HomeMy WebLinkAbout12-13570 CITY OF ZEPHYRHILLS
� 5335-8TH STREET
(si3)�so-oozo 13570
BUILDING PERMIT
Permit Number: 13570 Address: 4626 KRUSEN FIELD RD
Permit Type: SPECIAL EVENT ZEPHYRHILLS, FL.
Class of Work: SPECIAL EVENT Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 13-26-21-0080-00000-0010
Improv. Cost:
Date Issued: 10/26/2012 Name: CITY OF ZEPHYRHILLS
Total Fees: 5.00 Address: 4626 KRUSEN FIELD RD
Amount Paid: ZEPHYRHILLS, FL. 33542
Date Paid: Phone:
Work Desc: PIGZ IN Z'HILLS BBQ & BLUES - OCT 27/2012 - FEES WAIVED BY CM J. DRUMM
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REINSPECTION FEES: Reinspection fees will wmply with Florida Statute 553.80(2)(c)when extra inspection
trips are necessary due to any one of the following reasons: a)wrong address b)condemned work resulting
from faulty wnstruction c) repairs or corrections not made when inspections called d)work not ready for
inspection when called e) permit not posted on job site f) plans not at job site g)work not accessible.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
"Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing,aonsult with your lender or an attorney
before recording your notice of commencement."
Complete Plans, Specifications Must Accompany Application.All work shall be pertormed in accordance with
Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O.
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CONTRACTOR SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
� � Temporary Sales �Checklist
City of Zep6yrhills
5335 8'°Street
Zephyrhills,Fl.33542
Phone:813-780-0020/Faa:813-780-0021
REQUIREMENTS
✓ Detailed Plot Plan showing setup of location. Refer to Ord 1038-09, Sec 5
.� Notarized letter from property owner stating their approval.
✓ A flame retardant certificate is required IF a tent is involved. Inspection required once tent
is erected and rior to openi.ng for business.
✓ Approved certified fire extinguishers per NFPA 10.
✓ No Smolting 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 REQUIREMENT'S_(In addition to the above)
Proof of State License.
Proof of Liability insurance.
List of items to be sold at site.
Copy of Drivers License and Social Security Number of a11 personnel dealing
with the sale of fireworks at the tent location.
FEEs
$30.00—City Registration(If Regulated by DBPR—Fee is Waived)
$500.00—Fireworks fee-Fire Department fee
$ 5.00—Temporary Sa1es Fee for 1 S`two days
$ 1.00—Temporary Sales Fee per day for each consecutive day thereafter,not to
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
$ 50.00—Tent Fee(40.00BD, 15.00*/FD)-{*$15.00 waived for Fireworks)
$40.00—Electrical Fee(if applicable)
Property Owner: �
Applicant: � r c� �j�irn��2 C-�.
Phone Contact: ' �N � , �� 3 �
Address Site: �j-u,�n �� �� , �{ � ��r��C�
Date(s)of Sale:
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Ordinance No. 1038-09(for additional requirements) 1
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Greater Zephyrhills Chamber of Commerce 38550 Fifth Ave.,Zephyrhills, Florida 33542
Phone: (813) 782-1913 Fax: (813) 783-6060
www.zephvrhillschamber.or�
October 5, 2012
James Drumm
City Manager
City of Zephyrhills
5335 Eighth Street
Zephyrhills, FL 33542-4312
RE: Requesting waiver of fees for Pigz in Z'Hills BBQ&Blues
Mr. Drumm,
Thank you for your support at last year's.We'd like to request consideration again of a waiver of permit fees
for tents at this year's Pigz in Z'Hills BBQ&Blues to be held October 27,2012.
Please find certifications,insurance liability documentation and site plan approval as supplemental
information.
Thank you and I'll look forward to talking with you or the acting Chief in regards to further fire and safety
requirements at this event.
Kind regards,
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Vonnie Mikkelsen , v� � '
Executive Director � � 'Z—
IC ' �' '�
'`�c R e GERTIFICATE OF LIABILITY INSURANCE H�15�ZO 2DD/riYY)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INPORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVEIY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OP INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER�S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certiflcate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and condkions of the policy,certain policies may require an endorsement. A statement on this ceRiflcate does not confer rights to the
certificate holder in Ileu of such endorsement(s).
PRODUCER �ME: Andy Miller
LEE REED INSURANCE PHONE 813 �
PO Box 908 ,v No ��:( ) 82-5502 ac No.{813)788-1996
Zephyrhills,FL 33539-0908 no�Ress.andy@leereedins.com
�NSURER�9) AFFORD�NG COVERAGE ���
INSURER A Owners Insurance Company 32700
INSURED Zephyrhills Chamber of Commerce,ItIC. INSURER B
38550 5th Ave. iNSUReR c
Zephyrhills,FL 33542 INSURER D
INSURER E
INSURER F.
COVERAGES CERTIFICATE NUMBER. 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 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 CIAIMS.
INSR
�7R TYPE OF INSURANCE INSR wvo POLICY NUMBER MM/DD/YYYY MM/DD� LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $1,000,000
COMMERCIAL GENERAL LIABILITY PREMISESrE acu�rcence $ $O,OOO
CLAIMS-MADE �OCCUR MED EXP(Any one person) $ $,��0
A 864612-20343749 3/3/12 3/3/13 PERSONAL 8 ADV INJURV g 1,000,000
Y
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1,000,000
POLICY PR� LOC $
AUTOMOBILE LIABILITY
Ea accident g 1,000,000
ANYAUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED 864612-20343749 3/3/12 3/3/13 —
A AUTOS AUTOS X BODILY INJURY(Per accident) $
X HIRED AUTOS X NON-0WNED
AUTOS Per accidenl A A $
$
UMBRELUI LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE
AGGREGATE $
DED RETENTION$
"'WORKERS COMPENSATION $
�4ND EMPIOYERS'LIABILIN WCSTATU- OTH-
viN TORY IMITS ER
ANY PROPRIETOR/PARTNEWEXECUTIVE ^ $
OFFICER/MEMBER EXCIUOEDT �I N!A E.L.EACH ACCIDENT
(MandNOry in NH)
N yes,describe under E.L.DISEASE-EA EMPLOYE $
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPER,4TIONS!LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required)
Event: Zephyrhills 3rd Annual Pigz in Z'Hil►s BBQ&Blues Fest
Saturday,October 27,2012
CERTIFICATE HOLDER CANCELLATION
City of Zephyrhills
5335 8th$t. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Zephyrhills,FL 33542 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE C�.—�
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�O 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD25(2010/05) The ACORD name and logo are registered marks of ACORD
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PART II. A,PPLICANT INF'ORMATION
Name of Organization: ��r��- 1Z y 1�-�-�`� c�rc�� ��'''",-"`�'�'
A licant must be a not for profit entity, eglster to do business in the State�Florida
PP
. Contact person: �ICm�I-� �� ����-C-t�
Mailing address: ,
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Phone autnber(including area code): �d13� ��a "�1�3
Aiternate phone number �I 3 �J 3 —l0 0�a
Fax number(including area code):(_g�3� tI f 3 --(�D� U
Email address: �
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Date incorporated: �'z �� � r����
G�urent corparate status: (Circle On ctive Inactive .
Employer ldentificativn Nuuiber(EIN: s� '" d6� �/ 7/
pA.RT II. EVEN'� SPONSORSffiP
Name of event: � � � i . �S !J Z>n!�`ii 6S �� � �j1�S
Do you have any co-sponsors for the ev_ent?: No '�Yes
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If yes,please list: �'h,c,�r�-+�� -� G{9c� � � � �'� �
Will an admission fee ba chargea to attend this event? No t/Yes
If yes,how much will the fee be? �� /� •� �-�-�-�- ��'��
Pleuse note, a�t application for any IeveI of City subsidy of a special event must be filed with the
City Manager by June 1 for events occurring during the following fiscal year (October 1-
Septencber 34) . .
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Tn the event of inclement or hazardous weafiher, do you have an alternate date selected?i/No Yes
Zf yes,what is the alternate date?: .�3/!-�
What electrical services will be required/pro"vided far the event? (Please be as specific as possible):
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What other utilities will be required for the event?
Restroams arba e cans and collection
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Please list all equipment, e.g, stage, tents, vehicles, etc. that you propase to use in the event or bring
onto City property, streets or pazks azeas (All subject to approval�Note that tents 10'x 10'or larger
wil!also reQUdre a fire ratdn�certi�cate.
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Please provideJattach a description including a map and loeation and number of public faciliries to be
provided for the event{e.g., toilets, garbage cans, etc.):
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Please attach documentation of the appropriate application for Pasca County Health Depar(ment
permitting for public facilities.
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' APPLICATYON FUR CONSi7NIPTION OF ALCOHOLIC SEVERAGES.
Events including the consnmption of alcoholic beverages must attach proof af liability
insvrance in the amvunt of Two Millivn Dollars (52,000,000.00) naming the City of Zephyrlttlls
as an additional insured.
No applicant sha11 be issued more than tleree pernuts per year, artd no permttted event may e.xceed
two days in duration.
Please pravide a general description of fiaw the use of alcohol will be incorporate into th.e proposed
special event: _
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Please attach a diagram/map to this application depicting specific clearly idenn�able, designated
and secured areas within the event venue where beverabae sales and consumption are to occur.
Please attach documentation to this applicaiion of appropriate applicatlons for state alcohalic
beverage licensing for this event �Q �� ��� ,�GQ , •
Please provide a description of how security and beverage law compliance will be provided,
including hours of sale and consumption during the event
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Please pravide a description of the #ype(s) of beverages(s) and beverage container(s) ta be used in �
corijunction with the even�
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11j Occupancy No.: �
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;
ZEPHYRHiLLS FIRE RESCUE ,
6907 DAlRY RD.ZEPHYRHILLS, FL. 33542 WORK(813)-780-0041 FAX: (813)780-d044 !
�
� Yo,�N►r W�� K�,��s�� �,
Business:� �� c�< <�w1YV1 t1LC�.Em.Contact:
Address: �r.l ��rcr� Emergency contact phone#: `�g�- I�! 3 ���-��� I
Tel No: Other Information: �
The fire safety inspection has been completed utilizing the Florida Fire Prevention Code and any
applicable NFPA code and/or standard.Should you have any questions, you may contact the '
Fire Marshal at the telephone number above. !
Y/N/NA Y/N/NA/Date �
1.Address,front/rzar("6"inch minimum) 13. Emergency Lights j
2. Knox Box(keys inside,labeled) 14.Fire Extinguishers �
3.Lightweight Truss Sign 15.Electrical(other) I
4.Fire Lane Access(marked-unobstructed) 16.Storage Issues ,
�
5. Hydrants Accessible 17.Mech/Elect Rms Labeled �
6. FDC Accessible 18.Hood Cleaned/Tagged I
i
7. Private Hydrant(painted/tagged/test) 19.Fire Alarm/Tagged !
8. Exit Doors Open Freely 20.Hood Suppression/Tagged �
9.Egress Unobstructed 21. Fire Sprinkler/Tagged
10.Extension Cords/Multi-piug Adapter 22.Suppression(other)
11.GFI's by Water Source 23.Occupancy Load sign posted
12.Exit Lights 24.Other �
Violation comments shall be noted base on the corresponding number above. Place date of
iast inspection for fire protection items in space provided above. ,
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� �0.. Y 1 C.�h3l.c�- l lr�lt �1 ��" T►'�-1 `��yTS
y* � _��c-r,u� � �..� �� c,�► ���tv�� -�ncr�z« <�o�� ,
.t�-'r� "lw� an T-�t��.+� P)L ��� �' i t+�� �S���- � � L.��l
t ^ N� Z' � c c � �. ��.��,
� ��,�"' ��� r2_ls�SS $1 �� 4 N Zc-c'i�a� (�H�,�l r�c�
No violations JS C��y��-T'=��
Your fire safety inspection determined there were some viofations.
The�ire Marshal will be contacting you to advise of the time frame in which the violations noted
shaU be corrected. A re-inspection will then be conducted after that time frame. Failure to
correct in time frame given may result in fees being assessed. Reinspect Date: a-"11 1 M�12- Dfi �-� �Y
Report Completed By: �-t> �S Date:_/p f� 2�1 Z.-
`��� ���" �j�'�f- r T
Accompanied By: Time.
Inspection Acknowledged By: Date: