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Home My WebLink About10-11298 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780 -0020 11298 FIRE WORKS PERMIT Permit Number: 11298 Address: 5953 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 - 00000 -0030 Improv. Cost: Date Issued: 12/17/2010 Name: ZEPHYR LLC Total Fees: 557.00 Address: 7162 READING RD #730 Amount Paid: 557.00 ,_CINCINNATI. • 45237 -3845 Date Paid: 12/17/2010 P • Work Desc: FIREWORKS TEMPORARY SALE- DE 41.'720 • THRU JAN 7, 2011 )111 I4' - , / - - - y 11.11 V ;170 5.•• VrEMPORARY SALES 22.0 CTOR CER ATE / /30.00 C (6 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. 1/ CONTRACTOR SIGN RE Z 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 204 E. Martin Luther King Blvd. Tampa, FL 33603 Tel: (813) 234 -2264 Galaxy Fireworks Fax: (813) 234-1516 www.galexyfireworks.com Fax TO! City of Zephyttliils Frain: RUBY SPELL Fax: (813) 780 -0021 Pages: 2 including cover Phone: Data 12/17/2010 Re: PERMITTING cc: ❑ Urgent ❑ For Review ❑ Please Comment ❑ Please Reply 0 Please Recycle Comments: Thanks and have a great day, Ruby Spell AC Rd CERTIFICATE OF LIABILITY INSURANCE 6/9/21 THIS EC RTIFICATE is ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(8), AUTHORIZED REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the poricy(tes) must be enthused. If SUBROGATION 15 WAIVED, subject to the terms and conditions of the policy, certain policies may require an endontement. A statement on this certificate does not confer rights to Me certificate holder In Eau of such endomems s , PRODUCER NA MIE: SrittoD,- Gallagher and Associates, Inc. -- FAX 6240 SON Center Rd. — No : • •- L Cleveland OH 44139 ADORES& FNOOUCaR CUSTOMER IDE: INSURER(S) AFFORDING COVERAGE NAIC 0 u INSURED INSURER A : LexinatOf Insurance Co Galaxy Fireworks Inc - INSURRRB:Axis Surplus Ins Com0anv 204 E. Martin Luther King Blvd "" " Tampa FL 33603 INSU RRC:New Hampshire insurance Co. 23841 INSURER D : INSURER B : INSURER F : COVERAGES CERTIFICATE NUMBER: 821771136 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INfDIC��ATTE�ED(, NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDRION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO - MALL H THE TERMS, EXXCCWSIONS ISSUED PERTAIN. S PPOOLIICCIES.LLIM AFFORDED ITSSHO N MAY HAVE BEEN REDUCED PHEREIN I IMS B L N TR S TYPE OF INSURANCE AUULbUM EF N - POLICY P FOLIC"�p wIR WM POUCY NURSER IMMIDDIYYY117 PAM IDW"YYYI LIMITS .. A GENERAL UABIUTY 64200905 6/10/2010 6/10/2011 EAC _ IRRE NCE 51,000,000 x COMMERCIAL GENERAL LIABILITY PAEM aow 550 000 CLAIMB-MAM Ell OCCUR MED EXPSMy one prison) $ PERSONAL d, ADVINJURY 61, 000,000 GENERAL AGGREGATE 52,000,000 GEN'L AGGREGATE OMIT APPUES PER: PRODUCTS - cOMPlOF AGG 52, 000, 000 -- 7 Foue, n .�,, 1 LOC $ C AUTOM0e0.EUABIUTY CA66144430 6/10/2010 6/ }0/201} COMBINEO SINGLE WAIT 61,000.000 MeemMen0 x ANY AUTO BODILY *WRY (Per pe/son) ALL OWNED AUTOS BODILY INJURY (Per e0deenn _ SCHEDULED AUTOS FROPER71QAMAf;E x MIRED AUTOS ecdlien1) w 5 X NON-OYRJEDAUTOS $ 5 uMBRELLALUIB X OCCUR EAV753129 6/10/2010 6/10/2011 EACMOCCURRENCE $4,000,000 X EXCE55 UAB CLMMS4M0E AGGREGATE w _ $4,000,000 DEDUCTIBLE $ RETENTION 5 $ WOnRMMI COMPEN3ADON I T U TU I !Tr AND EMPLOYERS' UABIU7Y — ANY PROPRICORIPARTNER/EXECUTIVE r� N f A E.L. EACH ACCIDENT s OFFICER/MEMBER EXCLUDED? I J (Mandatory M NH) E.L. OISEASE - EA EMPLOYEE 5 n Foe, d al0'under DESCRIPTION OF OPERA - DONS Mew E.L. DISEASE _ POLICY UMIT 5 oaSCRIPTION OF OPERATIONS f LOCA7tONS 1 VEHICLES (Attach ACORD 101, Addtiomd Remelts S6heduts, I men woe le required) • Stand )rocaton: 5943 -5953 Gall Boulevard, Zephyrhills, FL 33542 Additional Insured: City of Zephyrhills, Pasco County Board of County Commisioners, Zephyr Mark Rider all their agents, representatives and subsidiaries. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED WORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DEUVERED IN ACCORDANC WITH THE POLICY PROV City of ZephyrhiUe, Pasco County Board of County Commisioners and Zephyr Mark Rider AUTHOR12mREPRESENTAEVE 5335 8th Street zephyrhille, FY. 33542 ® 1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD • STATE OF FLORIDA . .Y DEPARTMENT OF FINANCIAL SERVICES DIVISION: OF STATE FIRE MARSHAL TALLAHAS FORMA CERTIFICATE OF REGISTRATION • WHOLESALER OF SPARKLERS THIS CERTIPI$S THAT GALA) Y.FIREWORK5 INC z04 "E MARTIN" LUTHER IKINC'BLVD T AMPA; FL 33603 — HAS•REC�ISTI ED P[l S13ANZ TQ THE,PROVISIONS OF FLORIDA. STATUTES TO A RETAILED. Chief Financial Officer 02101 07 -62 Hillsborough 72584000012006 17677Q0001 s1000.00. 01131j 2011 Issue Date' Type Class County License/Pertnit Number Application # Taxes & Fees Expire Date • • • • C ERTIFICATE OF INSURANCE ISSUE DATE ACDRDTM 12/01/2009 PRODUCER This certificate is issued as a matter of infgrmation 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 800-476-2211* • COMPANIES AFFORDING COVERAGE company Columbia Casualty Company INSURED Company James River Insurance Company Galaxy Fireworks, Inc. 204 East Martin Luther King Drive Tampa, FL 33603 Company C Company D Company • 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 ray have been reduced by paid claims. CO TYPE OF INSURANCE POLICY NUMBER EFFECTIVE LIMITS OF LIABILITY LT EXPIRATION A GENERAL LIABILITY 4015647136 06/10/2009 EACH OCCURRENCE $ 1,000,000 Convnarcial General Uability 06 /10/2010 FIRE DAMAGE $ 50,000 ❑ Claims Made ® occurrence I] owa ana� MEDICAL. EXPENSE $ EXCLUDED ® Deductible $2.500 PERS. AND ADVERTISING INJURY $ 1,000,000 ❑ GENERAL AGGREGATE $ 2,000,000 General A9gr� teUmtteppiiesper. PRODUCTS AND COMP. OPER. AGG. $ 2,000,000 ❑ Policy DI project Location AUTOMOBILE LIABILITY COMBINED SINGL LIMIT $ El Any Automobile BODILY INJURY (P r person) $ ❑ A9 Owned Automobiles ❑ Scheduled Automobiles BODILY INJURY ( r accident) $ ❑ Hired Automobiles PROPERTY DAMA E (Per accident) $ ❑ Non-awned Automobiles COMPREHENSIVE , COLLISION WORKERS' COMPENSATION WC Statutory Limit I Other 1 AND EMPLOYERS' LIABILITY EL EACH ACCIDENTf $ EL DISEASE (Each + employee) $ B EXCESS LIABILITY 000319131 EL DISEASE (Polio Limit) BI $ SL ❑ LITY 06/10/2009 EACH OCCURREN E $ 4,000,000 06/10/2010 AGGREGATE $ 4,000,000 $ $ $ Please Note, Excess Umbrella Policy shown on certificate will extend coverage to the underlying: Automobile Liability Policy # M8VF3034, Limit $1,000,000 CSL,; 11/18/09 to 11/18/10; Insured with T.H.E. Insurance Company, Agent: Allied Specialty Ins.; Treasure Island, FL (1-800 -237 -3355) call direct for COI AND: r Florida Workers Compensation Coverage Policy# WC093035; Limit: $1,000,000; 11/18/09 to 11/18/10 is provided by T.H.E. Insurance Company, Agent: Allied s� Specialty Ins.; Treasure Island, FL (1 -800- 237 - 3355); Call direct for COI (continued next page) CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIB D POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE SSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO TH 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. Pasco Board of County Commissioners and Zephyr Mark Authorized Representative Rider 5953 Gall Boulevard Zephyrhills, FL 33542 Page 1 of 2 Certificate ID# 98QMK1Y9 ADDITIONAL INFORMATION ISSUE DATE 12/01/2009 PRODUCER CERTIFICATE HOLDER MCGRIFF, SEIBELS & WILLIAMS, INC. Pasco Board of County Commissioners hnd Zephyr Mark Rider P.O. Box 10265 5953 Gall Boulevard Birmingham, AL 35202 Zephyrhills, FL 33542 800 -476 -2211 INSURED Galaxy Fireworks, Inc. 204 East Martin Luther King Drive Tampa, FL 33603 (continued from previous page) Stand Location: 5953 Gall Boulevard, Zephyrhills, FL 33542 Pasco Board of County Commissioners and Zephyr Mark Rider The above listed are Additional Insured respects to General Liability policy as re1uired by written contract subject to policy terms, conditions and exclusions. • • i Page 2 of 2 CertificateID 98QMK1Y9 • LEASE AGREEMENT "Phis l .case Agreement is entered into as of the 27th day of July , 20 10 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: I. Premises Location: The property that is the subject of this Lease Agreement (the is located at the following address 5943 Gall Boulevard, Zephvrhills. 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 Tenn (as hereinafter defined), access thereto (includingthe right to cross surrounding property belonging to Lessor. if anyl, 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: D V Term 1 is from December 15, 2010 until January 10, 2011 ( "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 I.essee will pay Lessor the sum of $1.000.00 for term 1 that will be due and payable on the first day of the applicable Term. h. Permits: Lessee agrees to acquire in - and aftpermits retptiredby govemingauthoritiesforLessee 'sinterrdedaseofthe Ifthepermllsare not approved for any reason, this Agreement will be null and void, and all deposits will be refunded to Lessee. 11; after any necessary permits have been issued to Lessee, Lessee is prevented from usingthe Premises for the intended purpose of selling fireworks during any part ofa Term because ofan act of (iod, 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 Tenn, as Lessor chooses. Lessor shall makc 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 I essee use of the Premises, including but not limited to claims by Lessee's licensees, or invitee, and trespassers. ft 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 She Premises. Any inamtlation shall not damage any of Lessor's improvements on the Premises. 9. Insurance: Lessee shall provide Lessor with proofofliabitity insurance before the Tenn 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. ii. Option: .. ..... .. -. - ., - : • ..'•. HowevH . -._ � f 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: lithe 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 wrinen 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 dale first above written, as evidenced by the signatures of their respective duly authorized representatives appearing below. Galaxy Fireworks, Incorporated (Lessee) Zephyr LLC (Lessor) By: \ ttt►�Lik LAllk/ .'.. ill .... 1 9 - B y: / L y.. / ' Signature Siva ure Sharon Hunnewell-Johnson, President if > ,..z: = '•- Name and Title - Name d Ti 9 11')lt L) /e / ,,/ O X Date Signed Date Signed /. Before me, the undersigned Notary Public, personalty appeared _, known to me to be the person who executed the foregoing Lease Agreement and she/he acknowledged to and before me that sheltie executed such instrument and agrees to fully comply therew • T. �'(/ IN W NESS EREOF, 1 have set my hand and seal this I + + day of �b i . 20 �� . N ry Public, State of Florida p ��/ Z , • "" "' "• PATRICK D. 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Temporary Sales Checklist City of Zephyrhills 5335 8"' Street Zephyrhills, Fl. 33542 Phone: 813- 780-0020 / Fax: 813- 780-0021 REQUIREMENTS � Plot Plan showing setup of location. Notarized letter from property owner stating their approval. t..V flame retardant certificate is required IF a tent is involved. Inspection is required once tent i erected and prior to opening for business. . Approved certified fire extinguishers per NFPA 10. /No Smoking signs must be placed outside entrances. ✓IF there is a wire fence or chain link fencing must have at least 5 Ft setback from tent and at least 2 exits. .7 IF tent has sides, the sides shall be in the up position unless there is inclement weather, then 2 sides must be in the up position. FIREWORK REQUIREMENTS - (In addition to the above) �Pc�oof of State License. Proof of Liability insurance. l/ ;/ LList of items to be sold at site. 1 Z Copy of Drivers License and Social Security Number of all personnel dealing with the sale of firewq s at the tent location. FEES v_» .dc, $ 3,N) ,City > - gistraticfn (If Regulated by DBPR - Fee is Waived) ,, 'Ps 1Q Qty- - works fee, - -Fire Department fee ✓� ''-'0‘://ill ' 6mporary Sales Fee for 1s` two days \1 i t , ... iii i Tetfiporary Sales Fee per day for each consecutive day thereafter, not to 3� , i , ,' „r Ai l ' excee duration of 30 consecutive days and no more than one occurrence . i per calendar year per Ordinance #408. .0 - A . ° ° $ 0 .00 - Tent Fee 35.00BD 15.00 * /FD ` ( 15.00*/FD) -( $15.00 waived for Fireworks) IP a" ` " $ 35.00 - Electrical Fee (if applicable) Property Owner: L---Q.__ � Applicant: • _• '� __ �■ K _ ��I'!Sri Phone Contact: �i ,,� ' Address Site: , • ."; p,-,_ A . Date of Sale: �:��!► -I<�J• - ' 41111t 0 ' ;'LIA - q//3 - 7 , 5 - 7_,',5 --- 2 e,.'1 813 - 780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 ' Building Department 4' 0 11 -/ �' ,,, �^, U (,q Date Received �� Phone Contact for Permittin _ — Owner's Name VAMM Owner Phone Number O . a .._ . 4 Owner's Address �VNI e► e ' Owner Phone Number • TE3%2I. Fee Simple Titleholder Name I Owner Phone Number I l Fee Simple Titleholder Address I JOB ADDRESS ��t��all IMM1 LOT # SUBDIVISION PARCEL ID# /0 <J\.Jp� oc�' 00,0 (OBTAINED F OM PROPERTY TAX NOTICE) WORK PROPOSED t _ J NEW CONSTR E ADD /ALT 1 SIGN fl = DEMOLISH H INSTALL C REPAIR PROPOSED USE ri SFR n COMM I I OTHER 1 TYPE OF CONSTRUCTION r BLOCK Q FRAME r STEEL r A___. I DESCRIPTION OF WORK \ \ �V�. \ \ . ' O BUILDING SIZE SQ FOOTAGE HEIGHT 1 $ VALUATION OF TOTAL CONSTRUCTION T ELECTRICAL $ AMP SERVICE PROGRESS E Y f ni PLUMBING $ 1 777 � "" p i � ^ • • =MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION li'v` IC/ 1 „ ` � 1 1 n� t f Y r1GAS 1-1 ROOFING n SPECIALTY I I OTHER ' FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA 1 NO � ' l 47 BUILDER COMPANY AX "(x� / /vS SIGNATURE REGISTERED Y / N FEE CURREN I Y/ N I Address 1 License* 1 ELECTRICIAN COMPANY SIGNATURE REGISTERED I Y 1 N ( FEE CURREN I Y/ N 1 Address I License # PLUMBER COMPANY SIGNATURE REGISTERED 1 Y/ N I FEE CURREN 1 Y/ N I Address I License* I MECHANICAL COMPANY SIGNATURE REGISTERED 1 Y/ N 1 FEE CURREN i Y/ N I Address 1 License* I I OTHER COMPANY SIGNATURE REGISTERED 1 Y/ N I FEE CURREN 1 Y/ N 1 Address I License* I I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R -0-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. (A/C upgrades over $7500) 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 if shingles Sewers Service Upgrades A/C Fences (Plot/Survey/Footage) Driveways -Not over Counter if on public roadways..needs ROW Zephyrhills Fire Rescue 6907 Dairy Road, Zephyrhills, FL 33542 Fire Marshal Bus (813) 780 -0041 Kerry Barnett Fax (813) 780 -0044 E- mail: kbarnett @1fire.zephyrhills.fl.us Plan Review #: 10 -145 Project: Fireworks Tent Sale Number of Pages: Packet December 10, 2010 I have received and reviewed the packet for the fireworks tent located at 5953 Gall Blvd 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. Tent and tent sides shall have the certification showing the flame retardant rating imprinted or stitched into the tent. 2. Tent guidelines shall be followed. 