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Home My WebLink About12-13103 CITY OF ZEPHYRHILLS •---�'' 5335-8TH STREET ' (si3)�so-oozo 13103 FIRE SPARKLERS PERMIT Permit Number: 13103 Address: 7325 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: 34-25-21-0000-00300-0020 Improv. Cost: Date Issued: 5/24/2012 Name: SWEETBAY SUPERMARKET Total Fees: 100.00 Address: 3801 SUGAR PALM DR Amount Paid: 100.00 TAMPA, FL 33619 Date Paid: 5/24/2012 Phone: Work Desc: FIRE SPARKLER SWEETBAY RETAIL SALE#1752 � �� . (� ��- � � � % ! 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 pertormed in accordance with City Codes and Ordinances. "SPARKLERS" per Section 791.01, Florida Statutes, means a device which emits showers or sparks upon burning,does not contain any explosive compounds,does 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 �,_. a�3-�ao-oo2o City of Zephyrhiils Fire Fax-813-780-0021 Permit App�ication Date Received Phone Contact for Permit 800 868 9151 , .,»�e.._....,, ..__�.. �, .,...�. � .��«x�„�,. ��.,��a:�,,�., Owner's Name Sweetbay#1752 Owner's Phone Number $�3 780 1046 owner's Address 7325 Gall Blvd,Zephyrhills, FL 33541 Fee Simple Titleholder Name Titleholder Phone Number C� C� �, I Fee Simple Titleholder Address —� J ,.Ft�r-;t�,»••� ... .. .��'aat�.: te>?�- Job Address 7325 Galt Blvd �� Lot# Sub Division Parcel# . ;.,�.e;karca..�:ww,fa��v.rr,-,,r�.9c�-�at,mr.,�;�:�4:x°��r�.e�a^.�bF�.3�:a�,:�'�a�:d��7�tc�:,:� � �� i Bio-Hazard Waste Storage-ANNUAL � Hazardous Material(Tier II or RQ Faciliry)ANNUAL � Comm Exhaust Kitchen Hood/Ducc � Hood Installation � CoMrolled Bum � LP/Natural Gas-Installation � Emergency Generator<30 kw � LP/Naturaf Gas-ANNUAL Sale � Emergency Generator>30 kw � Places of Assembly-ANNUAL (�f�3 � Fire Protection Maintenance-ANNUAL a Recreational Burn �� ❑� emi �n r Sprinkler ❑ ❑ ❑ � X� sparkiers Inside Retail Sales of State Approved Sparklers Fire Alartn � ❑ ❑ ❑ C� � Sprinkler System Installations Hood Cleaning � ❑ ❑ ❑ �� Standpipes(Sprinkler Sys) Hood Suppression � ❑ p ❑ � � Toroh RoofinglTar Kettle � Fire Alarm Installation � Waste Tire Storage ANNUAL Fire Pumps Fire Works — S�a r�lf.--S Flammable Application-ANNUAL Valuation of Projed Fuel Tanks Q Other: �`�! .�:Y3'a,x. .i..�;.v�:'-�..,c.{:CC[Y.:.tRks�+ti�$s:'.c, h �n.�.�q`' �� '' ^�w: C011tf8CtOf Signature Company Registered Y/N Fee Current Y/N Address License# ELECTRICIAN Signature Company Registered Y/N Fee Current Y/N Address License# PLUMBER Signature Company Registered Y/N Fee Current Y/N Address License# MECHANICAL Signature Company Registered Y/N Fee Current Y/N Address License# Vendor Signature Company NT Fireworlcs Registered Y/N Fee Current Y/N Address 6255 SE 78th reet,Ocala,FL 34474 a-=�+°^��^��^,� .. . , License# Directions: . . �, �.�:ux�a�.y:,•.; �.>�l,�.,. � �< ra>�;�w Fill out applicaUon completely. Owner&Contractor sign back of application,notarized(Or,copy of signed conVact with owner) J n,P yi,�.`}�.i�,Q� If over$2500,a Notice of Commencement is requfred(Mechanical work over$5000) r'� �"�y; Su p p t y t w o(2)s e t s o f d r a w i n g s w i t h a p p lica b te documentation y[ /p�,r`� �� Allow 10-14 days for review after submittal date. Parcel#-obtained from Pro ��U��J � perty Tax Notice(http://appraiser.pascogov.com) -Site plan at store-placement dictated by Fire Marshals office -State Sparkler Licence attached -Product List attached '4C°� CERTIFICATE OF LIABILITY INSURANCE DATE�MMIDD/YYYY) 11 16 2011 I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUIING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to I the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement s. PRODUCER NAME: Britton-Gallagher and Associates, Inc. aHONe - - - - - - Fax-- - — - - 6240 SOM Center Rd C N xt:44 -24 -4711 (aiC,N�440-�-1234 E-MAIL iCleveland OH 44139 ADDRESS: __ _ _ INSURER�S)AFFORDING COVERAGE NAIC# -- -- - - -- -- -- -- - -- - INSURERA��X171��QI1 IR$�d 1S�Q��-��?R�- --- - 1 4_�� -- INSURED - _ 5530 INSURERB.j�{1$ Sur�lus_ _Ins Com��n�%_ American Promotional Events Inc iNSUaertc dba TNT Fireworks -- -- - - � P. O. BOX 1318 INSURER D- -- --- -- -- ---- - -- --- --- -- � ---- --- Florence AL 35631 wsuReke. _ _ _ _ _ � INSURER F. COVERAGES CERTIFICATE NUMBER:2145633279 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 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - — - -- � WSR '�q L U R � I POLICY EFF POLICY EXP I� LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMlDD/YYYY MMlDDNYYY LIMITS A GENERALLIABILITY � �44272132 ,11/1/2011 1;1,�2012 �I EACHOCCURRENCE $1,000,000 X ��COMMERCIAL GENERAL LIABILITY I� , DAMA E TO RENTED - -- I � � CLAIMS-MADE rX J OCCUR I �, PREMISES IEa occurrence) 550,000 __ _ i � MED EXP(P,ny one person) $_ _ _ _ , C =� I ��' PERSONAL&ADVINJURY �$1,000,000 ' -I- -- - -- - - -- - I I ! GENERALAGGREGATE _ �$2,000,000_ �_GEN'LAGGREGATELIMITAPPLIESPER �, PRODUCTS-COMP/OPAGG 52,000,000 '�, POLICY � PRO- LOC � $ - - —- AUTOMOBILE LIABILITY , i Ea acadent�_ ' g ANY AUTO BODILY INJURY(Perperson) r$ �--�AUTOS NED � �AUTOSULED , I I - -- - - - _ _ -- - I — i M1 BODILY INJURY(Peraccident) $ NON-OWNED HIREDAUTOS qUTOS PROPERTYDAMAGE ----- I � �, , .SPer acadenr�-- - - $- -- —- -- - i $ B I UMBRELLALIAB � OCCUR I� iEAU763757 Ill/1/2011 R1/1/2012 EACH OCCI,RRENCE $1,000,000 X EXCESSLIAB i � ------ - _ _ _ ___� CLAIMS-MADE i �AGGREGATL �$1,000,000 � DED RETENTION$ � -- -` -- --- -- WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY � , �, WC ST4TU- OTH- TQRY LIMI�___ , ER ,ANY PROPRIETOR/PARTNER/EXECUTIVE Y�N �, -- - - - I OFFICER/MEMBER EXCLUDED� ❑I N/A I I, I _E L EACH ACCIDENT _ $ _ _ _ __ (Mandatory in NH) i -—- -- -- - If yes,descnbe under �, E L DISEASF-EA EMPLOYEE�$ DESCRIPTION OF OPERATIONS below � E L DISEASE=-POLICY LIMIT •$ I - II DESCRIPTION OF OPERATIONS I LOCA710NS I VEHICLES (Attach ACORD 101,Atlditional Remarks Schedule,H more space is required) Certificate holder and City of Zephyrhills are named as additional insureds. I I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED pOLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN I Sweetbay ACCORDANCE WITH THE POLICY PROVISIONS. 7325 GALL BLVD. I ZEPHYRHILLS FL 33541 AUTHORIZED REPRESENTATIVE �4�� O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD , . Jtdius Halas • �" . DIVISIO�i DIRECTOR Keith McCarthy , `a �- SAFF,7Y PROGRAVI MAlVAGER FLORIDA DEPARTME�IT OF FINANCYAL SERVICES DIVISION UF STATE FIRE MARSHAL 24(3 East Gaines Stteet -Tallahassce,Florida 32399-0342 Tel.550-413-3644 Fax.85U-410-2467 Sweet Bay Supermarket 6255 SE 78th Street Ocala FL 34472 �u�uu.0 CERTIFICATE OF REGISTRATIOIV � � RETAILER LOCATION PERMIT THIS CERTFIES THAT: Sweet Bay Supermarket 3$Ol Sugar Plum Dr Tampa FL 33b19 Has registered pursuant ta the provisions of Florida Statues to engage in tile husiness of selling sparklers at the following fixed place af business: SweetBay #1�52 7325 Gall BIvd Zephyrhills FL 3354i Pasco Issue Date: 4210 1/2 0 1 2 TYPe� 07 Class: 56 Caunty: Hillsboraugh License/Percnit Number: 020476-0031-2008 Expiration Date: Ol/31/2013 � ��" Chief Fenancial4fficer �53-01369695 - REPRINT - PACK LIST - REPRINT - 21362 Order #: 1369695-S3-00002 Chain Store Sales-FL Chains Order Date: 4/'5/12 Terms: Net 30 Days CUST PO: SLSNIl�i: Chain Stores - East Sold To: 1420077 Ship To: 1131571 - FLI1752 KASH 'N KARRY SWEETBAY 1752 PO BOX 3005 7325 GALL BLVD. PORTLAND, ME 04104 ZEPHYRHILLS, FL� 33541 Desc/Case Packing Item Quantity Selling Suggested _______________________________�P_#_ Ordered Units Sell Price -------- --------------- *************************** Novelties----------*********************** 2 PAK SNAP 225 FDP J09 320514 1 CS 225 EA 1 . 00 225/2/50 27736022922 *************************** Sparklers *********************** #8 SPRKLERS ASST BOX FDP JO 380236 1 CS 120 EA 2 . 00 120/6/5 27736022755 *************************** Counter Cases *********************** DSP 50 SS FL #2 J12 672191 1 CS 1 CS 2194 . 38 1/1 Containing: BOOMIN SALUTE SS J10 USA 102073 8 EA 8 EA 59 . 99 6/1 27736022076 PROUD EAGLE SS J10 USA 102072 10 EA :10 EA 29 . 99 10/1 27736013111 COLOR BLAST SS AG J11 102016A 16 EA :16 EA 19 . 99 10/1 27736025589 PARTY PAK SS-USA J09 101933 10 EA :LO EA 15 . 99 16/1 27736004577 SUPER VALUE PACK REV J09 200722 12 EA :L2 EA 10 . 00 12/3 27736017775 STARS AND STRIPES SS J09 101833 18 EA :L8 EA 9 . 99 24/1 27736022106 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 18 EA 5 . 00 4/28/5 27736023288 GROUND BLOOM FLOWER-30 CT 290066 15 EA ]_5 EA 5 . 00 2/15/30 27736010899 STRIKER J10 200862 8 EA 8 EA 5 . 00 24/1 27736026043 2 FOR 1 VALUE PAK J10 200848 8 EA 8 EA 10 . 00 12�2 27736025619 SMOKE BALLS BOX OF 8 J12 351052 48 EA 48 EA 2 . 00 4/24/8 27736028337 DOUBLE PAK MORNING GLORY J 380276 54 EA 54 EA 1 . 00 4/54/8 27736029426 Page No 1 - REPRINT - PACK LIST - REPRINT - ' Order # : 1369695-53-00002 Desc/Case Packing Item Quantity Selling Suggested Ordered Units Sell Price -------------------------------CP- --------------------- ------------------------- SIGN - NO SMOKING 730099E 2 EA 2 EA 0 . 00 1/1 Case Totals: 3 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) (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 � W s � p 2 v E� �� 5 i.�i Te � y Y f.7 S w �� a A t'�,a �� or m '�yL bl F'. d � � A$ < <*% �% U a � Q "�y � w'�� «.,� o d �'z� Q� � c �`��.e ii. ��b � �� d �'a ►��t d c p��pya m i � �V? � p tr. y+.�e � 4 � C.�3'� 1 O w � � �fa"~� a ��1 S W� �' w c:r � �w�q w �a .� OrC p�m F'" Q�t! Q6 �G �p/.y A-�r�.T'. 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TL �;�=�2 F'ire C'hicf Bus (81 i) 780-0041 Keith �'illialns Fa� (813) 780-0044 23 May2012 _�w.�___.._...___ ...__ .._�. .�..__ ___.__._...____.____�____ _�___._____.._.__�._ _ Plan Number 12-019 Project: Sparkler Sales at Sweetbay#17521ocated at 7325 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 Sweetbay Store #1752 located at 7325 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 num.ber to request. Review and approval of the submitted plans does not relieve the contractor fram the responsibility of correcting any deficiencies noted during inspection. Respect lly submitted on 23 May 2012 by, � < < G� �� ,��.c�c�-s---� Keith A. Williams, EFO, CFO, CMO, MIFireE Fire Chief Fire Safety Inspector, #148104 (� �:� ��i ��