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Home My WebLink About13-14795 . ` CITY OF ZEPHYRHILLS 5335-8TH STREET �sis)�so-oozo 14795 FIRE SPARKLERS PERMIT Permit Number: 14795 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: 12/06/2013 Name: SUPER WAL-MART Total Fees: 100.00 Address: 7631 GALL BLVD Amount Paid: 100.00 ZEPHYRHILLS, F'L. 33542 Date Paid: 12/06/2013 Phone: (479)204-1063 Work Desc: SPARKLER SALE WALMART q 1 . �l�� /�� 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. .-� ., r"� . �-� ,,� �� J � '' '` ,.�l� �,�''�1 '��1..,�, c >:� CONTRACTOR SIGNATURE PERMIT OFFICE PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE - 813-780-0041 TNTO FlREWORKS Site Plan Worksheet STORE NAME 1 LOCATION#LAYOUT OF WAL-MART LOCATION'S TYPE OF EVENT: In•store sales of Consumer Fireworks Walmart 706 Zephvrhjlls. FL REAR OF BLIILDING _ t".��"7 f"� ,�... K�., �:='.��.�=� �r�;�.y�:.��.�- �.(,,..;.,.�:V �.a , -:� s,;��i �a.'^g_";"'�'� -. �;. -�__a.��:"'3 P:��-�"�':':""�'"7 {• a�;�°� �!''{'��°�i:,, ...�, _ �~ i.� -� ��;7�� :'P+W�''i � �� 'a�•.`.��'�.?ej�. -':' � ACIIDR A�ey(SltlOILI AiJe) .. Firew�rlu � Registers , , ' , , , � ' � � 1 � i, # ��t�R�.� FRONT INSTURCTIONS:Wal•Mart anerall laces the les dis o co er fireworks roducts in the fron of the atores on the froM side aisles(Action AIlev1 near the entrancelexit whfch la known as the s�sonal alsls.This is a aeneral overview of a ical Wai•Mart Su er Center and roduct lacement ma /should be dictated�b instruc�tion af the insaector deuendina on the indEvidua!iocations needa and or atore setuo �1��9i7'1 E!b �L,�N(S} H�A�'��.�i� �'c�_s x�•, ,��: '�Y ZEPI'�Y KIL � �RE MARSH�L'S t}F�FIC`= i�ate.�4� -- .+Y�evx�.0 �'`'..� � __ �.�--- - __� _ s�s-�ao-oo2o City of Zephyrhills Fire Fax-813-780-0021 Permit Application Date Received � Phone Contact for Permit 800 868 9151 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 � � � Fee Simple Titlehoider Address Job Address 7631 Gall Blvd � Lot# Sub Division Parcel# � Bio-Hazard Waste Storage-ANNUAL � Hazardous Material(Tier II or RQ Facility)ANNUAL � Comm Exhaust Kitchen Hood/Duct � Hood Installation � Controlled Burn � LP/Natural 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 ry emi � er Sprinkler � ❑ ❑ o � X� Sparklers Inside Retail Sales of State Approved Sparklers Fire Alarm � ❑ ❑ ❑ � � Sprinkler System Installations Hood Cleaning � ❑ ❑ � � � Standpipes(Sprinkler Sys) Hood Suppression � ❑ ❑ ❑ � � Torch Roofing/Tar Kettie � Fire Alarm Installation � Waste Tire Storage ANNUAL � Fire Pumps XX Fire Works.SPARKLERS � Flammable Application-ANNUAL �O� �� 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, Ocala, FL 34474 �icense# Directions: Fill out application completely Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner) If over$2500,a Notice of Commencement is required(Mechanicai work over$5000) Supply two(2)sets of drawings with applicable documentation 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 TNTO FlREUVORKS Site Plan Worksheet STORE NAME J LOCATION #LAYOUT OF WAL-MART LOCATION'S TYPE OF EVENT: In•store sales af Consumer Fireworks Walmart 706 Zeahvrhills. FL REAR OF BUILDING �,.� �rt.;,.•;- � •a.y�z;�n.: ,'y"'� `¢�S,_.:,,�°`;�."-.-"�"�1 �� :�kA+�^' � F:_�t��:�.�.��'-�� - -�.L=`i.}" :'!:i. -",'. :_ .'".�.'a` - 2 e.,. ..3" �;.a i"`"u�"`'`_-?-`+"`.rP`' _ 4+.�":��:'�� w - - ��-.:i� „arr-:i .tii�..�°,. :.�..�. ,;� � c Es _':".,;'� t �3:��"�'�.t^"�::..,; - -- — { . ."•:,,:'i.�.''�_1 .' - .tz: Actbn AYeY(8eroial Aide) {;t •. Flmv�rW � Regiaters , , , � , ' � 1 � � , , ;:. r� � isnwwn e.ar FRONT INSTURCTIONS:Wal•Mart oenerallv aleces the sales dlsolms of consumer fireworks nroducts in the front of the atores on the froM side aisles(Actfon Allevl nearthe entrancelexit whfch ia knovm as the seasonal alsJe This is a aeneral overview of a t�rpical Wal-Mart Saper Center and oroduct alacement mav/sI►ould be dictated�by instruc�on of the inapector deuendlny on the indhridua!iocations needs and or atore setuo �3-vli��y - REPRINT - TNT FIREWORKS PACK LIST - REPRINT - 21362 Order #: 17?4809-S3-00002 Chain Store Sales-FL Chains Order Date: 10/17/13 Terms : Net 60 Days CUST PO: 66��3579579 SLSMN: Chain Stores - East Sold To: 1410002 Ship To: 1056090 - WAL07()6 WALMART - CORPORATE 00001 WALMART 0706 702 SW 8TH STREET 7631 GALL BLVD BENTONVILLE, AR 72716 ZEPHYRHILLS, FL 33540 Desc/Case Packing Item Quantity Se=Lling Suggested CP # Ordered Un_�ts Sell Price - - - -- - ------ ------ -------------- -------------- - -------- ------�------------------- *************************** Assortments ****:t*,t**************** BLAST ZONE USA SS J10 102018 1 CS :LO EA 29 . 9700 10/1 70046873 CELEBR.A MI GENTE NY12 102242 1 CS 20 EA 19 . 9700 20/1 551358835 FUN BLAST SS COM W/PDQ J12 102205 2 CS 48 EA 9 . 9700 24/1 550437037 RED WHITE BOOM SS J10 102019 1 CS 6 EA 49 . 9700 6/1 550503498 *************************** Sparklers ****�****************** #8 GOLD SPARKLER COL J11 380272 1 CS 48 IP 2 . 0000 48/6/5 551036187 *************************** Counter Cases *********************** DSP WM SS TR NY12 672674 1 CS 1 EA 1979 . 0800 1/1 Containing: #8 SPRKLERS ASST BOX PDQ 380247 84 EA f34 EA 2 . 00 84/6/5 550503481 TNT SNAPS 4 PAK J09 320532 153 EA l.'i3 EA 2 . 00 153/4/50 550503480 FUN BLAST SS COM W/PDQ J1 102205 24 EA ?.4 EA 9 . 97 24/1 550437037 GROUND BLOOM FLOWER-30 CT 290066 15 EA _L5 EA 5 . 00 2/15/30 703478 BLAST ZONE USA SS J10 102018 20 EA �?0 EA 29 . 97 10/1 70046873 BACKYARD SHOW WOPDQ USA SS 102015A 20 EA 20 EA 19 . 97 10/1 70055727 SMOKE BALLS BOX OF 8 J12 351052 96 EA 96 EA 2 . 00 4/24/8 550437025 SIGN - NO SMOKING 730099E 2 EA 2 EA 0 . 00 1/1 Page No 1 - x�rxllv 1 - llv 1 r 1K�WUKI�b YL�LK L15'1' - K�Yt(1N'1' - Order # : 1724809-S3-00002 Desc/Case Packing Item Quantity Se:lling Suggested CP # Ordered Un.its Sell Price -- - -- - --- ----------- - -- -- - - - - ------ - - ---------- ---- - ---- ----- --- ------ -- -------- Case Totals : 7 CS Total Pallets : PL Total Repack Cases : CS DECLARATION OF COMPLIANCE American Promotional Events, Inc . , dba TNT Fi�eworks, 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.:3 . 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) (:Ll) 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 i�esting. 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: pendergrasskCtntfireworks . com. www. tntfireworks . com Page No 2 ZEPKYRNlLL� FIRE DEP/�RTf�[E�T 6907 Dairy Road, Zephyrhilis, FL 33542 FIRE SERVICE USER FEES Occupancy No.: Plan No.: Contractor: Business Name: Billing Address: Business Address: Business Phone No.: Biliing Phone No.: Business Fax No.: Billing Fax No.: Contact: Contact: PLAN REVIEW FEES INSPECTION FEES PERMIT FEE F,ALSE ALARM FEE Site Plan NiC Mnual N/C Sprinkler �50 1st Alarm N/C Mufti-Family/Commercial .06 sf 1st Re-inspection WC Standpipes S50 2nd Alarm N/C (Minimum Charge$25.00 2nd Re-inspection a100 Fire Pump S50 3rd Afarm N/C � Plan Revisions DBL 3rd Re-inspection �250 Hoods 550 4th Alarm a100 4th Re-Inspection a500 Fire Alarm 350 5th Alartn a150 SPRINKLER SYSTEMS (Business dosed until LP Gas a50 6th Alartn $200 0-25 Heads $50 violations corrected) Natural Gas NON COMPLUINCE a150 26 pius Heads a100 SPRINKLER SYSTEMS Fuel Ta - Per�a�c STANDPIPE SYSTEM Hydro Undergrounds �45 park rs � 5100 � Per Riser S50 Hydrostabc Test $65 Per s s 5500 FIRE PUMP Acceptance Test a45 �e�system Camp Fire S25 � Per Pump a100 Hydrant Flow $75 Controlled Bum 5100 FIRE ALARM SYSTEM Hood/Duct $50 0-25 Devices S50 FIRE ALARM SYSTEM Place of Assembly $50 annuai 26 plus Devices 5100 System Acceptance $50 Fire Protection $25 SUPPRESSION SYSTEMS Recail Acoeptance $50 Flammabk App1'icauon S50 a+nuai Wet $50 OTHER Waste Tire Storage S50 �nnuai Dry S50 Fire WalUSmoke Wall �15 Perwau Generator<KW E100 CO2 $50 LP Gas $25 ��a�k Generator>30 KW 150 Other S50 Natural Gas $25 persystem Bio-Harard Waste 5100 �n�uai KITCHEN EXHAUST Fumgation Tenting 550 � Hood/Ducts $50 Tent 10'x10'or greater $15 �te�t Torch PoUApplied S50 OTHER Fire Pump $45 Haz.Materials 5100 � LP Installation per tank �50 Fire Suppression $30 Fuel Tank instailation a50 System Acoeptance � (Per Tank) S50 B E�fiaust Hood/Duct �30 Nawral Gas lnstallation �50 Re-inspection OBL (Per System) (other than annuat) � Spray Booth �50 � InspecGon scheduled DBL B and pncelled less than 24 hours Construction Insp. N/C Emergency Vehicle A� $50 FALSE ALARM - -- -PLiWS�t�Tf►t,�--�— -- -1NSPE�T101V�flTl1L� f�ERM1�-�fli'�-�-- ----�{i��i�— GRAND TOTAL Comments: Date: � ti � Inspector: �-�'w �2`��0 nin Page 1 of 1 Jet1'AC.vater C�5�� CHIEF FT11iANCIAL OFFICER BUREA[T CEiiEF 3ulius Halae DIVISION DIRECTOR Kti�McCarthy SAFETY PROGRAM 1VI�►1�1AGER FLt)RIDA DP:PARTMENT OF FINANCIAL SERVICES DIVIStON OF STATE FIRE MARSHAI, 200 F,aet Gaines Stroec -Tallahassce,Florida 32399-0342 Tel.550-413-3644 Fax.850-419-2467 Wal-Mart Stores Inc. 6255 SE 78th Street Ocala Fl 34472 34472 CERTIFICATE OF REGISTRATION RETAILER LOCATION PERMIT THIS CERTIFIES T�IAT: Wal-Mart Stores Inc. 5255 SE 7$th Street Ocaia F134472 Has registered pnrsuant to the provisions of Flarida Statues to engage in the business of seliing sparklers at the following fixed place of business: Wal-Mart#706 7631 Gall Blvd Zephyrhills FL 33541 Pasco Issue Date: 02/O1/2013 Type: 07 Class: 66 County: Marion License/Permit Number: 565026-0018-2005 Expiration Date: 01I31/2014 � . , � Cluef Financial Officer https://www.citizenserve.com/120/CAPFor 120?Action=Dowx�oadDocument�DocumentID... 4/8/2013 ,aco� CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDDIYYYY) 1��1/2014 10/3ll2013 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 Lockton Companies,LLC NAMEACT 3280 Peachtree Road NE,Suite#250 PHONE Fnx ac No: Atlanta GA 30305 E-MAIL (404)460-3600 ADDRESS: INSURER S AFFORDING COVERAGE NAIC il INSURERA Everest Indemni Insurance Com an 10851 INSURED American Promotional Events,IT1C. INSURER B. 1359629 DBA TNT Fireworks,IIIC. INSURER C. P O Box 1318 INSURER D. 4511 Helton Drive Florence AL 35630 INSURER E. INSURER F. COVERAGES CERTIFICATE NUMBER: 12067057 REVISION NUMBER: XXXXXXX 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 CLAIMS. INSR 7ypE OF INSURANCE ADD SUBR POLICY EFF POIICY EXP LTR POLICY NUMBER MMIDD MMlDD/YYW LIMITS A GENERAL LIABILITY Y N SI8GL00242-131 11/1/2013 11/1/2014 DAMAGETO RENTED MMERCIAL GENE BILITV PREMISES(Ea occurrence) $ 3OO OOO CLAIMS-MADE X OCCUR MED EXP M� one erson PERSONAL&ADV INJURY 5 ]�OOO�OOO GENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG POL�CY PR� LOC $ AUTOM081LE LIABILITY NOT APPLICABLE N � (Ea acadent) $ ANY AUTO BODILY INJUF2Y(Per person) $ ALL OWNED SCHEDULED BODILY INJUFiY Per accident $ AUTOS AUTOS NON-OWNED PROPERTY D.4MAGE HIRED AUTOS AUTOS $ XXXXXXX sXXXXXXX UMBRELLA LIAB OCCUR NOT APPLICABLE EACH OCCURRENCE S XXXXXXX EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION NOT APPLICABLE W A7U- TH- AND EMPLOYERS'LIABILITY Y!N TORY LIMIT ER ANY PROPRIETOR/PARTNER/EXECUTNE E.L EACH AC�"IDENT $ OFFICER/MEMBER EXCLUOED? ❑ N 1 A " (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ XX�XXX If yes,descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS f LOCATIONS/VEHICLES (Aftach ACORD 701,Additional Remarks Schedule,if more spaee is required� City of Zephyrhilis and Certificate holder is an additional insured on the General Liability as required by written contract subject to policy terms,conditions, and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION OATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 12067057 AUTHORIZED REPRESENTATIVE Wal-Mart #0706 7631 GALL BOULEVARD ZEPHYRHILLS FL 33541 � ' r'� " -"-,�� ,�/,/��`. --t, �_ ACORD 25(2010/05) The ACORD name and logo are registered marks oi ACORD �OO HB$- 'I O CORD CORP TION.All rights leserved � November 25, 2013 Jackie Boges Building Dept 5335 8th Street Zephyrhills, FL 33542 Dear Jackie, Enclosed please find all permitting information for the Wal-Mart & K-Mart location that we will be furnishing with state approved sparklers this New Year's season. If there is any additional information you need please contact me at 1-800-243-1189. You may also contact Kelly Alley in our Ocala office at 1-800-868-9151. Thanks again for all of your help. Sincerely, Charles Walker TNTO Fireworks Director of Compliance walkerc@tntfireworks.com AMERICAN PROMOTIONAL EVENTS, INC. P.O BOX 1318•4511 HELTON DRIVE•FLORENCE,AL 35630 PHONE(256)764-6131 •FAX(256)760-0154 www.tntfi reworks.co m ` '� � �� o � � � � � � � � � � .� . �� E �� 8 � � �� o � � � �� ! � 0 , q� � �+ � e �� .� � � d � s � s � � � s � � � � � � �� '� x � �� }.7� � ��r�T, p � r� � � F. ."I�i s4 � � V � � T1 � � I � �� ? � � i � � i � � � � pS .�j � s r i r� � N � f � �� , �� o� 9 � � � � � '� ° � �� • �� o � �� o �� .� � E�� '� � `� $ ° � � � � c �g � � � F �o � `�a o � � v'di o � � � � � �� m � � � m � �. s � xs .� � �i � :au�' � � � r N � � � � � O O p O � Y 3 3 � Y � � � 0 0 u u N N 1C f0 d n � � v v � � m m m m � LL LL C Y O O � 3 '^ o '� LL > � � � .-�i � �, x x v F °3' `n > > � m Z a`r x x a rl Y d d p W W ry a N N N � � > > J J Q � m m J J � � � N eM n n � t0 O � � O Y 3 tt r � `° � � � � Y �