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Temp. Use Permit - American Legion Free FairCity of Okeechobee 55 S.E. 3rd Avenue Okeechobee, Florida 34974 (863) 763 -3372 Temporary Use Permit Permit Number: 17 -001 Permit Expiration: February 12, 2017 11:59PM Purpose of Request: American Legion Free Fair Property Owner: American Legion Post 64 Address: 501 SE 2nd Street City: Okeechobee State: Florida Zip Code: 34974 Date(s) of Event: February 3 — 12th, 2017 Applicant: American Legion Post 64 Applicant's Address: 501 SE 2nd Street Phone Number: 863 - 763 -2950 Address of Project: 501 SE 2nd Street Current Zoning: Residential Multiple Family (RMF) FLU Designation: Commercial (C) Subdivision: 1St Addition to City of Okeechobee Restrictions /Remarks: All debris must be removed upon final completion date. Owner understands and agrees to the following: X Issuance of a permit may be subject to other conditions and time limitations. X Issuance of a permit is not authorization to violate public or private restrictions. X Failure to comply with applicable regulations may result in withholding future permits. X There may be additional permits required from other governmental entities. NO SET UP OR TEAR DOWN BETWEEN THE HOURS OF 12 MIDNIGHT AND 7:00 A.M. 48 HRS AFTER FAIR CLOSING, PROPERTY MUST BE VACATED. TRASH MUST =,E PICKED UP DAILY IN PARKING LOT AT CITY HALL. I certi that I have examined this permit, it is correct and I will abide by its requirements. &C ad Ao plicant's Signature Date 7-i 7 eneral Services Assistant EF: .ORD.716, Temporary Structures CITY OF OKEECHOBEE General Services Department, Room 101 55 Southeast 3' Avenue Okeechobee, FL 34974 Phone: 863 -763 -3372 ext. 218 Fax: 863 -763 -1686 DATE RECEIVED: /62-4-14? DATE ISSUED: '�. 7 -i 1 APPLICATION N0: DATE(S) OF EVENT: ; j )- 4207. 17-col ! e FEE: $175.00 DATE PAID: o,( If Non- Profit/Civic Organization 5:0cP- 12.,4 %a TEMPORARY USE PERMIT APPLICATION OTHER TEMPOR 1 APPLICANT I Name of PropertyOwner(s): „lc ec li06 e---e. MEI/ORIN/ 4);-t e 11 >Pe -' Address: ._7;67/ ....5.,,- 02, j57 , d)/ C 14.ee- 1;4 3A jV %f Date. . Telephone Numbers: Home: ,3 - y6'74 0/ Sita Mobile /Cell'763 -21 yC. Pager. Name of Applicant: A rye jc y c2 ,Le., ,p 13 as T.f Public Works Department Ap. •,ti" Address: ..h0 /$k: .3,p eveecI©6'c r7.- .....341.57+L Date: Telephone Numbers: Home: Work: Mobile /Cell: Pager: X Lu 0. 0 Future Land Use Map Designationer 1( rieeicAL Current Zoning Designation: Legal Description of Property: 1_,5-/-5 2 8~ x a53 1 -4)6i &J - ei iy Address of Property: 5C'/ .5k UA5r c7� ee i 0 6 -e e 11-14..3If97 Please Explain Type of Use: Ref /4444, 4_1 i i ee Briefly describe use of adjoining property: North: t ; - Comm L , -Tpi-i East: C-Nu i'C /-1 - C!Aii / o7 South: I^lorn c West: IA .4.4 Other temporary structures subject to the following regulations: 1. Christmas tree, fireworks and similar seasonal sales operated, by a non - profit organization. 2. Carnival, circus, fair or other special event operated by a non - profit organization on or abutting their principal use. * 3. Commercial carnival, circus or fair in commercial or industrial districts. 4. Similar temporary structures where the period of use will not exceed 30 days a year. The a iicant shall: 1. Submit proof of liability insurance, paid in full covering the period for which the permit is issued, in the minimum amount of $1,000,000.00 per occurrence. 2. Remove all debris within 48 hours of expiration of permit 3. Have notarized written permission of property owner, if applicant is not the property owner. 4. 'Submit Site Plan * 5. Submit State inspection Certificate(s) * 6. Submit State Annual Permit • I hereby certify that the information on this application is correct. The information included in this application is for use by the City of Okeechobee In processing my request. False or misleading information may be punishable by a fine of up to $500.00 �rfd tmprlsonment.of up to thirty days and may r ult in the summary denial of this application. ( • l Signature of Applicant City Staff (Please review the application, attach comments or special conditions): Date Occupational and /or State License Verification: ,I.. i'' OP Date: , Fire Department Approval: .,� jjr/' Date. . Police Department AppX, Date: #1-// 64 Public Works Department Ap. •,ti" Date: Building Inspector Appro - MI Date: Z*70 i 7 City A inistratorlApp�_ Date: 3 1��?" Revised 2!1/08 bic Page 1 of 2 Okeechobee County Property Appraiser n^ ara, CFP Parcel: « 3- 21- 37 -35- 0020 - 02530 -0020 » Owner & Property Info Result: 1 of 1 AMERICAN LEGION POST 64 Owner 501 SE 2ND STREET OKEECHOBEE, FL 349740000 Site 501 SF 2ND ST, OKEECHOBEE Description 1ST ADDITION TO CITY OF OKEECHOBEE LOTS 2 3 4 5 6 BLOCK 253 AND BEG AT INTERSECTION OF HIAWASSEE & 7TH ST RUN E ON N BDRY OF 7TH ST 200 FT TO SE COR OF LOT 6 BLK 253, THENCE N ON DIVIDING LINE BETWEEN LOTS 6 & 7 OF BLOCK 263, EXTENDED TO S PAKR ST, W 0 ...more »> 2016 Tax Roll Year updated: 12/8/2016 Aerial Viewer Pictometery Google Maps 2015 X2014 ` -)2011 2009 02005 ;Sales t E.211D ST Use Code 3.946 AC S /T /R 21 -37 -35 CLUBS /LODG (007700) The Description above is not to be used as the Legal Description for parcel in any legal transaction. The Use Code is a Dept. of Revenue (DOR) code. Please contact the Okeechobee County Planning & Development office at 863 - 763 -5548 for specific zoning information. Tax District 50 Property & Assessment Values 2015 Certified Values 2016 Certified Values Mkt Land (1) $204,217 Mkt Land (1) Ag Land (0) Ag Land (o) Building (3) XFOB (15) Just Class Appraised Exempt Assessed $204,21 SW41HST 4TH ST $512,253 Building (3) $518,16 ; a` $14,25;" $736,63 $736,63 OTHER$736,63 $14,252 XFOB (15) $730,722 Just $0 Class $730,722 Appraised OTHER$730,722 Exempt Assessed $730,722 ( Total Taxable county:$0 city:$0 other:$0 school:$0 Sales History Sale Date Total Taxable Sale Price $736,63 county:$0 city:$ other :t school:$° S4'14114ST, Book /Page Deed V/I I Quality NONE Building Characteristics Bldg Sketch Bldg Item 1 Sketch Bldg Desc CLUB HOUSE (006900) Sketch Sketch 2 WH BLDG (008400) RCode Year Blt Base SF 1970 9686 Actual SF Bldg Value REST /LOUNG (005601) 9686 2400 6990 $203,061 $46,844 $268,261 Extra Features & Out Buildings Code CONC B ASPH 2 Desc COM SLB WL Year BR 1994 Value Units $621.00 i 363.000 Dims OxOxO Condition (% Good) PD (075.00) COM SLB WL 1991 $2,755.00 2204.000 http://ap2.okeechobeepa.com/gis/recordSearch 3 Details/ OxOxO PD (050.00) 12/9/2016 12/05/2016 10 :21AM FAX 2039310682 Specialts_Insurance,LTD ACCP� CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER$ 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 18 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). lib 0002/0002 DATE (MM/DDIYYYY) 12/5/16 PRODUCER Specialty Insurance, LTD. P.Q. Box 16901 West Haven, CT 06516 INSURED John & Joyce Richardson dba J&J Amusements PO Box 485 New Middletown, Ohio 44442 CONTACT Thomas Plouffe ME: NAME: PHONE 203-931-7095 jAIC, Ne, Exl }'.. ADDRESS: tplouffe@peoplepc.com INSURERS) AFFORDING COVERAGE INSURERA: Admiral Insurance Company INsuSER B : Progressive Express Insurance Co f Fa . Ng), 203 -931 -0682 INSURER C - INSURt0: INSURER E INSURER F NAIL # -_ 24856 02962 • ISION NUMBER: 4VVcremuc7 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. • -- ------- - - -- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLCY PROVISIONS - AUTHORIZED REPRESENTAriv# ...2.-Zii Thomas A. Plouffe INSR NS TYPE OF INSURANCE I DD!. I'p SIAM SUER POLICY NUMBER • ..,•u'uH il� ` }L�rl +'a' ►'au.c LIMITS A X GENI. COMMERCIAL G1:NSRAL LIABILITY i CLAIMS -MADE X OCCUR CA000021894 -02 6/28/16 6/28/17 H OCCURRENCE • GE TO RENTED MISES (Ea occurreng!i) $ 1,000,000 8 300,000 .. .. ED EXP (Any ono person) S 5,000 PERSONAL a ADV INJURY $ 1,000,000 $ 2,000,000 AGGREGATE LIMIT APPLIESPER: PRO T 1�1 - I l LOC POLICY n JEC OTHER: GENERAL AGGREGATE PRODUCTS - COMP /OP AGG 5 2,000,000 $ g AUTOMOBILE LIABILITY 02666548 -0 9/11/16 9111/17 COMBINED SINGLE LIMIT' s 2,000 000 $ _ _ — BODILY INJURY {Por person) ANY AUTO ALL OWNEO AUTOS HIRED AUTOS PIP =310,001: SCHEDULED AUTOS NON •OWNED AUTOS BODILY INJU - PROPER IYi (Prr alwtdent . Ye :� accident) ,a,,., $ $ $ UMBRELLA LJAB EXCESS LIAO _ OCCUR CLAIMS-MADE EACH OCCU 5 AGGRFGAT * $ S DED 1 RETENTIONS WORKERS COMPENSATION AND EMPLOYERS' UABIL.TFY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFP•- •,iiR/ MEMBER EXCLUDED? (Mrndatory in NH) if yet describe under DESCRIPTION OF OPERATIONS below NIA PTRTUTE RH- E.L EACH AC6!@. $ E.L. DISEASE., RJ OYEE 5 EL DISEASE - rF10LICY LIMIT EL. 5 February 1- 13,2016 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHIGIAS (ACORD 701, Additional Remarks Schedule, may be attached it more space le required) The American Legion Post 64 and the City of Okeechobee, FL are added as an additional insured but only with respects to the operations of the named insured during the policy period. tows 1 Ir-mue 1 c nvr.arcn The American Legion Post 64 501 Southeast 2nd Street Okeechobee, FL 34974 fax# 863 - 763 -9602 -- ------- - - -- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLCY PROVISIONS - AUTHORIZED REPRESENTAriv# ...2.-Zii Thomas A. Plouffe ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 56 3 &A AVE. c)i ( Co) ( 4? .41 E6 I ft*W' PA/Aid& kirr ■ A4. "ail ewe et:wet:dill 4-7ma. 5E, 51}1 A . z. kr% , R ADAM H. PUTNAM COMMISSIONER Florida Department of Agriculture and Consumer Services Division of Consumer Services /Bureau of Fair Rides Inspection J & J AMUSEMENTS PO BOX 485 NEW MIDDLETOWN, OH 44442 1# Rides: 16 # Go Karts: 0 i -_ EVENT REPORT Phone 1- 800 - 435 -7352; Fax (850) 410 -3797 FairRides@FreshFromFlorida.com # Rides Passed: 15 # Go Karts Passed: 0 USAID i Theme Name I Status ICIRT# I 04949 -MINI JET DINO Pass 177719 08211 PARATROOPER Pass 177736 08335 SUPER JET Pass 177739 08355 COMBO Pass 177741 08356 BEAR AFFAIR Pass 177745 08357 COMBO � Pass 184894 08361 RING OF FIRE Not Ready ptructurai - Structural Integrity: Excessive corrosion 08984 TCOM80 I Pass 178509 09818 SWING CAROUSEL I Pass 179830 11466 -MERRY GO ROUND Pass 189317 11616 ROUNDUP I Pass 178513 I1 11636 FIRE BALL Pass 189488 ktta chmente - Restraints: Broken Attachments - Restraints: Broken Attachments - Restraints: Broken INVOICE #: 2912110 EVENT NAME: AMERICAN LEGION FAIR EVENT ADDRESS /LOCATION: 501 SECOND ST. EVENT CITY /COUNTY: OKEECHOBEE /OKEECHOBEE OPEN DATE: 02/07/2017 INSPECTION #: 1702 -03870 1# Rides Failed: 0 # Go Karts Failed: 0 Deficiency # Rides Not Ready: 1 # Go Karts Not Ready: 0 I 05T# l Unit 14470 ILOST TREASURE Pass 14912 FUN SLIDE Pass 15087 'GONDOLA WHEEL Pass 15357 TILT -A -WHIRL Pass i 11673 1 11574 I 13 11566 15 -1 Attachments - Restraints: Broken rAttachments - Restraints. Srokon Attachments - Restraints: Broken Attachments - Restraints: Broken 189344A 189345A 189500 189498 11592 17 r - 11577. 2 11514 6 11565 9 11 I acknowledge that all identified rides issued a stop operation order (RT #) and /or carriers or components issued an out of service (OST #) are not in compliance with Florida Statute 616.242 and /or Rule Chapter 5J -18, F.A.C. and shall not operate until it passes a subsequent inspection by the Department. Date i 7 Run Date: February 7, 2017 2:38 PM Page: 1 of 1