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Home My WebLink About12-13102 CITY OF ZEPHYRHILLS 5335-8TH STREET • (si3)�so-oozo 13102 FIRE SPARKLERS PERMIT Permit Number: 13102 Address: 7422 GALL BLVD Permit Type: FIRE SPARKLERS ZEPHYRHILLS, FL. Class of Work: FIRE-SPARKLERS Township: Range: Book: Proposed Use: COMMERCIAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 35-25-21-0010-07200-0011 Improv. Cost: Date Issued: 5/24/2012 Name: K-MART Total Fees: 100.00 Address: 7422 GALL BLVD Amount Paid: 100.00 ZEPHYRHILLS, FL. 33542 Date Paid: 5/24/2012 Phone: Work Desc: FIRE SPARKLER KMART RETAIL SALE#3761 � h /`A Y� V d��-�, � �� - �3 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$100.00, whichever is greater. All work shall be perFormed in accordance with City Codes and Ordinances. "SPARKLERS" per Section 791.01, Florida Statutes, means a device which emits showers or sparks upon burning,dces not contain any explosive compounds,dces not detonate or explode, is handheld or ground based,can not propel itself through the air,and contains not more than 100 grams of chemical compound which produces sparks upon burning. . � 1 CONTRACTOR SIGNATURE PERMIT OFFICER PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE - 813-780-0041 Zepliyrhills Fire Rescue 69U7 Dairy Road, Zephyrhills, ��L >;��2 Fire Chief Bus (81 il 7$U-0041 Keith V�'illiams Fax (813) 780-0044 23 May 2012 - - _ _ ,__ _ __.._._..__._. _.____ _._ Plan Number 12-018 Project: Spazkler Sales at K-Mart 7422 Gall Blvd Number of Pages: 4 Pages Date received by this Office: 5-21-2012 This Officer has reviewed the plan for establishing a sparkler sales display and storage of � stock inside K-Mart located at 7422 Gall Blvd, Zephyrhills. Plans are approved as submitted with the following conditions: 1. No Smoking signs must be posted at display and at storage location 2. Sales location must not impede egress aisle ways. 3. Location shall be similar to previous sales conducted at this location Inspections Required: 1. Site visit by fire inspector prior to sales, contact the above number to request. Review and approval of the submitted plans does not relieve the contractor from the responsibility of correcting any deficiencies noted during inspection. Respectfully submitted on 23 May 2012 by, 1��i��`v ` � l C �''' "�� Keith A. Williams, EFO, CFO, CMO, MIFireE Fire Chief Fire Safety Inspector, #148104 a�saso-oozo City of Zephyrhills Fire Fax-813-780-0021 Permit Application Date Received Phone Contact for Permit 800� 868 9151 . r�. Y . . �. ��.k�....�..�...,�,,.��:::�,.t,..,��-�,..�..��.��,�:��, ,. .. Owner's Name K-Mart#3761 Owner's Phone Number 813 �82 1957 Owner's Address 7422 Gall Boulevard,Zephyrhills,FL 33541 Fee Simple Titleholder Name Titleholder Phone Number � � � Fee Simple Titleholder Address «s.:e�+'x�::.�.+a;e �,.a=+�� Job Address 7422 Gall Boulevard � Lot# Sub Division Parcel# �.