +8137836196 N0. 7293 P. 3 Zephyrhills Fire Rescue 6907 Dairy Road, Zephyrhills, FL 33542 Fire Marshal Bus (813) 780 -0041 Kerry Barnett Fax (813) 780 -0044 E -mail; kbarnett@fire.zephyrhills.El.us Plan Review #: 09 -096 Project: Fireworks Display Number of Pages: Fireworks Packet November 24, 2009 I have received and reviewed the packet for Pyrotecnico to conduct a fireworks display located at 7050 Gall Blvd (Florida Hospital) and will allow the project to move forward. Please note that this review does not eliminate any further requirements as the project continues moving forward. By paying for permit, contractor acknowledges to comply with the items listed below. Should anyone have any questions, please do not hesitate to contact the Fire Marshal's office. 1. NFPA 1123 shall be followed to its entirety. Failure to follow the guidelines may prohibit the show to be conducted. 2. Ensure shells have required labeling. (description, size, type, warning • statement) 3. Ensure shells are inspected by the operator following their delivery to the Site. 4. Preparation area for display shall be secured from public by at least 100 feet in all directions. 5. The minimum secured site for the display shall be 140 feet in all directions from location of fireworks or 280 foot diameter around fireworks area. (2" shells) Being a health care facility the distances are doubled, 280 feet in all directions or 560 foot diameter. AM has ability to reduce distance when favorable conditions exist and added safety precautions taken. 6. Ensure mortar racks are secured to prevent movement during the display or if a shell explodes in the mortar. 7. Racks containing mortars shall be limited to 15 mortars per unit. 8. Discharge of shells shall not come within 25 feet of any overhead obstructions. 9. No spectator or spectator parking shall be within the secured site, including fallout area. This also include employees of Florida Hospital. 10. The secured site shall be taped off showing no access. Florida Hospital and/or Pyrotecnico shall post individuals around perimeter to ensure no admittance. 11. Parking of vehicle housing fireworks shall be on the outer perimeter of the fireworks area. DEC. 1. 2009 2:14PM FL HOSP ZEPHYRHILLS +8137836196 NO. 7293 P. 4 2 12. During the display, support personnel shall be positioned to visually observe roofs of any structure within the secured and fallout area. This can be done by either Florida Hospital Security personnel or fireworks personnel, One person shall be on the roof top area of Florida Hospital. These people shall have communication with fire service assigned to the display. 13. Operator is responsible to have a sufficient number of assistants for the display. Assistants shall be at least 18 years of age. 14. All personnel in discharge site WILL HAVE head, eye, hearing, and foot protection. Cotton, wool or flame resistant, long sleeve, long legged clothing will be worn, 15. No smoking materials shall be within 50 feet of any fireworks 16. At least 2 pressurized water extinguishers shall be on site for the display. 17. Following the display, the firing crew shall conduct an inspection of the discharge and fallout areas. Any unexploded shells found shall not be handled for a minimum of 15 minutes and then doused with water and sit an additional 5 minutes before handled. 18. The fire marshal or his designee reserves the right to stop the display if, in his/her opinion, feels a hazardous condition exists. Inspections Required; 1. Site inspection with operator and Florida Hospital staff. Display and fallout areas will be secured and fireworks will be in position for the display. This meeting shall be conducted under daylight conditions. Contact fire marshal with time. 2. Post si ' nspection. fe, KE r � 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 NI?PA codes and local ordinances. • Jacqueline Boges To: Kerry Barnett Subject: fire work permit Place in your box a permit for fire works from pyrotecnico for 7050 gall blvd . Jackie Boges Code Support Specialist ext. 35 1 PYROTECNICO OF FLORIDA LLC „0 6490 City of Zephyrhills 11/9/2010 12/5/10 ZephyrhillsHosp 500.00 5510 Permits & Licenses 1000.002 First Commonwealth : Fi... 500.00 Headquarters U.S. Locations PO. Box 149 Atlanta, GA 877. 924. 0102 tik„ l��� \ ` New Castle, PA 16103 724. 652. 1288 Las Vegas, NV 800. 956. 7976 \II Montgomery, AL 800. 255. 1199 PYROTECN1C J nfoC�3pyrotecnico.com 7244 . 652. 9555 �� -ii; New Orleans, LA 800. 783. 2513 91 T A L F FAMILY F I R E W O R K S . 1 8 8 9 800. 854. 4705 www.pyrotecnico.cOm Tampa, FL 888. 352. 7976 October 30, 2010 City of Zephyrhills Attn: Jackie Please see the attached permit application for Florida Hospital Zephyrhills on 12/5/10. Please contact me if you have any questions or concerns at 800 - 854 -4705 or email the address below. Please fax or email me a copy of the signed permit when it is issued. Thank you Pyrotecnico Marsha LeFebvre mlefebvre(&pyrotecnico. com FX: 724 - 652 -1288