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Home My WebLink About12-13104 � CITY OF ZEPHYRHILLS 5335-8TH STREET (sis)�so-oo20 13104 FIRE SPARKLERS PERMIT Permit Number: 13104 Address: 7631 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: 34-25-21-0110-00000-0010 Improv. Cost: Date Issued: 5/24/2012 Name: SUPER WAL-MART Total Fees: 100.00 Address: 7631 GALL BLVD Amount Paid: 100.00 ZEPHYRHILLS, FL. 33542 Date Paid: 5/24/2012 Phone: (479)204-1063 Work Desc: FIRE SPARKLER WALMART RETAIL SALE #706 � C� .�_�� 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 wsts related to the aforementioned. Complete Plans, Specifications and Fee Must Acmmpany 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,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. ,=�- r,�� l , � CONTRACTOR SIGNATURE �l� PERMIT OFFICER PERMIT EXPIRES IN 30 DAYS�ITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE - 813-780-0041 �,—� 813`-780-0020 Cit of Ze h rhills Fire Y P Y Fax-813-780-0021 Permit Application Date Received �� Phone Contact for Permit 800 868 9151 ��..��,.a:.,.m�.�_<., .._�,��.a�.��w.:��..�+.�,��.�.,. Owner's Name Wal-Mart#706 Owner's Phone Number 813 782 1957 Owner's Address 7631 Gall Blvd,Zephyrhills, FL 33541 Fee Simple Titleholder Name Titleholder Phone Number C� �� Fee Simple Titleholder Address . , . .,.,,R,�e >::x?,��,•s�-ars�F��.,..;.�f,„,e�. .,r..�t.ia.;M�;.�'.�b.p�e � Job Address 7631 Gall Bivd � Lot# Sub Division Parcel# �e ^v-:a�°��.x�Y�°-�'�.^�:, v.°ar,'x��°a��.. ,�.�,s:..��,,,saa��:�,asa;.'�"::yt•rm��.�s ` s+aF'�W+��;t.�a&: &t��i"& #� 3 Q Bio-Hazard Waste Storage-ANNUAL � Hazardous Material(Tier II or RQ Facility)ANNUAL � Comm 6chaust Kitchen Hood/Duct � Hood Installation � ConVOiled Bum � LP/Natural Gas-Installation a Emergency Generator<30 kw � LP/Natural Gas-ANNUAL Sale � Emergency Generator>30 kw � Places of Assembly-ANNUAL � Fire Protection Maintenance-ANNUAL � Recreational Burn ❑� emi �n � Sprinkler ❑ ❑ ❑ � � Sparklers Inside Retail Sales of State Approved Sparklers Fire Alarm � ❑ ❑ ❑ � � Sprinkler System Installations Hood Cleaning � ❑ ❑ ❑ C� � Standpipes(Sprinkler Sys) �� 1r 2 r D y� Hood Suppression � ❑ ❑ ❑ � � Torch RoofinglTar Kettle l fJ � � Fire Alartn Installation � Waste Tire Storage ANNUAL Fire Pumps _� Flammable Application-ANNUAL Valuation of Projed � Fuel Tanks Q Other: •.Y.�.64Yi:.TA.a_t',:��FWI�X�eaF:is..$°a;s'.-"A:aw��::�k\«".k: .'�'�'.'BYi`"c; . 8',ddm3��'.4u�,.°9`sS�. Conhactor Company Signature Registered Y/N Fce Current Y/N Address license# ELECTRICIAN Company Signature Registered Y/N Fee Current Y!N Address License# PLUMBER Company Signature Registered Y/N Fee Cument Y/N Address License# MECHANICAL Signature Company Registered Y/N Fee Current Y/N Address License# Vendor Company NT Fireworks Signature Registered Y/N Fee Curnent Y/N Address 6255 SE 78th Street,OCala, FL 34474 license# . . . . , .,..3 L:.S.x'4.�i:4`ia..': �:,i'f&w.