�-..dre:�c: . � Bio-Hazard Waste Storage-ANNUAL � Hazardous Material(Tier II or RQ Facility)ANNUAL � Comm Exhaust Kitchen Hood/Duct � Hood Installation � Controlled Bum a LP/NaWral Gas-Installation Emergency Generator<30 kw LP/Natural Gas-ANNUAL Sale n 2 � Emergency Generator>30 kw � Places of Assembly-ANNUAL � , �'V � Q �,�, Fire Protection Maintenance-ANNUAL Recreational Bum � emi � r Sprinkler � ❑ ❑ ❑ � � Sparklers Inside Retail Sales of State Approved Sparklers Fire Alarm � ❑ ❑ ❑ � � Sprinkler System InstallaUons Hood Cleaning � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) Hood Suppression � ❑ ❑ ❑ � Torch Roofinglfar Kettle � Fire Alarm Installation Q Waste Tire Storage ANNUAL Fire Pumps Fire Works —5��-��"S Flammable Application-ANNUAL Valuation of Project Fuel Tanks Q Other: TM:aMxr..�.ti�.a;.4�,s,:� bs'�t�.,z��C+.au.R:<�:ai�'6.k .:�:.^r , COIIVBC�Of 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 treet,Ocala, FL 34474 �icense# Directions:r-v , , f _ . , , > - -� _. _ _. . _ .. .,., . .. .�, a. , Fill out application completely. � Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner) ��j�eA,L�..�� "" If over$2500,a Notice of Commencement is required(Mechanical work over$5000) �� p� �v Supply two(2)sets of drawings with applicable documentation „�b ,� Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com) -Site plan at store-placement dictated by Fire Marshals office -State Sparkler Licence attached -Product List attached � .. , . Julius Hatas , DNISION DIRECTOR Kcith McCarthy ' SAFETY PROGRAM?14ANAGER . �� FLORIDA DEPARTMENT OF FINANCIAL SERV)CES DIVISION OF STATE FIRE MARSHAL 200 East(�aines Street -7"allahassee,Florida 32349-Q342 Tel.550-413-3644 Fax.850-41 Q-2467 K-Mart/Sears Holdings ��y�,�^� ��--^�V~.NW-~.� G255 SE 78th Street Ocata FL 34472 i_. .. p . .. CERTIFICATE UF REGISTRATION RETAILER LOCATION PERMIT THIS CERTFIES THAT: K-MartlSears Holdings 3333 Beverly Rd Hoffinan Estates IL 60179 Has registered pursuant to the provisions of Florida Statti�s to engage in the business of selling sparklers at the fallowing fixed place af business: K-Mart #3761 7422 Gall Blvd Zephyrhills FI� 3�541 Pasco Issue Date: 02/O1/2012 TYPe� 0� Class: b5 ��ri�Y� 4ut of State License/Permit Number: 211018-0033-2011 Expiration Date: O1/31/2Q13 � - • 1� Chief Financial Offtcer �S3-01369419 - REPRINT - PACK LIST - REPRINT - 21362 Order # : 1369419-S3-00002 Chain Store Sales-FL Chains Order Date: 4/5/12 Terms : Net 30 Days CUST PO: SLSNIDT: Chain Stores - East Sold To: 1420037 Ship To: 976089 - KMT3761 KMART STORES - COMPANY 0002 KMART 3761 3333 BEVERLY ROAD, C4-250A 7422 GALL BOULEVARD HOFFMAN ESTATES, IL 60179 ZEPHYRHILLS, FL 33541 Desc/Case Packing Item Quantity Se:lling Suggested CP # Ordered Un:its Sell Price ------------------------------------------------------------- ------------------- *************************** Novelties *********************** 2 PAK SNAP 225 FDP J09 320514 1 CS 2:Z5 EA 1. 00 225/2/50 2343126 *************************** Sparklers *********************** #8 SPRKLERS ASST BOX FDP JO 380236 2 CS 240 EA 2 . 00 120/6/5 2480675 *************************** Counter Cases *********************** DSP 50 SS FL J12 672093 1 CS 1 CS 2240 .46 1/1 Containing: BOOMIN SALUTE SS J10 USA 102073 8 EA 8 EA 59 . 99 6/1 2481231 SHOW OF FREEDOM USA SS J09 101831A 8 EA 8 EA 39 . 99 10/1 2481234 FREEDOM RINGS SS USA J09 101832A 12 EA :L2 EA 24 . 99 16/1 2459780 PARTY PAK SS-USA J09 101933 8 EA 8 EA 15 . 99 16/1 2459772 SUPER VALUE PACK REV J09 200722 16 EA �L6 EA 10 . 00 12/3 2491296 STARS AND STRIPES SS J09 101833 18 EA ]L8 EA 9 . 99 24/1 2481229 CAL ROCKET FOUNTAIN 3-PK 200967 30 BG 30 BG 5 . 