3. Ensure that all people buying fireworks fill out the required paperwork. Copies shall be made of that paperwork for the this office. Inspections Required: 1. Tent Inspection — all items shall be ready for display and guideline check sheet completed. Inspection shall be conducted prior to opening to public. r KE RRY :: - ': 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.: ..— Plan No.: ! t9 /i Y5 Contractor: 1 i /'ire,st Business Name: Billing Address: _ :• i _ . Ate_ Business Address: = - Business Phone No.: Billing Phone N•.: Business Fax No.: Billing Fax No.: Contact: Contact: PLAN REVIEW FEES INSPECTION FEES PERMIT FEE _ FALSE ALARM FEE R Site Plan N/C ` Annual N/C Sprinkler $50 — 1st Alarm N/C Multi - Family/Commercial .06 sf 1st Re N/C Standpipes nsp $50 2nd Alarm N/C (Minimum Charge $25.00 _ 2nd Re- inspection $100 Fire Pump $50 _ 3rd Alarm N/C 9 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 5100 _ SPRINKLER SYSTEMS Fuel Tanks - per tank $50 STANDPIPE SYSTEM — Hydro Undergrounds $45 parklers $100 El Per Riser $50 _ Hydrostatic Test $65 per system Fire Works $500 , FIRE PUMP _ Acceptance Test $45 per system Camp Fire $25 0 Per Pump $100 .__. Hydrant Flow $75 Controlled Burn $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 550 _ OTHER Waste Tire Storage $50 Annual Dry $50 — Fire WaWSmoke 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 9 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 550 _ Fire Suppression $30 Fuel Tank Installation $50 _ System Acceptance (Per Tank) $50 _ Exhaust Hood/Duct $30 0 Natural Gas Installation $50 r Re - inspection DBL (Per System) (other than annual) _ 9 Spray Booth $50 9 Inspection scheduled DBL _ and cancelled less than _ _ 24 hours Construction Insp. N/C — _ Emergency Vehicle Ac $50 A FALSE ALARM PLANS TOTAL INSPECTION TOTAL PERMIT TOT•i TOTAL r 1 GRAND TOTAL ilt= Comments: Date: 41/ Insq, ctor: �Co L,,,i/--.- 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, 1 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 govemment 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 811, 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 YOU - DER OR AN ATTORNEY BEFORE RECORDI • UR NOTICE OF COMMENCEMENT. FLORIDA JU' • T (F.S. 17 03) OWNER OR AGEN .. e.- ' . '`' • TRACTOR - a ' . . . . w v �� h . is Su•..'.:. swomto o: ■-,. I Syt n "ty by , , wr S Jr Id by i C L� � ....e. A .ti/ W / ho Y is/ / are personally known o : or has/have produced Who is/are • -. • nally known to m or has/have produced as identification. (-____ -_— as identification. . A _ l Notary Public Notary Public Commission No. Commission No !! ti 1 vc f- . /. MIMI . ni, r , i • :' � N am:. �i,�:. ---fm's ¶ ' w • a ' ,, ; w u Explre8 Aprfl 3, 2012 * C lx lm t s e i g r ► 2012 Bonded thru Troy fen lam* 500400 0i9 ' Tole y \ 2 ...> .«. 774.. . ' � } . .. . . r : y � � :.. a � � 17C O Pasco County Parcel: 10 -26 -21 -0020- 00000 -0030 001 • Page 1 of 1 Data Current as Of: Weekly Archive - Saturday, April 10, 2010 Parcel ID J 10 226 - 21 - 0020 - 00000 - 0030 (Card: 001 of 006) I Classification 1 16 - Shopping Center Community Mailing Address Final 2009 Value ZEPHYR LLC Ag Land $0 7162 READING RD #730 Land $194,419 CINCINNATI OH 45237 -3845 Building $223,519 Physical Address - See All 5 addresses (First Extra Features $6,642 Shown) 5845 GALL BLVD Market Value $424,580 ZEPHYRHILLS FL 33542 -3457 Assessed (Non School Amendment 1) $424,580 Legal Description (First 4 Lines) See Plat for this Subdivision .'°' Taxable Value $424,580 PINE GROVE PB 2 PG 15 COM SW COR LOT 10 TH NO2DG 02' 12 "W 313.00 FT FOR POB TH CONT NO2DG 02' 12 "W 306.96 FT TH I Land Detail (Card: 001 of 006) Line I Use (Description° Zoning II Units In Type iI Price II Condition II Value SHOPNG 1 1600 CTR 00C2 12,000.00 SF $7.32 0.65 $57,096 SHOPNG 2 1600 00C2 38 $2.87 0.65 $70,908 CTR ,000.00 SF SHOPNG 3 1600 CTR 00C2 37,145.00 SF $2.75 0.65 $66,415 F Additional Land Information I Acres II 2.00 II Tax Area II 30ZH II FEMA Code II X °Commerical Code° M3012A0 I Building Information - Use 16 - Shopping • • 1 1 • 1 1 . Year Built 1969 Stories 1.0 Exterior Wall 1 Concrete Block Stucco Exterior Wall 2 None Roof Structure Rigid Frame w /Bar Joist Roof Cover Built -Up Tar and Gravel Interior Wall 1 Plywood Panel Interior Wall 2 Drywall Flooring 1 Cork or Vinyl Tile Flooring 2 Carpet Fuel Electric Heat Forced Air - Ducted A/C Central Baths 2.0 • I Line I Description Sq. Feet Repl. Cost New 1 11 SPA I I 1,100 11 $106,814 I 2 II SDA 400 II $45,696 I 3 II CAN II 300 II $10,282 I Extra Features (Card: 001 of 006) I Line I Description I Year I Units d Value I 1 1 PAV ASP 1969 22,800 1 $4,617 Sales History Previous Owner I HUESING JAMES R Year II Month Book /Page Type Amount 2000 II 03 I 4341 / 1041 1 QC 11 $0 1987 JI 09 I 1661 / 1677 II W II $ 1985 1 02 I 1394 / 0304 1 WD 11 $ http: // appraiser. pascogov.com / search /parcel.aspx ?sec= 10 &twn= 26 &rng =21 &sbb= 0020 &b... 4/14/2010 Page 1 of 1 tN. „4„ ± r s .a F, j - r l fi .., ,, '. , � `s „ „,,, ,. w : h y� 4- t } r F. k � i�v it O 'It k id _ * a, � a .1 ; : - ft 1.1, .r.ittriA41111,'''' ilis.r.'—:,.:74. , ';'^i 'A. !''''' ' '' . r ',i.: 2 -;- --.` 4.7 44 '4, k \ .... .,,..; - '‘ -' / ':., it lit ' . r mot; N , 4 ci `� , N , ' t r axe. \ ,s • 4 � ♦ F � p ! .� a } ‘ ,;1. EIGER.R0 . EIGER.RO 3 4,, P�"ws"' r — 4 ffi st, : .. � v , fit e , s."',.: e �♦ oL, i N. -.',7,-,1, s •, 7,47- i' x ` ' t {y : ,kr r ` ` .� y y ' O rl e/' � ; � . 1 ° r (AM --/' • . 11 \ ,„&-- "1\ � v' F .„ a , C\....„c..._-\\ Cr— ---? . http: // maps. pascogov. com /mapdata/442116543020399.jpg 4/14/2010 • • 3i Galaxy Fireworks, Inc. Page 1 of 8 , 204 E. Martin Luther King, Jr. Blvd ' Tampa, FL 33603 0 Ewo, ��k 813.234.2264 Phone @ n t sa�wo r z Ks 0 a ° �,� 83.234.56 Fall -Free _ �M 0 U r , 8113 . 15116 Fax v Location Source:THEFT 12/10/2009 12:00:00 AM Destination:TAMPA 09 (SHOWGIRLS) Items marked with an * next to the piece price are "Buy One, Get One Free" items. �. � 4:44114144: g t '��# `�§F 4 fl ? t < r� � u se 4443 '' : a ',i L1'lii i' 1 � - O r • x e ate. ? t� ' ;' 401.1 1 � g y ."� 41 fr " S&S ASSRT (SS) Big Bang 2 PIECE 4/1 $199.80 * $69.95 GLX - 106 S&S FOUNT #5 Cones Jumbo 8 PIECE 96/1 $667.20 * $6.95 P3051 S&S FOUNT Butterfly & Flowers 36 PIECE 48/6 $765.60 $12.95 * $4.00 0833 S&S FOUNT Butterfly & Flowers 5 PACK 48/6 $765.60 $12.95 * $4.00 0833 S&S FOUNT Crowd Thinner (Galaxy) 1 PIECE 6/1 $209.70 * $34.95 PS0001 S&S FOUNT Cuckoos 15 PACK 24/6 $300.00 $12.50 * $2.75 0852 S&S FOUNT Cuckoos 9 PIECE 24/6 $300.00 $12.50 * $2.75 0852 S&S FOUNT Fire Tongue 12 PIECE 24/1 $598.80 * $19.95 Y22 - 117 S&S FOUNT Jazz 5 PIECE 12/1 $299.40 * $24.95 GCF081 S&S FOUNT Killer Bees 7 PIECE 24/4 $262.80 $10.95 * $3.00 W499A S &S FOUNT Killer Bees 3 PACK 24/4 $262.80 $10.95 * $3.00 W499A S&S FOUNT London Tower Bridge 2 PIECE 10 /1 $399.50 * $39.95 SF33 S&S FOUNT Malibu Madness 16 PIECE 36/1 $538.20 * $14.95 FOA S&S FOUNT Rock Music 15 PIECE 36/1 $306.00 * $8.50 P3024 S&S FOUNT Rosy Cheeks 11 PIECE 18/1 $269.10 * $14.95 GCF050 S&S FOUNT500 Awe -Some 1 PIECE 4/1 $199.80 * $49.95 GPH3079 S&S FOUNT500 Floro GIo 4 PIECE 6/1 $245.70 * $40.95 Y64 - 006 S&S FOUNT500 Glitz 2 PIECE 6/1 ' $299.70 * $49.95 GPH3094 S&S FOUNT500 Rolling Stone 1 PIECE 4/1 $159.80 * $39.95 S&S FOUNT500 Rumba 3 PIECE 6/1 $239.70 * $39,95 GPH3085 S&S FOUNT500 Space Bastion 1 PIECE 4/1 $199.80 * $49,95 Y64 - 002 S&S NOVEL Booby Traps 26 PIECE 10/144 $720.00 $72.00 * $0.50 T8501 S&S NOVEL Crackling Balls • 1 PIECE 16/12 $479.20 $29.95 * $2.99 0205A Manager's Initials Operator's Initials • • Galaxy Fireworks, Inc. Page 2 of 8 813.2 204 E. Martin Luther King, Jr. Blvd G � Tampa, FL 33603 - Q t:AREWORKS 34.2264 Phone LII\Y7 0 800.334.2264 Toll -Free @ L, ofi isWO 813.234.1516 Fax Location Source:THEFT 12/10/2009 12:00:00 AM Destination:TAMPA 09 (SHOWGIRLS) Items marked with an * next to the piece price are "Buy One, Get One Free" items. 4si, 4;iiii kint 7# �s $ p� �ptlQ d It , 715 ? Y : @Sp f { iii 7 4x a m r , r 1p * 9'f t :- AtLc:. ��' • 3 !. kF Iw S&S NOVEL Party Popper (6pk) 28 PIECE 12/24 $359.40 $29.95 * $2.00 P9001B S &S NOVEL Party Popper (6pk) 5 PACK 12/24 $359.40 $29.95 * $2.00 P9001B S&S NOVEL Snap -N -Pops - (6/40) 2 PACK 6/40 $300.00 $50.00 * $1.25 T8500A S&S NOVEL Snap -N -Pops - (6/40) 90 PIECE 6/40 $300.00 $50.00 * $1.25 T8500A S&S S &W Ground Bloom Flower 74 PIECE 20/12 $300.00 $25.00 * $2.25 09018 S&S S &W Ground Bloom Flower 18 PACK 20/12 $300.00 $25.00 * $2.25 09018 S&S S &W Spinning Wheel 8 PACK 12/6 $251.40 $20.95 * $3.50 0544 S&S SMOKE Mammoth Smoke 49 PIECE 6/24 $360.00 $60.00 * $2.50 GM807 S&S SMOKE Smoke Balls (White, 12 27 PIECE 20/6 $360.00 pk.) $18.00 $3.25 GM823 S&S SMOKE Smoke Balls (White, 12 13 PACK 20/6 $360.00 pk.) $18.00 $3.25 GM823 S&S SMOKE Smoke Grenades 2 PACK 12/48 $432.00 $36.00 * $0.75 T8571 S&S . SMOKE Smoke Grenades 79 PIECE 12/48 $432.00 $36.00 * . $0.75 T8571 S8S SPARK # 10 Gold Sparkler 49 PIECE 24/12 $252.00 $10.50 * $1.25 GP - 0978B S&S SPARK # 10 Gold Sparkler 22 PACK 24/12 $252.00 $10.50 * $1.25 GP - 0978B S&S SPARK # 8 Color Sparkler 1 PIECE 24/12 $252.00 $10.50 * $1.25 GP - 0740B S&S SPARK # 8 Gold Sparkler 70 PIECE 24/12 $228.00 $9.50 * $1.00 GP S&S SPARK # 8 Gold Sparkler 3 PACK 24/12 $228.00 $9.50 * $1.00 GP - 0977B S&s SPARK 10" Morning Glories 69 PIECE 24/12 $252.00 $10.50 * $1.50 GLX 28 - 023G ' F/C ASSRT (FC) Final Countdown (WL) 3 PIECE 6/1 $461.70 * $76.95 GLX - 800 F/C ASSRT (FC) Mars Attack 1 PIECE * $359.95 P0022 F/C ASSRT (FC) Rocket Barrage (WL) 8 PIECE 12/1 $539.40 * $44.95 GLX - 814 F/C ASSRT (FC) Saturn's Revenge (WL) 2 PIECE 4/1 $739.80 * $184.95 GLX -811 F/C B &T # 5 Floral Tubes 14 PIECE 24/1 $286.80 * $11.95 Y23 - 169 Manager's Initials Operator's Initials • • ' , Galaxy Fireworks, Inc. Page 3 of 8 204 E. Martin Luther King, Jr. Blvd fik L ...T. , 813 234 2264 Phone 0 � o#1. „ins. e ` Free Ew O _ 813.234.1516 Fax Location Source:THEFT 12/10/2009 12:00:00 AM Destination:TAMPA 09 (SHOWGIRLS) Items marked with an * next to the piece price are "Buy One, Get One Free" items. $ iD �er ii ii; � j poo ' i as � s ; 0 N A I " �1 , ' 4144,,,4- , z ' , S' .,' " 0 : ` ar t. ? ` e. � A . ` , _ A }� ., F/C B &T #100 Assorted Tubes 1 PIECE 24/1 $382.80 * $15.95 Y60 -100 F/C B &T #200 Assorted Tubes 6 PIECE 24/1 $599.76 * $24.95 Y60 - 200 F/C B &T #300 Assorted Tubes 2 PIECE 16/1 $479.20 * $29.95 Y60 - 300 F/C B &T #900 Assorted Tubes 1 PIECE 4/1 $299.80 * $74.95 F/C CAKES Armageddon 11 PIECE 12/1 $371.40 * $30.95 P5062 Brew Crew (Last CaII, World Class F/C CAKES Bottoms Up, Pop A Top, 2 PIECE 24/1 $358.80 * $14.95 Happy Hour) F/C CAKES Close To Heaven 6 PIECE 18/1 $359.10 * $19.95 P5101 F/C CAKES Cool Beauty 4 PIECE 8/1 $479.60 * $59.95 Panda F/C CAKES Desert at Night 6 PIECE 40/1 $598.00 * $14.95 F/C CAKES Fascinating Cake 5 PIECE 12/1 $359.40 * $29.95 F/C CAKES Galaxy Discovery . 6 PIECE 24/1 $598.80 * $24.95 Legend F/C CAKES Galaxy Storm 12 PIECE 24/1 $598.80 * $24.95 Legend F/C CAKES Mortal Knight 4 PIECE 10 /1 $299.50 * $29.95 F/C CAKES Sniper 7 PIECE 12/1 $359.40 * $29.95 China National F/C CAKES Snowstorm 1 PIECE 40/1 $598.00 * $14.95 80525301243 F/C CAKES Space Express 3 PIECE 12/1 $479.40 * $39.95 GPH3068 F/C CAKES Splitter Splatter 16 PIECE 18/1 $449.10 * $24.95 World Class F/C CAKES Strong Man 4 PIECE 12/1 $419.40 * $34.95 Panda F/C CAKES Summer Bowl Commotion 1 PIECE 8/1 $319.60 * $39.95 GCM0148 F/C CAKES Universal Beast 7 PIECE 6/1 $239.70 * $39.95 F/C CAKES Welder 9 PIECE 24/1 $598.00 * $24.95 Brothers F/C CAKES Wild Bear 16 4 PIECE 12/1 $718.80 * $29.95 BP2576 Manager's Initials Operator's Initials • Galaxy Fireworks, Inc. Page 4 of 8 204 E. Martin Luther King, Jr. Blvd � " La v y Tampa, FL 33603 - f� 813.234.2264 Phone REwok 800.334.2264 Fall -Free _ V O r �] 813.234.1516 Fax V (�( ,-/ �� Location Source:THEFT 12/10/2009 12:00:00 AM Destination:TAMPA 09 (SHOWGIRLS) Items marked with an * next to the piece price are "Buy One, Get One Free" items. s f O alE�1 ts €s a � M1 1 r rE. r S l ' €,.trt t " o- i£ ,er �'�" # � i' �1CB' ., lqe, °'. ',, ,„ "tie F/C CAKES Wild Mushroom 9 PIECE 12/1 $419.40 * $34.95 Brothers F/C CAKES500G Act of God 5 PIECE 6/1 $479.70 * $74.95 Legend F/C CAKES500G After The Storm 1 PIECE 4/1 $359.80 * $89.95 GPH3103 F/C CAKES500G American Highlights 1 PIECE 4/1 $329.80 * $82.45 LBM F/C CAKES500G Breathless 2 PIECE 3/1 $449..85 * $149.95 Megabanger F/C CAKES500G Cannonade 1 PIECE 4/1 $359.80 * $89.95 Glorious F/C CAKES500G Carnival Attack 5 PIECE 6/1 $449.70 * $74.95 Legend F/C CAKES500G Celestial Exploring 1 PIECE 2/1 $299.90 * $149.95 BP2087 F/C CAKES500G Crazy Exciting on Steroids 2 PIECE 4/1 $339.80 * $84.95 WC 500 F/C CAKES500G Defender 1 PIECE 2/1 $179.90 * $89.95 P5361 F/C CAKES500G Evil Spirit 1 PIECE 4/1 $359.80 * $89.95 Legend F/C CAKES500G Flicker 1 PIECE 6/1 $479.70 * $74,95 World Class F/C CAKES500G Galaxy Assault 1 PIECE 2/1 $199.90 * $99,95 Legend F/C CAKES500G Galaxy Explosion 1 PIECE 4/1 $299.80 * $74.95 P5322 F/C CAKES500G Galaxy Eye Opener 2 PIECE 4/1 $299.80 * $74.95 Glorious F/C CAKES500G Galaxy Magic 2 PIECE 4/1 $299.80 * $74.95 Glorious F/C CAKES500G Galaxy's Desire 1 PIECE 4/1 $299.80 * $74.95 PS0004 F/C CAKES500G ' Galaxy's Raging Gorilla ' 1 PIECE 4/1 $299.80 * $74.95 Glorious F/C CAKES500G Galaxy's Thunder 5 PIECE 6/1 $449.70 * $74.95 Legend F/C CAKES500G Guns & Roses 2 PIECE 4/1 $359.80 * $89.95 LBM F/C CAKES500G Head Banger 2 PIECE 4/1 $359.80 * $89.95 Y63 - 047 F/C CAKES500G High & Mighty (Brothers) 1 PIECE 4/1 $359.80 * $89.95 BP2192 F/C CAKES500G Invasion Station 3 PIECE 4/1 $363.80 * $90.95 Y63 - 062 Manager's Initials Operator's Initials Galaxy Fireworks, Inc. Page 5 of 8 204 E. Martin Luther King, Jr. Blvd Tam a, �ZfZWOrZ 813.234. FL 2264 33603 Phone ree 8 Fall -F _ LjIIi\Y7 R I c?" 813.234.1516 Fax _@, . Location Source:THEFT 12/10/2009 12:00:00 AM Destination:TAMPA 09 (SHOWGIRLS) Items marked with an * next to the piece price are "Buy One, Get One Free" items. la . 4 0000' ?4 ,1'1 b 2 gg . ipt 14 y ss S t� �: ' � � f ...t x ti;i y'$4k� %' s i r : �''''e Palguy .r; �€ ,'1' 01 'MAW ,,.; a 5j BE E s 3, �j Syr **L ,71, i ��' s ,i . ;.. ,�. .��, i �.�`, � �..,., « -, , 9� ,4," f{c n , , , p� .�' � F/C CAKES500G Jumbo Saturn Missile Battery II 2 PIECE 6/1 $449.70 * $74.95 Panda F/C CAKES500G Landing Force 1 PIECE 2/1 $449.90 * $224.95 Legend F/C CAKES500G Mass Destruction 2 PIECE 3/1 $389.90 * $129.95 Legend F/C CAKES500G Need For Speed 12 Shot 2 PIECE 4/1 $359.80 * $89.95 Legend F/C CAKES500G One Bad Mother 1 PIECE 4/1 WC $359.80 * $89.95 80525313185 9 F/C CAKES500G One Bad Mother in Law 1 PIECE 4/1 $359.80 * $89.95 F/C CAKES500G Pyro Indulgence 2 PIECE 4/1 $359.80 * $89 China National F/C CAKES500G Red Alert (China National) 2 PIECE 4/1 $359.80 * $89 China National F/C CAKES500G Swamp Gator 2 PIECE 4/1 $359.80 * $89.95 Panda F/C CAKES500G The Big Dog W C 9 g 1 PIECE 2/1 $389.90 * $194.95 80525345048 6 F/C CAKES500G The New Frontier 3 PIECE 6/1 $449.70 * $74.95 Legend F/C CAKES500G World Class Oriental 5 PIECE 6/1 $479.70 * World Class Dragon $79.95 F/C FC Bad Boy Crackers /Mighty 96 PACK 100/1 $895.00 * SWB100A Crackers $8.95 F/C FC Celebration Crackers -2492 3 PIECE 6/1 $299.70 * $49.95 T766 F/C FC Firecrackers - 2,000 4 PIECE 8/1 $559.60 * $69.95 T734 F/C FC • Firecrackers - 40/16 • 67 PIECE 24/40 • $286.80 $11.95 * $0:50 GP - T716 • F/C FC Junior Burst 10 PIECE 12/12 $568.80 $47.40 * $3.95 Y35 - 075 F/C FC Junior Burst 2 PACK 12/12 $568.80 $47.40 * $3.95 Y35 - 075 F/C FC M1000, Assorted (36) 241 PIECE 40/36 $798.00 $19.95 * M (M5000) 36 $0.5 M F/C FC M1000, Assorted (36) 0 PACK 40/36 $798.00 $19.95 * $0.50 M88 (M5000) F/C FC M -5000 Packs of 12 35 PACK 120/12 $600.00 $5.00 * $0.50 World Class Manager's Initials Operator's Initials • • f.. Galaxy Fireworks, Inc. Page 6 of 8 204 E. Martin Luther King, Jr. Blvd to Tama FL 33603 813.234. Ew 2264 Phone /� ///n �� 1 l'REv 800.334.264 Toll -Free n - ( (�-� ",NrrxiS 410, ;" 813.234.1516 Fax V // 1�lJ- - Location Source:THEFT 12/10/2009 12:00:00 AM Destination:TAMPA 09 (SHOWGIRLS) Items marked with an * next to the piece price are "Buy One, Get One Free" items. , i s �1s� t, 1 . F/C FC M -5000 Packs of 12 125 PIECE 120/12 $600.00 $5.00 * $0.50 World Class F/C MISSILE shotrn Missile Battery 25 51 PIECE 120/1 $538.80 * $4 Galaxy, WC, Generic F/C MISSILE Saturn Missile Battery - 8 PIECE 12 1 * GP - 300 shot / $431.40 $35.95 1130C300 F/C MISSILE Saturn Missle 750 1 PIECE 2/1 $309.90 * $154.95 GP - 11300750 F/C RC Roman Candle - 5 Ball w/ 46 PIECE 72/1 $392.40 * 5.45 0527 - Report $ F/C RC Roman Candle - 8 Ball 16 PIECE 48/1 $477.60 * $9.95 GP - T6514 F/C RC Roman Candle- 8 Ball w/ 32 PIECE 54/1 Report $537.30 $9.00 0528 - F/C RELOAD Amazing Ballet Reloadable 1 PACK 2/1 $309.90 $154.95 * BS4812 WC F/C RELOAD Excalibur 3 PIECE 6/1 $869.70 * $144.95 80525301401 5 F/C RELOAD Galaxy's Star Cruiser 1 PIECE 4/1 $679.80 * $169.95 Legend WC F/C RELOAD Goliath 1 PIECE 4/1 $679.80 * $169.95 80525301404 6 F/C RELOAD Gorilla 12 Shot Artillery 2 PIECE 12/1 $611.40 * $50.95 GP - 506 F/C RELOAD Invasion Artillery 1 PIECE * $244.95 Y23 - 233 F/C RELOAD Power Man 12 3 PIECE 6/1 $419.70 * $69.95 Legend F/C RELOAD Prime Artillery Shells 2 PIECE 6/1 $311.70 * $51.95 GCRS005 WC F/C RELOAD Super Magnum 7 PIECE 12/1 $611.40 * $50.95 80525341408 2 F/C RELOAD Truly Cool 2 PACK 2/1 $999.90 $750.00 * Legend WC F/C RELOAD United We Stand • 2 PIECE 3/1 $719.85 * $239.95 80525301407 7 F/C RELOAD Untamed Terminator 1 PACK 2/1 $699.90 $349.95 * Legend Manager's Initials Operator's Initials Galaxy Fireworks, Inc. Page 7 of 8 204 E. Martin Luther King, Jr. Blvd Axe a� Tampa, FL 33603 - O - s 813.234.2264 Phone 7or ' 800.334.2264 Toll -Free _ row 0 813.234.1516 Fax Location Source:THEFT 12/10/2009 12:00:00 AM Destination:TAMPA 09 (SHOWGIRLS) Items marked with an * next to the piece price are "Buy One, Get One Free" items. .S3a pe A { lm P,t11 a £ ds f @& a t Q `a� aay ` _ �'� sy :ow** s q .s q ua . v € w s h - ; Rt �`t �C P PC� a f ry, F/C RELOAD War of the Galaxy ' Reloadable 5 PIECE 6/1 $539.70 * $79.95 Legend F/C ROCKET Artillery Shell Rocket 19 PIECE 20/1 $699.00 * China $34.95 National F/C ROCKET Bottle Rockets 44 PIECE 25/12 $273.75 $10.95 * $2.50 GP - 0440S F/C ROCKET Bottle Rockets 2 PACK 25/12 $273.75 $10.95 * $2.50 GP - 0440S F/C ROCKET Display /Jumbo Jet 18 PACK 24/1 $384.00 $16.00 * T0642 F/C ROCKET Emerald Meteor 20 PIECE 96/1 $619.20 * $6.45 T0004 F/C ROCKET Galaxy Explorer 6 PIECE 10 /1 $499.95 * $49.95 Legend F/C ROCKET Galaxy Explosion Rocket 2 PACK 20/1 $399.00 $19.95 * • F/C ROCKET Ring Shell Rocket 15 PIECE 24/1 $672.00 * $28.00 F/C ROCKET Scorpion Rocket 30 PACK 36/1 $1,438.20 $29.95 * F/C ROCKET Whistle Bottle Rockets 15 PACK 20/12 $299.00 $14.95 * $3.00 GP - 0445 F/C ROCKET Whistle Bottle Rockets 24 PIECE 20/12 $299.00 $14.95 * $3.00 GP - 0445 F/C ROCKET Whistle Bottle Rockets -3 15 PIECE 20/12 $319.00 $15.95 * $4.00 0445D F/C ROCKET Whistle Bottle Rockets -3 10 PACK 20/12 $319.00 $15.95 * $4.00 0445D F/C W &P B -52 Bomber 1 PIECE 72/6 $356.40 $4.95 * $1.00 L507 Total Retail Value: 13,446.07$ • Managers Initials Operator's Initials • • , _, Galaxy Fireworks, Inc. Page 8 of 8 204 E. Martin Luther King, Jr. Blvd �� Tampa,FL33603 — ❑ t 4 1. - RKS 813.234.2264 Phone rfow O _ � r of - rmsW�� 813.234.1516 Fax Free Items Received Not Listed Above Cross out any unused blank spaces. " rte° .K. C,�, ,.� �!' #E! . „. " a &o Ili ?t � � � � a�`.d . „ F •,��f�' .. ,'�''�F. � . , _. �, •,�.�lr if ,�'! . 00000 00000 00000 00000 0000❑ 00000 O 000❑ ❑ 00❑❑ O 0000 ❑ ❑0❑❑ 00000 O 0000 O 0000 O 0000 00000 O 0000 O 0000 00000 00000 00000 • • Manager's Initials Operator's Initials • • , • , Temporary Sales Checklist City of Zephyrhills 5335 8 Street Zephyrhills, FL 33542 Phone: 813 - 780 -0020 f Fax: 813 -780 -0021 REQUIREMENTS Plot Plan showing setup of location. ✓ Notarized letter from property owner stating their approval. �A flame retardant certificate is required IF a tent is involved. Inspection is required once tent 's erected and prior to opening for business. Approved certified fire extinguishers per NFPA 10. .Smoking signs must be placed outside entrances. IF there is a wire fence .or chain link fencing must have at least 5 Ft setback from tent and at least xits. IF tent has sides, the sides shall be in the up position p on unless there is inclement weather, then 2 sides must be in the up position. FIREWORK R QOIREMENTS — (In addition to the above) ,/P of State License. t„ -oof of Liability insurance. 2 §t of items to be sold at site. opy of Drivers License and Social Security Number of all ty personnel dealing with the sale of fireworks at the tent location. FEEs $ 30.00 — City Registration (If Regulated by DBPR — Fee is Waived) $500.00 — Fireworks fee - Fire Department fee $ 5.00 — Temporary Sales Fee for P two days $ 1.00 — Temporary Sales Fee per day for each consecutive day thereafter, not to exceed duration of 30 consecutive days and no more than one occurrence per calendar year per Ordinance #408. $ 50.00 — Tent Fee (35.00BD, 15.00 * /FD) —( *$15.00 waived for Fireworks) $ 35.00 — Electrical Fee (if applicable) Property Owner: • VA,. Applicant: � - 1 O ( Phone Contact: • J 0,-(?) t' p - Address Site: b „� v Date of Sale: ' Q ^ - Aoki - \� r ° OP ID: CJ ACICP/W _ 1 DATE(MMIOD/YYYY) �•.r. CERTIFICATE OF LIABILITY INSURANCE 12117/10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder le an ADDITIONAL INSURED, the pollcy(les) mist be endorsed. N SUBROGATION 16 WAIVED, subject to the farms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the olntillcate holler In lieu of such endoi on1. M(. PRODUCER 386 - 2624601 CONTACT Brown & Brown of Florida, Inc. 386239 -5729 rim ISM; Daytona Beach Office IT No. EI t1; INC. No): P.Q. Box 2412 -' .j ] Daytona Beach, FL 32116 -2412 c 11TOMe m uGALAX-3 _ NI :UR AAWICROING COVERAGE NAIC r _ INSURED GALAXY FIREWORKS, INC. A; FL Retail Federation W0006 RUBY SPELL INSURER a 204 E. MARTIN LUTHER KING BLVD TAMPA, FL 33603 INSURER C : - INSURER D : INSURER E : •... INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEb 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 AU. THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. UMrrS SHOWN MAY HAVE BEEN REDUCED DY PAID CLAIMS. TYPE OF INSURANCE INIIR %DEL EMIR POLICY NUM ( LIMITS GENERAL UABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABTY I»A1P IORENTED • ILI F!REWSEE IEaaaame„eel S CLAIMS 0 OCCUR MED EHP Wv,ens person) $ PERSONAI. B ACV INJURY S GENERAL AGGREGATE S GERI AGGREGATE UMIT APPLIES PER: PRODUCTS - COMPIOP AOG S — 1 POLICY JEppMI�t:T I I LPG S AUTOMOMILE UASIUTY - COMBINED SINGLE OMIT _ ANY AUTO (G eoddand ALL AWNED AUTOS BODILY INJURY (Par Xmas) S — DOOILY INJURY (Pit MOMS S SCNEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Pm scC dint) S NON-OWNED AUTOS S S UMBRELLA LIAB OCCUR EACH OCCURRENCE q(CESSU4B CLAJMB -MADE AG(3RpOATE S _ DEDUCIBLE S ,■u.• 5 S — WORKERS COMPENSATION _ UU.. D EMPLOYERS' LMBIUTY X I wit FR AN A PIeoPNSToRtPARiNEWEXECU IVE Y/ N 0196- 23706 11118110 11/18/11 EL EACH CH AC,(,'IDENT $ 100,000 OFFICERSiEAy SR EXCLUOE07 ❑ Ni IM inntd,staryln EL. DISEASE -EA EMPLOYEE S 100,000 O ESCRIP OPERATIONS SMiF E.L. DISEASE - POLICY UNIT 5 500.000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Rohs" Schedule, If more space is !squired, CERTIFICATE HOLDER CANCELLATION CITZE01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE V$1LL. BE DELIVERED IN CITY OF ZEPHYRHILLS ACCORDANCE WITH THE POLICY PROVISIONS. 5335 STH ST ZEPHYRHILLS, FL 33542 AUTHORIZED REPRESENTATIVE , I 7"r Ml ® 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD