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CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780 -0020 11356 FIRE WORKS PERMIT Permit Number: 11356 Address: 4241 SKY DIVE LN Permit Type: FIRE WORKS ZEPHYRHILLS, FL. Class of Work: SPECIAL EVENT Township: Range: Book: Proposed Use: COMMERCIAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 18- 26 -22- 0010 - 08600 -0000 Improv. Cost: Date Issued: 12/23/2010 Name: CITY OF ZEPHYRHILLS Total Fees: 500.00 Address: 4241 SKY DIVE LN Amount Paid: 500.00 ZEPHYRHILLS, FL. 33542 Date Paid: 12/23/2010 Phone: (813)780 -0000 Work Desc: SPECIAL EVENT FIREWORKS SHOW - DEC 31, 2010 8 PM THRU JAN 1,2011 0130AM • - •., • - - -T 511.11 / 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. ?\ .■.-1k1 'tom-17P/. CONTRACTOR SIGNATURE '-� I : IC R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOURS NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813- 780 -0041 ZEPIYRHILLS FIRE DEPARTMENT 6907 Dairy Road, Zephyrhills, FL 33542 He Chief Keith Williams Bus (813)780 -0041 Fax (813)780 -0044 FIRE SERVICE USER FEES Occupancy No.: Plan No.: /4" /�j2 Contractor: 5J' ' �-e-- (2 Business Name: 3' 3,eY t to . Al Billing Address: 24 , S/c (Vile— LAI Business Address: 4/20 f , ff, UL2 G....\ r %N., tki _ 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 .__ 1st Alarm N/C Multi Family /Commercial .06 sf _ $100 Fire Pump $50 1st Re- inspection N/C Standpipes $50 ` 2nd Alarm N/C (Minimum Charge $25.00 — 2nd Re- inspection $10 ` 3rd Alarm N/C El Plan Revisions DBL — 3rd Re- inspection $250 Hoods $50 ^ 4th Alarm $100 4th Re- Inspection $500 Fire Alarm $50 — 5th Alarm $150 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 $100 0 Per Riser $50 ` Hydrostatic Test $65 per system ire Works &.00 FIRE PUMP _ Acceptance Test $45 per system Camp Fire $25 fl 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 —• — $50 _ OTHER Waste Tire Storage $50 Annual _ Dry $50 r 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 0 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 _ 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) 0 Spray Booth $50 El Inspection scheduled DBL ^ and cancelled less than _ 24 hours — Construction Insp. N/C _ Emergency Vehicle Acs $50 FALSE ALARM PLANS TOTAL I I INSPECTION TOTAL PERMIT TOTAL TOTAL L _ I GRAND TOTAL 215°) 1 Comments: Date: /2 /2i//e Insp ctor: __� Ii, j0% 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.fl.us Plan Review #: 10 -153 Project: Fireworks Display Number of Pages: Packet December 21, 2010 I have received and reviewed the packet for the display of fireworks located at Sky Dive Lane and requested a review by the Site Plan Committee due to this being a special event. Site Plan Committee met on this date with the applicant and went over the event. During the meeting the Airport Manager advised that the Airport Authority is aware of the display but it was too late to hold an Authority meeting. The Airport Manager advised that there was only one person that had some concerns but that individual discussed it with the applicant and it was resolved. Insurance was reviewed for proper coverage and was confirmed by Sky Dive City's insurance company that the display was not exclusion and coverage was satisfactory. FAA was consulted and advised that a NOTAM was to be issued by the airport. The airport Manager advised that would be done. The Fire Chief will conduct inspections and an engine company will be on site should n incident happen. At this time, this authority will allow the show to move forward. By paying for permit, the owner /occupant 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. A letter or paperwork shall be provided showing a class that was taken with pyrotechnic company prior to receiving the permit. 2. At the present, time no list was given to show exactly what was being discharged. The display area and setbacks will meet the criteria of what the owner /occupant believes he will shoot (roadside tent cakes and mortars). Any commercial grade stuff may cause the show to be cancelled due to no prior notification to review what additional changes may take place from the upgrade. 3. The display platform shall be secured. All mortars shall be secured to the display platform. 4. Fireworks display shall be in accordance to NFPA 1123 and the remaining items listed are the main points from the standard. 5. Proper PPE's shall be worn for the event. Long pants, long shirts, eye, ear and head protection. 2 6. Owner /operator shall be responsible to section off around display area and monitor access to only allow those involved with the fireworks display (set up, operation, inspection). 7. All fireworks shall have proper labeling. 