00 2/30/3 27736028450 PIT STOP #2 5 PK SS SM PDQ 320530B 28 EA �?8 EA 5 . 00 4/28/5 27736023288 GROUND BLOOM FLOWER-30 CT 290066 15 EA 15 EA 5 . 00 2/15/30 2459792 STRIKER J10 200862 8 EA 8 EA 5 . 00 24/1 3559589 2 FOR 1 VALUE PAK J10 200848 8 EA 8 EA 10 . 00 12/2 27'736025619 SMOKE BALLS BX OF 9 SM PDQ 351043B 40 EA 4.0 EA 2 . 00 4/40/9 2480670 14 IN TRIPLE PAK MG J11 380265W 54 EA 54 EA 2 . 00 2/54/20 27736027583 Page No 1 - REPRINT - PACK LIST - REPRINT - • ' Order # : 1369419-53-00002 Desc/Case Packing Item Quantity Selling Suggested �P # Ordered Units Sell Price -------------------------------------------------------------------------- SIGN - NO SMOKING 730099E 2 EA 2 EA 0 . 00 1/1 Case Totals: 4 CS Total Pallets: PL Total Repack Cases: CS DECLAR.ATION OF COMPLIANCE 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) (_L1) 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 t-esting. American Fireworks Standards Laboratory (AFSL) 7316 Wisconsin Avenue, Suite 214 Bethesda, MD 20814 301-907-9115 af slhq@af sl .org CONTACT INFORMATION FOR INDIVIDUAL MAINTAINING RECORDS ON WHICH DECLAR.ATION IS BASED: NAME: Kathie Pendergrass ADDRESS : 4511 Helton Drive Florence, Alabama 35630 TELEPHONE: 256-764-6131 FAX: 256-767-7200 E-MAIL: pendergrasskCtntfireworks.com. www.tntfireworks.com Page No 2 �CO°� CERTIFICATE OF LIABILITY INSURANCE DATE�MM/DD/YWY) 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�, AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. �i 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: I Britton-Gallagher and Associates, Inc PHONe -- -- --— �Fax - - -- -- 6240 SOM Center Rd. - - 71 ��AiC No1:440=544-1234___ i Cleveland OH 44139 A DR�ESS: I ___ INSURER�S)AFFORDING COVERAGE __ _ _ NAIC 1t � - ---- --- -------- - ----- -- INSURERA mpan�'-- ---- 4 -L- — INSURED 553 O INSURER B. ��urplus I�_�m-��--- -- --- - � American Promotional Events Inc. INSURERC. dba TNT Fireworks - - - ---- --- --- — ---- rt------ P O. BOX 1 3 1 8 INSURER D._ _ __ _ I -------- --- - - --�- - Florence AL 35631 INSURERE. INSURER F. COVERAGES CERTIFICATE NUMBER:129211648 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD i INDICATED NOTIMTHSTANDING 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, ' EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �LTR' TYPE OF INSURANCE IN R WVD� POLICY NUMBER MM/DOY� MM/DDY� LIMITS A i GENERALLIABIUTY 44272132 I1/1/2011 1/1/2012 EACH OCCURRENCE $1,000,000 �' X i � � �' DAMA E REN ED ��-- , COMMERCIAL GENERAL LIABILITY �� PREMISES(E:a occurrence SSO,000 �----- I j CLAIMS-MADE �OCCUR �, II MED EXP�Any one person) $ ' � �----- — - - - �' PERSONAl8�ADVINJURY $1,000,000 �- j GENERALAGGREGATE $2,000,000 i GEN'L AGGREGATE LIMIT APPLIES PER I � PR�p�CTS-COMPlOP AGG $2,000,000 r �� PRO- , I � POLICY LOC , $ AUTOMOBILE LIABILITY � - � � ��, Eaaccident� _g_ '� ANY AUTO � ��, , BODILY INJURY(Per person) $ I � ALLOWNED � SCHEDULED I . _ AUTOS � _ AUTOS � BODILY INJURY(Per acatlent) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE �$ - 'F_ AUTOS � �(Peraccitlen0 __ I� � � $ - --- I B UMBRELLALIAB X OCCUR � EAU763757 11/1/2011 1/1/2012 �EACH OCCUF2RENCE i$1,000,000 ' X �EXCESS LIAB '� I �, i � — - -- i I CLAIMS-MADE � i � -- -- , AGGREGATE I$1,000,000 �--- - — �, DED � RETENTION$ �I ' $ WORKERS COMPENSA710N � Vv�STPTU- OTH- AND EMPLOYERS'LIABILITY Y�N I '��T Y T R ANY PROPRIETOR/PARTNER/EXECUTIVE ' E L EACH ACCIDENT OFFICER/MEMBER EXCLUDED� ❑ N/A I 5 � (Mandatory in NH) , ' I I �E L DISEASE-EA EMPLOYEE�$ � If yes,descnbe under � � �f DESCRIPTION OF OPERA710NS below i �� ( E L DISEASE-POLICY LIMIT I g I ' i � i I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES�Attach ACORD 101,qdditional Remarks ScheOuk,if more space is required) j 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 K-Mart ACCORDANCE WITH THE POLICY PROVISIONS. , 7422 GALL BOULEVARD �I ZEPHYRHILLS FL 33541 pUTNORIZEDREPRESENTATIVE ��1� O 1988-2010 ACORD CORPfJRATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ,4co� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) `� 11/30/2011 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),AUTHORIZED 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: MCGRIFF,SEBELS&WILLIAMS,INC. ---- --- -- - -- --- - - PO.Box 10265 aC No Extl;80�-476-2211 ,��: Birmingham,AL 35202 E-MAIL - - — --- -- — -- ADDRESS. _ ___ _ INSURER�S)AFFORDING COVERqGE NAIC# __ —- - -- - - -- --- -- - - iNSUReRn:United States Fire Insurance Compan�r � 21113 - --- -- -- — --- - - -- - - -- - - - - INSURED INSURER B � American Promotional Events,Inc. _ __— __ _ __ __ � dba TNT Fireworks INSURER C � PO.Box 1318 --- - --- — — — - - ---- -- Florence,AL 35631 iNSURER o -- -- ----- --- - - � -- - INSURER E �'� INSURER F. -- - -- -- ----- -- --- -- COVERAGES CERTIFICATE NUMBER:xPH,13F�6 REVISION NUMBER: 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 RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJF_CT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP - LTR � TYPE OF INSURANCE � POLICY NUMBER MMIDD/YYYY MM/DDlYYYY LIMITS GENERAL LIABIL�TY '�, ' i EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY I ��1AGE TZS�RFRTEb I PREMISES f2a occurrence S —�- -�-- ' CLAIMS-MADE �OCCUR � �' �, �' �MED EXP(Any one person) S__ __ _ --- - - --- _-_ PERSONAL E�ADV INJURY � _ _ _ ---- --- --- -— -- ' , �'� GENERAL AGGREGATE �$ � --- --- - �-- ----- --- GEN'L AGGREGATE LPIROIT APPLIES PER I i PRODUCTS COMP/OP AGG�$ __ __ POLICY 7 LOC $ AUTOMOBILE LtABILITY , COMBINED SINGLE LIMIT ' Ea accidentZ__ :g_ ANY AUTO ' '� BODILY INJUI�Y(Per person) S ALLOWNED SCHEDULED --- ----- --- AUTOS AUTOS i BODILY INJURY(Per acadent)'$ NON-OWNED - --- HIRED AUTOS AUTOS � '' ' �PROPERTV DAMAGE �� - — ;�r acadent) _ _ ___ __ _ $ UMBRELLA LIAB pCCUR EACH OCCUf2RENCE $ EXCESS LIAB _ CLAIMS-MADE Ij AGGREGATE $ —-- - --- --- i--- — ---- -- DED RETENTION$ $ A WORKERSCOMPENSAiION 4087031868 11/01/2011 11/01/2012 X `�/CSTATU- OTH- AND EMPLOVERS'LIABILITV � � T_ORY LIIv11TS ER � ANY PROPRIETOR/PARTNER/EXECUTIVE Y�N I � �' E L EACH ACCIDENT g 500,000 OFFICER/MEMBER EXCLUDED� ❑'N�A , (Mandatory in NH) Ii � Ii � DISEASE-EA EMPLOYEE�, S 500,000 Ii yes,descnbe under '� � _ __ ___ _ ___ _ _ _ DESCRIPTION OF OPERATIONS below '� � � E L DISEASE-POLICY LIMIT ' � 500,000 � S 5 I� $ $ DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES (Altach ACORD 107,Additional Remarks Schedule,H more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Zephyrhilis AUTHORIZED REPRESENTATIVE -- 5335 8th Street � l c, Zephyrhills,FL 32703 A� s _-�,.:,;¢r�. _..>� �_ . Page 1 oi 1 OO 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD