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Home My WebLink About13-14171 CITY OF ZEPHYRHILLS • 5335-8T}i STREET (sis)�so-oozo 14171 FIRE SPARKLERS PERMIT Permit Number: 14171 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: 5/15/2013 Name: K-MART Total Fees: 100.00 Address: 7422 GALL BLVD Amount Paid: 100.00 ZEPHYRHILLS, FL. 33542 Date Paid: 5/15/2013 Phone: Work Desc: TEMPORARY SALE SPARKLER-FIREWORK-KMART � �� ,��. � _ �� " � � , � 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, Plorida 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. �� ' � � `;,j'�� ' ,, 1.�..�.�.�-�. �5��-�' CONTRACTOR SIGNATURE PERMIT OFFICE PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECiION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE - 813-780-0041 813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 Permit Application Date Recewed Phone Contact for Permit 800 868 9151 Owners Name K-Mart#3761 Owner's Phone Number 813 782 1957 Owner's Address 7422 Gall Boulevard,Zephyrhills, FL 33541 Fee Simple Titleholder Name Titleholder Phone Number � � � Fee Simple Titleholder Address Job Address �422 Gall Boulevard � Lot# Sub Division Parcel# � Bio-Hazard Waste Storage-ANNUAL a Hazardous Material(Tier II or RQ Facility)ANNUAL � Comm Exhaust Kitchen HoodlDuct � Hood Installation � Controlled Burn � LPlNatural Gas-Installation � Emergency Generator<30 kw � LP/Natural Gas-ANNUAL Sale � i�/ � / Emergency Generator>30 kw � Places of Assembly-ANNUAL � � Fire Protection Maintenance-ANNUAL � Recreational Burn ❑ r y emi � er Sprinkler ❑ ❑ ❑ B � Sparklers Inside Retail Sales of State Approved Sparklers Fire Alarm � ❑ ❑ ❑ � � Sprinkler System Installations Hood Cleaning � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) Hood Suppression � ❑ ❑ ❑ � � Torch Roofing/Tar Kettle � Fire Alarm Installation � Waste Tire Storage ANNUAL � Fire Pumps XX Fire Works-SPARKLERS � Flammable Application-ANNUAL Valuation of Project � Fuel Tanks Q Other 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 TNT Fireworks Signature Registered Y/N Fee Current Y/N Address 6255 SE 78th Street, Ocal , FL 34474 �icense# 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 submittai date Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov com) -Site plan at store-placement dictated by Fire Marshals o�ce -State Sparkler Licence attached -Product List attached �53-01600173 - REPRINT - TNT FIREWORKS PACK LIST - REPRINT - 21362 Order #: 1600173-S3-00002 Chain Store Sales-FL Chains Order Date: 3/29/13 Terms : Net 30 Days CUST PO: SLSMN: Chain Stores - East Sold To: 1420037 Ship To: 976089 - KMT3761 KNIART 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 Selling Suggested Ordered Units Sell Price -------------------------------CP- ------------------ *************************** -------- ------------------- Counter Cases *********************** DSP 50 SS MED J13 TR 672478 1 CS 1 CS 2719 .41 1/1 Containing: BOOMIN SALUTE SS J10 COM 102073 8 EA 8 EA 6�1 2481231 59 . 99 SHOW OF FREEDOM USA SS J09 101831A 12 EA 12 Ep, 10/1 2481234 39 . 99 FREEDOM RINGS SS USA J09 101832A 16/1 2459780 14 EA 14 EA 24 . 99 PARTY PAK SS-USA J09 101933 7 EA 7 EA 16/1 2459772 15 . 99 STARS AND STRIPES COM SS J 101833 18 EA 18 EA 24/1 2481229 9 . 99 SUPER VALUE PACK REV J09 200722 10 EA 10 EA 12/3 2491296 10 . 00 CAL ROCKET FOUNTAIN 3-PK 200967 30 BG 30 BG 2/30/3 27736028450 5 . 00 GROUND BLOOM FLOWER 20 CT 290157 40 EA 40 EA 4/20/20 27736030255 5 . 00 #20 NEON SPARKLERS J11 380266 48 EA 48 EA 48/7 27736027767 5 . 00 STRIKER J10 200862 14 EA 14 EA 24/1 3559589 5 . 00 MINI CALIFORNIA RKT 3PK J 200849A 24 EA 24 EA 6/24/3 27736025602 2 • 00 CRAZY FUN PAK SS N12 PDQ 102126A 21 EA 21 EA 4/21/5 27736027545 2 . 00 SMOKE BALLS BOX OF 8 J12 351052 72 EA �2 � 4/24/8 27736028337 2 . 00 CRAZY EYE BALLS W/ PDQ J13 290067B 42 EA 42 EA 1 . 00 8/42/3 27736013210 DOUBLE PAK MORNING GLORY J 380276 54 EA 54 EA 4/54/8 27736029426 1 . 00 SHORT STACK J13 200924B 2g EA 28 EA $�28 27736028054 1 . 00 SIGN - NO SMOKING 730099E 1 EA 1 Ep, 1/1 0 . 00 �iUBIViITTE�PLAN(S)HAVE 13F:Eiv ��,�'ir�vv9,s �Y ZEPHYRHILLS FIRE MARSHAL'S OFFICE Date:�e ° �ic�viewer: �"�-�- \ .__. Page No 1 � - REPRINT - TNT FIREWORKS PACK LIST - REPRINT - Order #: 1600173-S3-00002 DesC/Case Packing Item Quantity Selling Suggested CP # Ordered Units Sell Price ------------------------------ Case Totals: 1 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) (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 DECLAR.ATION IS BASED: NAME: Kathie Pendergrass ADDRESS : 4511 Helton Drive Florence, Alabama 35630 TELEPHONE: 256-764-6131 FAX: 256-767-7200 E-MAIL: pendergrassk@tntfireworks.com. www.tntfireworks . com Page No 2 ��Y� 9• 2013 1�.32P� TNt MA1N OFFICf � � N0, 3454 �yP. � '— .—. 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