�g... Directions: ' -�. - .. � . Fill out application completely. /l -� Owner 8 Contractor sign back of application,notarized(Or,copy of signed contract with owner) 4��p f�r(,-L� �'�e- If over$2500,a Notice of Commencemerrt�is required(Mechanical work over$5000) � `�� fj� Supply rivo(2)sets of drawings with appflcable documentation �`�� Allow 10-14 days for review after submittal date. Parcel#-obtained from Pro �� perty Tax Notice(http://appraiser.pascogov.com) -Site plan at store-placement dictated by Fire Marshals office -State Sparkler Licence attached -Product List attached Julius Halas ',DIVISIO`d DIRECTOR Kcith bieCarthy � ' S AFETY pRpGRAM MA:VACER .��. FLORIDA DEPARTNIENT O�FiNANCIAL SERVICES DIVISION OF STATE FIRE MARSHAL 200 East Gaines Strcet -Tallahassee,Fiorida 32399-0342 Te1.850-413-364d Fax.8SQ-410-2467 Wal-Mart Stores Inc. � Y~_W� �TT� 6255 SE 78th Street Ocala FL 34472 �l 1 j q ■ ■� CERTiFICATE QF REGISTRATION � �� RETAILER LOCATION PERMIT THIS CERTFIES THAT: Wal-Mart Stores Inc. b712 US HWY 98 WEST SANTA ROSA BCH FL 32459 Has registered pursuant ta the provisions of Florida Statues to engage in the business of seilzng sparklers at the following fixed place of business: Wal-Mart#706 7631 Gall Blvd Zephyrhills FL 33543 Pasco Issue Date: 02/Ol/2012 Type: p� Glass: 66 County: Walton License/Permit Number: 565026-0018-�405 Expiration Date: O 1/31/2013 / . w.�... 1� Chief Financiai Officer �53-01371435 - REPRINT - PACK LIST - REPRINT - 21362 Order #: 1371435-S3-00002 Chain Store Sales-FL Chains Order Date: 4,/6/12 Terms : Net 60 Days CUST PO: 5953154211 SLSNIl�T: Chain Stores - East Sold To: 1410002 Ship To: 1056090 - WALO'706 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 Ordered Units Sell Price -------------------------------CP- --------------------�------------------- *************************** Assortments *********************** BACKYARD SHOW WOPDQ USA SS Jl 102015A 8 CS 80 EA 19 . 97 10/1 70055727 BIG BLAST SS COM J12 102210 3 CS 6 EA g9 , 97 2�1 550437041 ERUPTOR SS - COM WM J09 DOM 101740A 1 CS 1 EA 149 . 97 1/1 727136 FUN BLAST SS USA W/PDQ J12 102205 4 CS 96 EA 9 , 9� 24/1 27736028726 RED WHITE BOOM SS J10 102019 4 CS 24 EA 49 . 97 6/1 550503498 *************************** Base Fountains *********************** DINOSAURS FTN 3 PAK PDQ J09 200816 1 CS 72 EA 2 . 00 �2�3 550503478 JUMBO 20 RKT FTN PDQ WM J09 200815 1 CS 48 EA 5 . 00 48/3 550503486 JUMBO FINALE -4 PAK- WM 200566 4 CS 20 EA 2g , g7 5/4 783462 *************************** Ground Spinners *********************** GROUND BLOOM FLOWER-30 CT BOX 290066 3 CS 90 EA 5 . 00 2/15/30 703478 *************************** Sparklers *********************** #8 SPRKLERS ASST BOX PDQ J09 380247 1 CS �34 EA 2 . 00 84/6/5 550503481 14 IN SUPER PAK MG J12 WM 380265 1 CS 1()8 EA 2 . 00 2/54/20 70077744 *************************** Counter Cases ****�****************** COUNTER CASE WM2 (AMZ SN SF) J1 672055 1 CS 1 CS 110 . 00 2/1 Containing: SOUTHERN NIGHTS FOUNTAIN J 200278A 32 EA 32 EA 1 . 00 32/1 550437042 SOLAR FLARES FOUNTAIN J12 200272A 48 BX 4.8 BX 1 . 00 48/1 550437030 Page No 1 - REPRINT - PACK LIST - REPRINT - � � Order #: 1371435-53-00002 Desc/Case Packing Item Quantity Selling Suggested Ordered Units Sell Price -------------------------------CP- ----------------30 EA-------30 EA 1 . 00 ----------------- ZING FOUNTAIN 4 PK J12 200037F 30/1 550437504 COUNTER CASEWMI (CRSLFFGBF) J1 672196 1 CS 1 CS 115 . 00 2/1 Containing: CAROUSEL J12 200863A 32 EA 32 EA 1 . 00 32/1 550437044 TNT FLASHING FOUNTAIN 8 J 200814A 35 EA 35 EA 1 . 00 35/1 550437036 GROUND BLOOM FLWS BAG 6 D 290154A 48 EA 48 EA 1 . 00 48/1 550437045 *************************** Promotional Supplies *********************** SIGN - NO SMOKING 730099E 2 CS 2 EA 0 . 00 1/1 Case Totals: 33 CS Total Pallets: pL Total Repack Cases : CS DECLARATION 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 testing. American Fireworks Standards Laboratory (AFSL) 7316 Wisconsin Avenue, Suite 214 Bethesda, MD 20814 301-907-9115 af slhq�afsl .org CONTACT INFORMATION FOR INDIVIDUAL MAINTAINING RECORDS ON WHIC'H DECLAR.ATION IS BASED: NAME: Kathie Pendergrass ADDRESS : 4511 Helton Drive Florence, Alabama 35630 Page No 2 �S3-01371375 - REPRINT - PACK LIST - REPRINT - 21362 Order #: 1:371375-53-00002 Chain Store Sales-FL Chains Order Date: 4,/6/12 Terms : Net 60 Days CUST PO: 5953153925 SLSMN: Chain Stores - East Sold To: 1410002 Ship To: 1056090 - WALO'706 WALMART - CORPORATE 00001 WALMART 0706 702 SW 8TH STREET 7631 GALL BLVD BENTONVILLE, AR 72716 ZEPHYRHILLS, FI� 33540 Desc/Case Packing Item Quantity Selling Suggested Ordered Uriits Sell Price -------------------------------CP- --------------- --�------------------- *************************** Counter Cases *********************** DSP TR.AIN RED SUMMR BL J12 SS 672207 1 CS 1 CS 1885 . 36 1/1 Containing: SIGN - NO SMOKING 730099E 2 EA 2 EA 0 . 00 1/1 SMOKE BALLS BOX OF 8 J12 351052 96 EA 96 EA 2 . 00 4/24/8 550437025 14 IN SUPER PAK MG J12 380265 108 EA 108 EA 2 . 00 2/54/20 70077744 FUN BLAST SS USA W/PDQ J1 102205 48 EA 48 EA g , 9� 24/1 27736028726 BACKYARD SHOW WOPDQ USA SS 102015A 20 EA 20 EA 19 . 97 10/1 70055727 BLAST ZONE USA SS J10 102018 20 EA 20 EA 29 . 97 10/1 70046873 Case Totals : 1 CS Total Pallets: pL Total Repack Cases: CS DECLAR.ATION OF COMPLIANCE American Promotional Events, Inc. , dba TNT Fireworks, certifiPS 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) Page No 1 I �� CERTIFIC DATE MMIDD ATE OF LIABILITY INSURANCE ' """' i THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON TdiE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES i 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 certifiaate does not confer rights to the certificate holder in lieu of such endorsement s. PRODUCER I NAME: Britton-Gallagher and Associates, Inc. PHONE -- --- ---- 6240 SOM Center Rd _ _ � Fqx --- -- — E-MAIL ---� NC No: 40-5��_2�4-- Cleveland OH 44139 ADDRESS: 'i - ____INSURER(S)AFFORDINGCOVERAGE__ __ _ NAICp ' INSURED ---- --------- ------- --- ------- INSURERA: _III ,ran A �OR1L?d71V -� - 5530 INSURERB. -'�94��— - American Promotional Events Inc �1 -S-��us Ins ComDanv ___ , dba TNT Fireworks iNSUReRC __ i ---- - i P• O. BOX 1 31 8 INSURER D i, �—— Florence AL 35631 iNSUReRe. _ __ — �-- INSURER F. - ----------------�---- I COVERAGES CERTIFICATE NUMBER:1390280319 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN iSSUED TO THE INSURED NAIMEOD ABOVEB OR THE POLICY PERIOD INDICATED NOTIMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMEN'T IMTH 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, I EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF POLICY EXP ---- -"-�—-- ------- A GENERAL LIABILITY MMlDDNriY MMlDD/YYYY LIM17S laaz�zi32 li/i/2oii i/i/zoiz X . EACH OCCIIRRENCE �$1,000,000 � I COMMERCIAL GENERAL LIABILITY I AMA E �R NT D - i �_ I� CLAIMS-MADE �� OCCUR I I� I I PREI MISES(Eaoccurrencel Sso,o00 �-- - , 1 � � � �i MED EXP(Any one person) $ �� I �' I PERSONAL,4ADVINJURY�$1,000,000 Il-J ----- --- -- I I -" --- GEM�AGGREGATE LIMIT APPLIES PER I I li GENERAL AGGREGATE _�$2,000,000 7- PRO- ' ' �PRODUCTS-COMP/OPAGG j$2,000,000 __ POLICV LOC I ---� _ AUTOMOBILE LIqBILITY � ' $ r � j _ ANY AUTO � ; (Ea accitlen0 _ _ �g_ I ALL OWNED � 'SCHEDULED I BODILY INJURY(Per person) '$ I _ �AUTOS I� NON�OWNED � � I BODILYINJLRY(Peraccident) $ f-- I �__I HIREDAUTOS ____AUTOS �� PROPERTY DAMAGE � ------ 7 � ' I ' Per accident'� � g _ __ �---- �-- _ B UMBRELLA LtpB X � S OCCUR , EAU763757 11/1/2011 1/1/2012 � X EXCESSLIAB � IEACH OCCURRENCE $1,000,000 _ CLAIMS-MADE I ' �------_- DED RETENTION$ I � ' AGGREGATE �$1,000,000 I --- ---j----------- WORKERS COMPENSATION i �$ I AND EMPLOYERS'LIABIUTY Y�N � i ; VUC STPTU- OTH- � ANY PROPRIETOR/PARTNER/EXECUTNE ' ��-�--� � �MLL��_ R OFFICER/MEMBER EXCLUDED� ❑i N I A I I I E L EACH ACCIDENT g (Mandatory in NH) , If yes,descnbe under , � � � ��-'----------- DESCRIPTION OF OPERA71pNS below �� ; `E_L DISEASE_EA EMPLOYEEI$ I � , � E L DISEASE-POLICY LIMIT $ i , i DESCRIPTION OF OpERATIONS/LOCATIONS/VENICLES (Attach ACORD 101,Additional Remarks Schedule,ff more space is requiretl� Certificate holder and City of Zephyrhills are nam , ed as additional insuredsl I CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Wal-Mart THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7631 GALL BOULEVARD ACCORDANCE WITH THE POLICY PROVISIONS. ZEPHYRHILLS FL 33541 � AUTHORIZED REPRESENTATIVE �� ACORD 25(2010/OS) �19$$-2010 ACORD CORPORATION. All rights reserved. The ACORD name an d logo are registered marks of ACORD Zephyrhilis Fire Rescue 6�)U7 Dairy Road, Zephyrhills, I�L �;5=t2 Fire C'hie,f t3us (8l�) 780-0041 Keith Williains �.� .�.._�.-_ �_._._.___......__.�_ �.�._. Fa� (813) 78U-0044 23 May 2012 .�.._.__�...----�--- _.-------- Plan Number 12-020 Project: Sparkler Sales at Walmart #706 located at 7631 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 Walmart #7061ocated at 7631 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 submi ted on 23 May 2012 by, � ��f'�r �..�..�"s-----:� Keith A. Williams, EFO, CFO, CMO, MIFireE Fire Chief Fire Safety Inspector, #148104 L t t d �-ai �-ai �-ai � � � � r O O O c333 s` � � � ., � � � � V V V a v v � �` m m m m m m I'� J J J N LL LL LL h N � Y O J J J � J J J � � (.1 � O } � � LL � _ _ _ � � a a a � v�i �J N nwj N � N � ti O � � N Q � N d � Q > j W W -� Q J > > � m m m J J J � � � � � N lf1 i--1 � N M Q 1� n n iR (p N � � m � p O F- J Q „' Y " 3 � � u a � � � � � � �o w � a' � Y � 3