8. Prep area shall be secured from public by minimum of 100 feet. 9. Owner /occupant shall inspect all shells following delivery to site to check for damage. 10. There shall be no smoking within 50 feet of any fireworks. 11. Tents shall not be located in display area. 12. Mortars shall be positioned and spaced so shells are propelled over the fallout Area and to afford protection for the shooter /operator. 13. Spotters shall be positioned to watch flight and behavior of aerial shells to be sure they are functioning as intended and shells are not landing outside the fallout area. 14. Pressurized water extinguishers shall be located at the display site and with spotters. 15. The AHJ has the authority to stop the display at any time should a hazardous condition exists; this includes crowd control, adverse weather and high winds. 16. The AHJ will give final clearance prior to the display being started. Inspections Required: 1. Pre -site inspection (at least 1 hour before sunset) 2. Post inspection after display 4e KERRY B - '4 , 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 Rescue 6907 Dairy Road, Zephyrhills, FL 33542 Fire Marshal Bus (813) 780 -0041 Kerry Barnett Fax (813) 780 -0044 E -mail : kbarnett,c,fire.zephyrh i 11 s.fl.us Plan Review #: 10 -153 Project: Fireworks Display Number of Pages: Packet December 21, 2010 I have received and reviewed the packet for the display of fireworks located at Sky Dive Lane and requested a review by the Site Plan Committee due to this being a special event. Site Plan Committee met on this date with the applicant and went over the event. During the meeting the Airport Manager advised that the Airport Authority is aware of the display but it was too late to hold an Authority meeting. The Airport Manager advised that there was only one person that had some concerns but that individual discussed it with the applicant and it was resolved. Insurance was reviewed for proper coverage and was confirmed by Sky Dive City's insurance company that the display was not exclusion and coverage was satisfactory. FAA was consulted and advised that a NOTAM was to be issued by the airport. The airport Manager advised that would be done. The Fire Chief will conduct inspections and an engine company will be on site should n incident happen. At this time, this authority will allow the show to move forward. By paying for permit, the owner /occupant 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. A letter or paperwork shall be provided showing a class that was taken with pyrotechnic company prior to receiving the permit. 2. At the present, time no list was given to show exactly what was being discharged. The display area and setbacks will meet the criteria of what the owner /occupant believes he will shoot (roadside tent cakes and mortars). Any commercial grade stuff may cause the show to be cancelled due to no prior notification to review what additional changes may take place from the upgrade. 3. The display platform shall be secured. All mortars shall be secured to the display platform. 4. Fireworks display shall be in accordance to NFPA 1123 and the remaining items listed are the main points from the standard. 5. Proper PPE's shall be worn for the event. Long pants, long shirts, eye, ear and head protection. 2 6. Owner /operator shall be responsible to section off around display area and monitor access to only allow those involved with the fireworks display (set up, operation, inspection). 7. All fireworks shall have proper labeling. 8. Prep area shall be secured from public by minimum of 100 feet. 9. Owner /occupant shall inspect all shells following delivery to site to check for damage. 10. There shall be no smoking within 50 feet of any fireworks. 11. Tents shall not be located in display area. 12. Mortars shall be positioned and spaced so shells are propelled over the fallout Area and to afford protection for the shooter /operator. 13. Spotters shall be positioned to watch flight and behavior of aerial shells to be sure they are functioning as intended and shells are not landing outside the fallout area. 14. Pressurized water extinguishers shall be located at the display site and with spotters. 15. The AHJ has the authority to stop the display at any time should a hazardous condition exists; this includes crowd control, adverse weather and high winds. 16. The AHJ will give final clearance prior to the display being started. Inspections Required: 1. Pre -site inspection (at least 1 hour before sunset) 2. Post inspection after display 1 KERRY BARN " "'IRE 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. k Temporary Sales Checklist y.� City of Zephyrhills ‘f ► ? l i n v 1/451, 5335 8 "' Street Zephyrhills, F1.33542 /2— /L' 1 (J o Phone: 813- 780 -0020 / Fax: 813- 780 -0021 CZAIrketai— REQUIREMENTS 1 / Detailed Plot Plan showing setup of location. Refer to Ord 1038 -09, Sec 5 V Notarized letter from property owner stating their approval. f A. flame retardant certificate is required IF a tent is involved. Inspection required once tent is 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. 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 • 2 UIREMENTS – (In addition to the above) /Proof of State License. IIUBMITTEL PLANS) )RAVE IIIIEEN 1tik ..l Proof of Liability insurance. BY ZEPHYRHILLS FIRE AR 0 ICE Date: < � , // � ist of items to be sold at site. ley evi sr: __ _ _. __ l/ / ___ • / Copy of Drivers License and Social Security Number of all personnel de with the sale of fireworks at the tent location. FEES i/ $ 30.00 – City Registration (If Regulated by DBPR – Fee is Waived) $_500.00 – Fireworks fee - Fire Department fee / $ 5.00 – Temporary Sales Fee for 1 two days $ 1.00 – Temporary Sales Fee per day for each consecutive day thereafter, exceed duration of 7 consecutive days and no more than two occurrences during a 12 month period on same property Ord #1038 -09, Sec 6 $ 55.00 – Tent Fee (40.00/BD, 15.00 * /FD) 4*$15.00 waived for Fireworks) $ 40.00 – Electrical Fee (if applicable) Property Owner: 510 VE Q C/ 7 � Y JAI C Applicant: 0 - V. 1 b _ -M- CUP: qQ Phone C , : - l 3 - . l 0 67 $ / /'►l U �\ _ 5) / 3-70 6 �3 0 ? ? ctJ . Address Site: Z 1 i 7 ' AW V 7 FPOWN - S a ss 1/ Z Date(s) of & r: S11-0 c0 b Ec 3 1 2a 16 fM To 7/1Ai 1 Zo // 013° fl N1 Ordinance No. 1038 -09 (for additional requirements) 12/20/2010 10:03 _ 8133223589 PASCOPAWS PAGE 02/05 FART III. A g ,PLIcANT INFOMAT!N Name of Organization: s � Y bi V G rtr Applicant muss be a not-for-profit entity, register to do business in the State of Florida Contact person: D AV 1 b & HPtY ess: Pa (o [ t / 3353? 35 3 / Mailing adder Phone nurnber (including area code): ( T 1 - 7 83 73 ?' Alternate phone number (0) 3) S 9' 8 ‘ / Fax number (includin area code): ! 3 7 83 2- 7 ss:_ Email addre@ -- S I<.'r J) i " E.C_1 , Gotli Date incorporated: Current corporate status: (Circle One) .Active Inactive Employer Identification Number (ExN): PART II EIMUNSUBita Do you have any co- sponsors for the event ?: , 7No Yes • If yes, please list: Will an admission fee be charged to attend this event ?: $No Yes If yes, how much will the fee be ?: Please note, an application for any level of City subsidy of a spec ; I ' ' 1 ' ed with the City Manager by June 1 for events occurring during the fol r tober 1- September 30) Approve . !C . day of 2 O1L. By Afr7 ,a �rou ► L cs R m Director of Development rim Ex+'( .6�'K� `�, 1. p u :A Authorized Signature per. i-;�rr. $f. SJe.c Site Plan Review Fee Paid • rau,�c. C . copi Fri Date/� .... - ... Amount it __....__. Lt eL 2 12/20/2010 10:03 8133223589 PASCOPAWS PAGE 03/05 MEHL EVENT RIFORMAILW Name of p roposed event: P I - W O P-K- D IS Mt, N E -4-c.) N EAR S EVE. Date(s) and time(s) of proposed event: SP .� / 3 c a t l'xoposed event location: i SKY l VE LAW E Z S 3 3.0 - If the proposed event is a parade, please list the point of origin, path, and the termination point as well as estimated number of entries (Attack maps as needed to clarify the parade route): Will the event require the closure of a state highway ?: )4.14o Yes If yes, a separate request forms for state road closure must be submitted with this application. Will the event require closure of a City street/avenue ?: ...K No Yes Estimated number of vendors: scX Estimated number of food/beverage concessionaires: Is it proposed that alcoholic beverages be sold, served or consumed at this event? No '?C Yes If yes, an application for a permit for consumption of alcoholic beverages must also be submitted and approved Briefly describe he proposed event and the specific activities a§sociated with it: /u1�1 .111 L f le_ CO L G E a• ; L' -o FULL t' F, 1 i T i N " - r 3 12/20/201e 10:03 8133223589 PASC'OPAWS PAGE 04/05 Have you held this event before in Zephyrhiils? No >4 Yes If yes, when: 96 1130 S Estimate of anticipated number of spectators/participants attending the event 3 In the event of inclement or hazardous weather, do you have an alternate date selected? No Yes If yes, what is the alternate date ?: What electrical services will be required/provided for the event ? (Please be as specific as possible): I ON E • 'What other utilities will be required for the event? bA)P' Please list all equipment, e.g. stage, tents, vehicles, etc. that you propose to use in the event or bring onto City property, streets or parks areas (All subject to approval) Note that tents 20' x 20' or larger will also require a fire rating certificate. , Q / on Et* / M s - r -- 4 q- ' Wit,: S - F ` L. /U / 5 L.WIPMF L .6 • Please provide /attach a description including a map and location and number of public facilities to be provided for the event( e.g., toilets, garbage cans, etc.). A5" `r 5u M i rrI D" 1 FM - e4 , 00 PP ce-T ic' ,. Please attach documentation of the appropriate application for Pasco County Health Department permitting for public facilities. Ai/4 4 12/20/2010 10:03 8133223589 PASCOPAWS PAGE 05/05 BART IV, AEQVIZED FACI.LI'igS ANA U Who is your liability carrier for this event? IOW ELL 5 Attach proof of liability insurance In the amount of One Million Dollars ($1,000,000.00), or Two Million Dollars (52,000,000.00) if the event will include the consumption of alcoholic beverages All policies shall nume the City o Ze k Allis as an additional insured for the event. N s VP.AN c.E c ©v Eft- vin I/we agree to obtain and maintain the required liability insurance and to secure all necessary local, state and federal permits and to comply with all terms and conditions applicable to the conduct of special events, as set forth in Ordinance No. 2005- , as amended. Z/we certify that the information contained in this application is true and accurate to the best of my /our knowledge. As applicant for the event, I/we agree to release and hold harmless the City of Zepbyrhills from liability of any kind for any and all damages arising out of any loss or injury resulting from the conduct of this event. This release includes a release for any and all losses or injury arising while conducting an event using City of Zephyrhills facilides or property and for any and *Mosses or injury to persons attending this special event. 1/we certify that individuals will not be barred from participation in this event due to race, creed, color, national on : ' , sex, age, or physical impairment. • ,41 By: 1 AngrAbo w Date: NEC.. 2—E 2- / 0 Title: i Printed Name: bik V AYES 5 12/20/2010 12:28 8137832171 ZHILLS PAGE 01/01 • . 4 r I. , �+[{p„�}[yr�r. 1'�IC• <�I,.,L'!�� 11 r { ',1%•"•,..; - tl V • i ,}i s; '� t r:'�Y l'''-:t1 .?`; Z ''''''''4 : : J : • . r ' i i , XV V� ?J s :, , 7 r 'lJ ! i r { i • 141 ')' . • . r�' / T. ���' y t, ,I . ' (t, 'r.".51,7411';',.;:,;;;17:; - (s k^!}„ ,x ' , r :. '' 1 .7..9 ) 1. r � �: � s t J l .. � r a , r t 1 I � Y rt � t ,:t, � •. t S �� • �J• � yv 5 ti 7.' l a < { ' �� . ,, j , ,, . ,, r3 .E ,li r, . 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' " r ' 1 ,Y. , :% 1 b11 • i t G_ L- 2'zi'i i'' ailnl'+iR t ,- 4 'r 1i1'11v. •1T'ti1 . 4 a • ••',, t. 1(0a, . 7 , I, , 1 , 1 ' . 'ir oh ,i � 54 I , " >;y',i r 1i1�' •i 1{ Yr ` •1 , �1 ". �Tr a � • '` i l r iY r '1 c - 'i(,' ii lil.�r- <'7F'i' 11t,- I�l RO j\kk 7."..1,....... • ... , . V L ( . b ki L T-- Cf V • A -T — 4 , ..... — rt cp Ni S pLi a( A (--- „,......_. ‘_... ......_.. P,._izm I TS .. • • • • 12/20/2010 10:03 8133223589 PASGOPAWS PAGE 01/05 $PE L tL i✓VENT APPI.,IQATIO11 TgRMS AND CONDITIONS • . Applications for a special event permit shall be filed with the City Manager not less than 90 calendar days and not more than 12 months before the proposed special event date. Permits for recurring events may be applied for and approved annually. • The grant of a permit shall constitute the issuance of a limited license, and shall not create a property right, or entitle the applicant to violate any general park rules, or regulations applicable to the use of public property adopted by ordinance. • The applicant shall be responsible for the payment of fees, deposits, or reimbursement of costs where a request is made to use City services, equipment, or property for a special event. In addition, the applicant shall be responsible for all costs incurred should inspection services be required in order to ensure compliance with the provisions of this ordinance. Any costs of repairs to or restoration of public facilities caused by the event shall be charged to the applicant. • The applicant shall be responsible to contact the Zephyrbills Police Department immediately upon the occurrence of any criminal activity or medical incidents where fire rescue is called or treatment is given. In addition, the applicant shall notify the City in writing of all such incidents in the Post -Event Report. 1 Jacqueline Boges From: RJ Keetch Sent: Wednesday, December 29, 2010 10:56 AM To: Site Plan Committee Subject: SkyDive City Special Event Approval Attachments: DOC122910.pdf SPR Members, Please see the attached approval for the fireworks event at SkyDive City. RJ Original Message From: ToshibaPTR [ mailto: ToshibaPTR Oci.zephyrhills.fl.usl Sent: Wednesday, December 29, 2010 11:46 AM To: RJ Keetch Subject: Scanned from ToshibaPTR 12/29/2010 11:45 Scanned from ToshibaPTR. Date: 12/29/2010 11:45 Pages:6 Resolution: 200x200 DPI Do Not Reply. 1