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Home My WebLink About11-12611 • CITY OF ZEPHYRHILLS . . 5335 - 8TH SIREET � ' (sis) �so-oo20 12611 FIRE SPARKLERS PERMIT Permit Number: 12611 Address: 7631 GALL BLVD Permit Type: FIRE SPARKLERS ZEPHYRHILLS, FL. Class of Wo�k: FIRE-SPARKLERS Township: Range: Book: Proposed Use: COMMERCIAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 34-25-21-0110-00000-0010 Improv. Cost: Date Issued: 12/12/2011 Name: SUPER WAL-MART Total Fees: 100.00 Address: 7631 GALL BLVD Amount Paid: 100.00 ZEPHYRHILLS, FL. 33542 Date Paid: 12/12/2011 Phone: (479)204-1063 Work Desc: FIRE SPARKLER SALE WALMART �,� OS`�-� I �z3 � f .1 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 $100.00, whichever is greater. All work shall be performed in accordance with City Codes and Ordinances. "SPARKLERS" per Section 791.01, Florida Statutes, means a device which emits showers or sparks upon burning, dces not contain any explosive compounds, does not detonate or explode, is handheld or ground based, can not propel itself through the air, and wntains not more than 100 grams of chemical compound which produces sparks upon burning. r /�i� �C� � `%��'"V/ �`- � / CONTRACTOR SIGNATURE P IT OFFICER PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED ZEPHYRHiLLS FiRE RESCUE - Fire Marshal Office - 813-780-0041 ais-�so-oo2o City of Zephyrhills Fire Fax-813-780-0021 . ' Permit Application Date Received - �-� Phone Contactfor Permit 800 868 9151 "'iS:F2�:A� a. :xxYcea+d.••. �.. .°� A�tHe.i< a..o��e�@�:$ Q tv.u�iF V bRw��II�. '.y:4 a�G•ea^:' a�3S'�"�'he owner's Name Wal-Mart #706 Owner' Phone Number 813 782 1957 Owner's Address 7631 Gall Blvd, Zephyrhills, FL 33541 Fee Simple Titleholder Name Titleholder Phone Number �� Fee Simple Titleholder Address &� �� Job Address 7631 Gall Bivd Lot # � Sub Division Parcel # ..� .>a;a .� :•:...s. > :•�. i�e.�';'�� ° � . . _ . � � ` �.� `�. _ � BiaHazard Waste Storage - ANNUAL � Hazardous Material (Tier II or RQ Facility) ANNUAL � Comm Exhaust Kitchen Hood/Duct � Hood Installation � Controlled Burn � LP/Natural Gas-Installation � Emergency Generator < 30 kw � LP/Natural Gas-ANNUAL Sale � Emergency Generator > 30 kw � Places of Assembly-ANNUAL � Fire Protection Maintenance - ANNUAL � Recreational Burn ry emi �n er sprinkier �❑ ❑ ❑� X� Sparklers Inside Retail Sales of State Approved Sparklers Fire Alarm � ❑ ❑ ❑� � Sprinkler System installations Hood Cleaning � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) � �/ �± ( ( / �'/ �p « Hood Suppression � ❑ ❑ ❑� � Torch Roofing/Tar Kettle � Fire Alarm Installation � Waste Tire Storage ANNUAL � Fire Pumps �' Fire Works — $ PAQ,I��,.��5 � Flammable Application- ANNUAL Valuation of Project � Fuel Tanks � Other• ;�;��. , • •�� •�; ~�a:� .�� Contractor Company Signature Registered Y/ N Fee Current Y/ N Address License # ELECTRICIAN Company Signature Registered Y/ N Fee Current Y/ N Address License # PLUMBER Company Signature Registered Y/ N Fee Current Y/ N Address License # MECHANICAL Company Signature Registered Y/ N Fee Current Y/ N Address License # Vendor � Company NT Fireworks Signature Registered Y/ N Fee Current Y/ N Address 6255 SE 78th Street, Ocala, FL 34474 License # :�:� k�� . . . . . , , . ,.... ° w �°�� Directions: Fill out application completely Owner 8 Contractor sign back of application, notarized (Or, copy of signed contract with owner) If over $2500, a Notice of Commencement is required (Mechanical work over $5000) Supply two (2) sets of drawings with applicable documentation Allow 10-14 days for review after submittal date. Parcel #- obtained fr��l��(��r�1�p��.��1j$W� - Site plan at store - placement dictated by Fire Marshals office aY ZEPHYRHILLS � AL'S OFFICE - State Sparkler Licence attached Date: - Product List attached ��viewor: i - - - - -- - - -- - - -- - �`�'O�°� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11 16 2011 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), AUTHORI2ED I REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement s. PRODUCER NAME: Britton-Gallagher and Associates, Inc. PNONe --- Fnx --- ' 6240 SOM Center Rd. a o exc: -24 -4711 I n�c No�;44Q�4-1234 E-MAIL Cleveland OH 44139 ADDRESS. _ _ I NSURERI S) AFFORDING COVERA NAIC # INSURE RA:L2X 11 7�t0I 1_ I riSllY'3I1 � 2 COR1D _�1��_ , INSURED 5530 INSUR SUYpl IriS COIII�dri� ___ _ r_ _ _ American Promotional Events IriC. INS _ _ � ba TNT Fireworks -- - - - - - - - - -- P . O . BOX 13 18 INSURER — -- -- - -- - - -- - - - - - - - — - � - - - Florence AL 35631 iNSU INSURER F COVERAGES CERTIFICATE NUMBER: 1390280319 REVISION NUMBER: i THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD , INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ; CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXC LUSIONS A ND CONDI OF SUCH POLICIES. L IMITS SHO MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR 7ypE OF INSURANCE A�� , POLICY EFF , POLICY EXP � --- LTR I INSR WVD POLICY NUMBER MM/DDIYYYY � MM/DD/YYYY LIMITS A GENERALLIABILITY 44272132 11/1/2011 I,�1/1/2012 EACH OCCURRENCE $1, 000,00 0 __ � X COMMERCIAL GENERAL LIABILITY � � ' PRE S (E a occu ence SSO 000 _ CLAIMS-MADE X_ l OCCUR � MED EX (A ny one p ?$ _— - ___ � PE RSONA L & AD INJU S1, 000 00 0 _ _ _ � -- - ---- -_—_ _ __— -_ _— I i � GENERALAGGREGATE _ _� $2,000,000 __ _ GEN'L AGGREGATE LIMIT APPLIES PER �F— � ___ �,PRODUCTS-COMPlOPAGG 52,000,000 POLICY I PRO- LOC � - - - -- - - '- 5 - - --- - ' AUTOMOBILE LIABILITY � '� , - { acciden _ _ $ ANY AUTO � BODILY INJURY (Per person) $ ALLOWNED � SCHEDULED ' , BODILYINJURY Peraccident $ i __ AUTOS __ AUTOS � � ( )' '� NON-OWNED PROPERTY DAMAGE I __� HIREDAUTOS AUTOS � � $ -- �Per accident _ _ $ -- -- — ' B i UMBRELLALIAB X � pCCUR � �EAU763757 11/1/2011 71/1/2012 � X EXCESS LIAB , � EAC O �i $1, 000, 000 __ �_CLAIMS-MADE AGGREGATE $1, 000, 000 - T - - ---- , � - - - -- --- - - - - - DED � RETENTION S ' � � � $ WORKERS COMPENSATION � WC STATU- � OTH-' ' AND EMPLOYERS' LIABILITY Y � N __�Y LIMIT ; ER __ _ _ _ _ ____ ANY PROPRIETOR/PARTNER/EXECUTNE E � EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED� ❑ N � A ---- _ _ _ __ _ _ _ _ _ _ _ (Mandatory in NH) E L DISEASE - EA EMPLOYEE'� $ ' If yes, descnbe under i i h ---- -- _ - -- _ _- __ DESCRIPTION OF OPERATIONS below I E L DISEASE - POLICY LIMIT $ i I ' I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 107, Additional Remarks Schedule, if more space is requiretl� I Certificate holder and City of Zephyrhills are named as additional insureds. I I CERTIFICATE HOLDER CANCELLATION I ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN i Wal -Mart ACCORDANCE WITH THE POLICY PROVISIONS. • 7631 GALL BOULEVARD I ZEPHYRHILLS FL 33541 AUTHORIZEDREPRESENTATIVE �� OO 1988-2010 ACORD CORPORATION. All rights reserved. , ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD STATE OF FLORIDA ' DEPARTMENT OF FINANCIAL SERVICES DIVISION OF STATE FIRE MARSHAL TALLAHASSEE, FLORIDA CERTIFIC�►TE OF REGISTRATION WHOLESALER OF SPARKLERS THIS CERTIFIES 7'fdAT• AMERiCAN PROMOTIONAL EVENTS DBA TNT FIREWQRKS 6255 S E 78TH STREET OCALA. FL 34472- HAS REGISTERED PURSUANT TO THE PROV1S10NS OF FLOttIDA STATUTES TO ENGAGE IN THL•; BUSiNFSS OF SELLING SPARKLERS TQ A R.E I'HIE,ER. ��,�y�'� Chief Flnaneial Oflicer 02 O1 2011 07 62 Marion 56506500012W5 2102400001 ]000.00 41 31 2012 Issuc Datc Type Class County License/Permit Number Application # Ta�ces 8c Fces E�cpire Dete STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DMSION OF STATE FIRE MARSHAL TALLAHASSEE, FLORIDA CERTIFICATE OF REGISTRATION DISTRiBUTOR OF SPARKLERS THLS CERTIFIE$ THAT: AM6RICAN PROMOTIONAL EVENTS, DBA TNT FIREWORKS 6255 SE 78TH STREET OCALA, FL 34472- HAS REC3iSTGRED PURSUAN'I' TO 1HE PROVISIONS OF FLORII�A STATUTES Tp ENGAGE IN THE BUSMESS OF SELLING SPARKLERS'I�0 A WHOLESALER. �� Chief Fiaancld OlTieer 02 O1 2011 07 61 Marion 84691500012007 2102390001 ]000.00 O1 31 2012 Issue Date Type Class County License/Permit Number A,pplication �t T�ces & Fces Expiro Date J3 - REPRINT - PACK LIST - REPRINT - 21362 Order #: 1310469-S3-00002 Chain Store Sales-FL Chains Order Date: 10/21/11 CUST PO: 0152755749 Terms: Net 60 Days SLSNR�T: Chain Stores - East Sold To: 1410002 Ship To: 1056090 - WAL0706 WALMART - CORPORATE 00001 WALMART 0706 702 SW 8TH STREET 7631 GALL BLVD BENTONVILLE, AR 72716 ZEPHYRHILLS, FL 33540 Desc/Case Packing Item Quantity Selling Suggested CP # Ordered Units Sell Price -------------------------------------------------------------------------------- *************************** Assortments *********************** BACKYARD SHOW WPDQ USA SS NY 102015 3 CS 30 EA 19.00 10/1 70055727 BLAST ZONE USA SS J10 102018 2 CS 20 EA 29.00 10/1 70017171 RED WHITE BOOM SS J10 102019 1 CS 6 EA 49.00 6/1 000799019 VALUE BLAST W/ PDQ USA SS N09 102014 2 CS 48 EA 10.00 24/1 70055720 *************************** Base Fountains *********************** COUNT DOWN SS W/YP NY10 200784A 1 CS 24 EA 6.00 24/1 70017565 JUMBO FINALE -4 PAK- WM 200566 1 CS 5 EA 29.00 5/4 000783462 *************************** Ground Spinners *********************** GROUND BLOOM FLWR-30 CT J10 290066W 1 CS 30 EA 5.00 2/15/30 000703478 *************************** Novelties ******************�**** TNT SNAPS 4 PAK J09 320532 1 CS 153 EA 2.00 153/4/50 000799080 *************************** Sparklers *********************** #8 SPRKLERS ASST BOX PDQ J09 380247 2 CS 168 EA 2.00 84/6/5 000799442 *************************** Promotional Supplies *********************** SIGN - NO SMOKING 730099E 3 CS 3 EA 0.00 1/1 Case Totals: 14 CS Total Pallets: PL Total Repack Cases: CS DECLARATION OF COMPLIANCE Page No 1 - K�YK1N 1- YAC:tC L1.5'1' - K�1'K1N'1' - Order #: 1310469-53-00002 Desc/Case Packing Item Quantity Selling Suggested CP # Ordered Units Sell Price -------------------------------------------------------------------------------- American Promotional Events, Inc., dba TNT Fireworks, certifies that all consumer fireworks identified on this invoice have been tested by the American Fireworks Standards Laboratory and found to conform with all applicable regulations, standards and bans enforced by the U.S. Consumer Product Safety Commission. Testing and certification for these items complies with rules, standards and bans applicable to consumer fireworks: Performance Standards 16 CFR 1500.17(a)(9) 16 CFR 1500.17(a)(11) 16 CFR 1500.17(a)(12) 16 CFR 1507 Powder Content Bans 16 CFR 1500.17(a)(3) 16 CFR 1500.17(a)(8) 16 CFR 1500.85(a)(2) Cautionary Labeling 16 CFR 1500.14(b)(7) 16 CFR 1500.83(a)(27) Contact information for laboratory that performed conformity testing. American Fireworks Standards Laboratory (AFSL) 7316 Wisconsin Avenue, Suite 214 Bethesda, MD 20814 301-907-9115 afslhq@afsl.org CONTACT INFORMATION FOR INDIVIDUAL MAINTAINING RECORDS ON WHICH DECLARATION IS BASED: NAME: Kathie Pendergrass ADDRESS: 4511 Helton Drive Florence, Alabama 35630 TELEPHONE: 256-764-6131 FAX: 256-767-7200 E-MAIL: pendergrasskQtntfireworks.com. www.tntfireworks.com Page No 2 Zephyrhills Fire Rescue 6907 Dairy Road, 7,ephyrhi(Is, Ft, �i5�? Fire Marshal Bus (813) 780-0041 kerry F3arnett Faa (81 ;) 780-0044 F,-mail: kbarnett�ii;fiire.zephyrhills.fl.us Plan Review #: 11-134 Project: Retail Sales - Sparklers Number of Pages: Packet December 9, 2011 I have received and reviewed the plans for the retail sales of sparklers located at 7631 Gall Blvd and will allow the project to move forward. Please note that this review does not eliminate any further reyuirements as the project continues moving forward. By receiving permit, applicant 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. Permit will be posted after inspection at location of sparklers. 2. A fire extinguisher shall be placed at location of the sparklers and shall be readily accessible. Inspection Required: 1. A site inspection is required once merchandise is placed on the sale floor. Failure to contact this authority will result in a monetary penalty that could result in hundreds of dollars. ' KERRY 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 NFPA codes and local ordinances. � Z��Y�HILL.S FIRE DEPARTMEIVT" 6907 Dairy Road, Zephyrhiils, FL 33542 Fire Chief Kei�h Vlliliiams Bus (813}780-0041 Fax (813)780-0044 FIRE SERVICE USER FEES Occupancy No.: Pian No.: /�— /3� Contractor. %N3� �� ' Business Name� G✓�I �rr� ��T Billing Address: G��"S �� Si Business Address: - 7�� 3 i �� .�� r2cL�A, � � t.j 7 t� Business Phone No : Billing Phone No.: Business Fax No.: Billing Fax No.: Contact: Contact: PLAN REVIEW FEES INSPECTION FEES PERMIT FEE FALSE ALARM FEE B Site Plan N/C Annual N/C Sprinlder $50 1st Alarm N1C Mufti-Family/Commercial .O6 sf 15t 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 � Ptan Revisions DBL 3rd Re-inspection $250 Hoods $50 4th Alarm $100 4th Re-lnspection $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 $SO NON COMPIIANCE $150 26 plus Heads $100 SPRINKLER SYSTEMS Fuel Tanks- ��k �5p STANDPIPE SYSTEM Hydro Undergrounds $45 parklers $100 � Per Riser $50 Hydrostatic Test a65 per system Fire Works $500 FIRE PUMP Acceptance Test $45 Pe� sys�em Camp Fire $25 � Per Pump $100 Hydrant Flow $75 Controlled Burn $100 FIRE ALARM SYSTEM Hood/Duct $50 8 0- 25 DeVICeS $50 FIRE ALARM SYSTEM PIeCE Of ASS@rtlbly $50 Annua� 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 $SO Annual Dry $50 Fire WalUSmoke Wall $15 per wall Genefator < KW $100 CO2 $50 LP Gas $25 per tank Generator >30 KVV 150 Other $50 Natural Gas $25 pe� sy�mm Bio-Hazard Waste $100 Annual KITCHEN EXHAUST Fumigation Tenting $50 � Hood/Ducts $50 Tent 10'x10' or greater $15 per tent Torch PoUApplied $50 OTHER Fire Pump $45 Haz. Materials $100 Annual LP Installation per tank $50 Fire Suppression $30 Fuel Tank Installatio� $50 System Acceptance ❑ (Per Tank) $50 8 Exhaust Hood/Duct $30 Natural Gas Installation $50 Re-inSpeCtton DBL (Per System) (otherthan annual) � Spray Booth $50 � Inspection scheduled DBL 8 and cancelled less than 24 hours Construction Insp. N/C Emergency Vehicle Ac� $50 FALSE ALARM PLANS TOTAL �� INSPECTIQN TOTAL � PERMIT TOTAL C� TOTAL �_ _ I GRAND TOTAL (J Comments: Date: L ?' / Ins��ctor� _� �` 1:i� � •��