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HomeMy WebLinkAbout2023 o�oSurFot�.�oG ELIZABETH A.NEVILLE,MMC oy► .y� Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS O Fax(631)765-6145 MARRIAGE OFFICER ?'�Ol 0� Telephone(631` d8.i S0—d RECORDS OF MANAGEMENT OFFICER southoldtown.northfork.net FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK JUR ® 4 2023 TOWN OF SOUTHOLD APPLICATION GiOuthOld Town Clerk PERMIT TO DISPLAY FIREWORKS APPLICATION IS HEREBY MADE, pursuant to the provisi6ns of Section 405.00-of the Penal Law of the State of New York,for a permit to display fireworks as hereinafter specified: DISPLAY IS TO BE SPONSORED BY North Fork Country Club PRINCIPAL OFFICE AT 26342 Main Road,Cutchogue,NY 11935 DATE&TIME OF;DISPLAY7/2/23 at 9:15 pm EXACT LOCATION-•OF DISPLAY North Fork Country Club golf course SUFFOLK COUNTY TAX MAP NUMBER FOR SITE RAIN DATE&TIME 9/3/23 at 9:00 pm The following persons are to be in charge of the actual shooting of the Fireworks: Name Age Experience Physical Condition Richard Davin 53 24+years Health:Excellent Techs-TBD (,Additional names and information may be submitted on an attached sheet Number and type of fireworks is as follows: 1.3/1.4G ,Cakes - 19 2" - 3" Shells-412 4"Shells - 102 Manner and place of storage of fireworks prior to display: Delivery of product on da off display Attached hereto and made a part of hereof is a diagram of the grounds on which the display is to be held. Also attached is a certificate or policy of insurance coverage. NOTICE. Written permission,with signature of the Property Owner,must be submitted with the Application. Santore's World Famous Fireworks,LLC FEE; $100 Name of Organization See policy:for additional information August N.Santore,Jr. By Printecl Name OT Applicant Signaturt7of Applicant e-mail address:asantoreir@santorefireworks.com 2/15/2023 Telephone Number 908-872-0624 Date of Application 5. All applications for a fireworks permit shall be subject to an application fee in an amount of$100.00, together with a processing fee in an amount to be detennined by the Town Board to cover the Town's costs for monitoring and enforcing compliance with the Penal Law. (The above instructions are in accordance with the Penal Law, Article 405 -Licensing and other provisions relating to fireworks.) Nora Fork Country Club February,17, 2023 To whom it may concern, North Fork Country Club has,engaged Santore's World Famous Fireworks to,provide us With a fireworks" display on July 2,2023 with a rain date of September 3,2"023. Part of our arra"ngement'is for Santore's World Famous.Fireworks to;obtairi and complete all necessary applications and permits.They have our permission to process all necessary paperwork.for the event.. If you have any questions or concerns;please,contact us. Thank you,. George:" Haase Jr Assistant Contr Iter 631-734-7139 ext 104 mail@northforkcc.com P.O'.BOX 79-"5 CUTCHOGUE,.NE-W YORK 11.935-0725" (631)734-709, o mx,(631"):734"-9"Q04 ufccmail@optonline".net tvww.northforkcc_com. flaw U.S.Department Eastern Service Center 1701 Columbia Ave. of Transportation Operations Support Group College Park,GA 30337 A V-E2 FIREWORKS DISPLAY NOTIFICATION Company Name: Santore's World Famous Fireworks, LLC Email Address of Person Submitting Request:terisa@santorefireworks.com Cell Phone Number for On-Site Technician: Richard Davin 631889-9938 Event Name: North Fork Country Club Display Date: 7/2/23 Rain Date: 9/3/23 Display Start Time: 9:15Dm Duration of Fireworks Display: 15-20 min Max Height of Fireworks: 400 Feet Address,City and State: 26342 Main Road, Cutchoeue, NY Latitude: 4100' 16" (North) Longitude: 72 29'25" (West) List the Closest Public Use Airport Within 5 Nautical Miles of the Display if the Fireworks Will Reach or Exceed 500 Ft. Special Notes Please email your request to: 9-ATO-ESA-OSG-Fireworks@faa.gov 1 Air Traffic Organization 1701 Columbia Avenue Eastern Service Center College Park,GA 30337 U.S. Department of Transportation Federal Aviation Administration Dear Fireworks Proponent: Thank you for informing us of your proposed fireworks display. Although there are currently no federal regulations specific to fireworks displays, the Federal Aviation Administration (FAA)has been tasked with regulating the safe and efficient use of the navigable airspace (49 U.S.C.§ 40103). In recognition of this role in promoting aviation safety, many jurisdictions require notice to the FAA as a condition of approval of a fireworks permit. We acknowledge your notification and have no objection to the fireworks display,provided it is conducted in a manner that does not create a hazard to other persons or their property. To enhance the safety of your event,we recommend the following actions: • Fireworks staff should remain vigilant to ensure that no aircraft are in the area prior to beginning the fireworks display. • If your event is within 5 miles of a public use airport, or if the display will exceed 500 feet Above Ground Level(AGL), contact Leidos Flight Service at 1-877-4-US-NTMS (1-877-487-6867) at least 24 hours (but not more than 7 days)in advance to request a Notice to Air Missions (NOTAM). You will need to provide the following information: o Name and address of the person filing the NOTAM o Date, time(s), and event location (City, State, and location in reference to the airport) o Maximum altitude of the display This letter should not be construed as superseding or invalidating any existing rules or regulations promulgated by any other federal, state, county, or municipal government which may be required for this display. If you have any questions regarding this information,please contact our office at(404) 305- 5570 or 9-ATO-ESA-OSG-Fireworks(a-),faa.gov Sincerely, W�a��u- Matthew N. Cathcart Manager, Operations Support Group ACOORL> ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 2/13/2023 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 CONTACT NAME: Britton-Gallagher and Associates, Inc. PHONE FAx One Cleveland Center, Floor 30 Arc No Ext:216-658-7100 Arc No):216-658-7101 1375 East 9th Street ADDRIESS: Cleveland OH 44114 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Everest National Insurance Company 10120 INSURED 18341 INSURER B:AXIS Surplus Ins Company 26620 Santore's World Famous Fireworks LLC 846 Stillwater Bridge Road INSURERC: Schaghticoke NY 12154 1 INSURER D, INSURER E, INSURER F: COVERAGES CERTIFICATE NUMBER:1645369512 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 CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMBS LTR POLICYNUMBER MMIDD/YYYY MMIDD/YYYY A GENERAL LIABILITY Y Y S18ML00235-231 2/9/2023 2/9/2024 EACH OCCURRENCE $1,000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $500,000 CLAIMS-MADE FxI OCCUR MED EXP(Any one person) S PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICYX PRO- LOC $ A AUTOMOBILE LIABILITY Y Y SIBCA00102-231 2/9/2023 2/9/2024 COMBINED SINGLE LIMIT Ea accitlent $1000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED PROPER nt AMAGE $ HIRED AUTOS AUTOS $ B UMBRELLA LIAB X OCCUR Y Y P-001-000074909-05 2/9/2023 2/9/2024 EACH OCCURRENCE $4,000,OOD X EXCESSLIAB CLAIMS-MADE AGGREGATE $4,000,000 DED I I RETENTION$ $ WORKERSCOMPENSATION WCSTATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNERIEXECUTIVE❑ E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement. "North Fork Country Club are interested in the maintenance of this insurance and it is agreed that the insurance will not be canceled,materially changed or not renewed without at least a thirty(30)day advance written notice to North Fork Country Club by certified mail-return receipt requested." Display Date:7/2/23. Rain Date:9/3/23.Location:North Fork Country Club North Fork Country Club,Hamlet of Cutchogue,Town of Southhold,Suffolk County are named as additional insureds,but only in respect of liability caused by the negligent acts or omissions of the named insured.Subrogation waived to the extent required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. North Fork Country Club 26342 Main Road Cutchogue NY 11935 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD NYS1 F New York State Insurance Fund PO Box 66699,Albany,NY 12206 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAAAAA 472010297 SANTORE'S WORLD FAMOUS FIREWORKS LLC 143 SUMMIT AVE BERKELEY HEIGHTS NJ 07922 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER SANTORE'S WORLD FAMOUS NORTH FORK COUNTRY CLUB FIREWORKS LLC 26342 MAIN ROAD 143 SUMMIT AVE CUTCHOGUE NY 11935 BERKELEY HEIGHTS NJ 07922 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE A2353 260-9 521284 02/07/2023 TO 02/07/2024 2/15/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2353 260-9, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:IIWWW.NYSIF.COM/CERTICERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR,PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE SUR NCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 1036397931 U-26.3 CERT11710 "rc E CERT.# 86894656 R ISSUED 05/05/2022 EXPIRES 05/0812023 ak NAME RICHARD M DAVIN HOME PO BOX 541 ADDR. MORICHES, NY 11955 FEE $ 5 CAT.E20 TYPE Fitness DESC PYROTECHNIC FIREWORKS EMPLOYER PYRO ENGINEERING WORK LOCATION , COMMEPC'AL OR VER LICENSE 161 229 777 C L)AV,N RICHARD M Pel BOX 541 MOR.CHES NY t1965 HAMAT _ 04106/2026 .. HAZ ,j.. 04/22i 1966 t,.c• 04/22`2025 ,..uM,4AD DI: "t 04 082021 r STATE OF NEW YORK DT PARTANT OF LA$C)R PYROTF0-WIAN CERTIR(ATF OF COMPFTFNCT RICHARD M DAVIN CLASS:B NON PROXIMATE AUDIENCE ONLY THIS CARD MUST BE CARRIED U@l1E11 USING PYRO I NYC&NYS CERTIFICATIONS REQUIRED IN NYC I'iN11iIMll1!lP7M CFIICATE ll SLUED t3 Y 1-u NY CERT_W 86894656 R ISSUED 05/05/2022 EXPIRES 05/08/2023 NAME RICHARD M DAVIN HOME PO BOX 541 AOOR MORICHES, NY 11955 FEE $ S CAT E20 TYPE Fitness OESC PYROTECHNIC FIREWORKS EMPLOYER PYRO ENOINEERING WORK LOCATION M PO MOR 6F; *2 11/19 IRA'P A. Go gle Maps North Fork Country Club 7/2/23 T 4 T 350 Ft .�rvr, y •,.�t 7 w ¢# \ Ft10, Ilk " 1TT.fes... -: ! �, • O Q,_►� ..,�, 1� t b-,��„�► ry c 31' ech E JVew AA,`K10f#' iy.x Measure distance Total distance: 350.63 ft(106.87 m) Launch Site - up to 4" Shells =Audience Viewing Launch Site - Cakes - 1.25" Fallout Zone for Cakes—150' Radius 0Fallout Zone for 4" Shells- 350' Radius Launch Site Lat/Long: 410 00' 16" N /72 29' 25" W Display Location: North Fork Country Club, 26342 Main Road, Cutchogue, Southold, NY SANT -WORLD FAMOUS- FIREWORKS t:-, a'.=t�.�'S•1 �"5`�i1�+.€} ^� ''f.x'_'�`,�,�:,..„ p�I�i4}�i�, M,.� ,:v'�r ?'� Y4�j''z,.�.yf}.q� t-a:� _ - - _ y SH-862(3122) F-01res: 12!_3 11/2023 DIVISION OF SAFETY HEALTHW E ARE YOUR DOL THIS LICENSE MUST BE LICENSE AND CERTIFICATE UNIT I °REiofLahor�nnt POSTEv IN YOUR Pi L.0 STATE OFFICE CAMPUS.BLDG. i I OF BUSINESS ALBANY, NY 92226 LicerSe No, D_5796 LICENSE TO DEAL_ Its OR MANUFACTURE EXPLOSIVES Santore's b1/clld Famous Fireworks, LLC 848 Stiliwater Bridge Rd Schoghticoke, NY i2154 Au)us' N. Santore, Jr. is hereby licensed to deal in or manufacture expiosives in comoiiance with t le requirements 0 the Lacer Lew a r_ Industria!Codo Rules.Any Change in tas cond'tions under 1':h'ch[';is i!cense is g'anted may cai,se,it to be'evokec Every person selling.deliveri^g or giving away any explosives must keep at the amcioal place of Business within the state,3 record of each transaction,including: the NAME or i YPc and QUANTITY of explosives SOLD.DELIVERED or GIVEN.Nate:No!icense is needed to purchase smokeiess powder, or black pomdar and euani ty is not exceeding Five pounds for use in firing antique fireamns or artifacts or replicas thereof.However,dealers MUST Dost ail such transactrar:s on the"Dealer-^farufacturer Report of Explosives T-arsactions Tt the DATE OF EACH SALE,DELIVERY or GIFT. the;`FAME.LICENSE NUMBER, and BUSINESS ADDRESS of the purchaser,donee;or Gerson to whom, the explosives were delivered and the firm, if any.represented by such person. the NAME,ADDRESS and LICENSE NUMIBER of:he person T.AK!NG Tlir EX�LQS!VES AWAY rom the seller or donor, f� l l� Am),Phillips,Director — FOR 7flE COMItiiIS&ONBR OF LABOR SH-862(5-98) Feder2d Explosives LicenseTermit U-S.Deparfinent of Justice �� S. �� � BureauofAtcohol,Tobacco-Firearms and Explosives a SurffihrEIH&i1II 7�IIRl In accordance with the provisions of Tffie M,Organized Crime Control Act o€1970,and the regulations issued thereunder(27 CFR Part 555),you may engage in the activity silecified in this lieane or permit within The limitations cFChapter 40,T;'de18,T3sufed.S( s Cod_e and the rc�ulations issued thereunder,until the eepiration date shown. TMS Lf G+'�1SE IS NQT-TRANSFERARI.l`+,fNEiRk 27 ALM 53_._See"WA 2CWGs'"and'NODS"on reverse. Direct ATF ATF--Chip> FELC icenselPetinit' Correspondence To 244 Needy Road :_IvimtierY' _ • NY-083-20-4C-0108 Martinsburg,VJV23405-9431. Chief FederalExosivesLicensm' Center(FELC) Date s 1 _ Name - SANTORES WORLD FAMOUS FIREWORKS:LLC - Premises Address(Changes?Notify theELC a least:lO days bc>forethe move)__: ... 846STILLlllfATERBRIDGE-EOA.i7 �' _.. ._•,`: SCHAGHTICOKE, MY 12,154- _ Type ofLicense or Permit 20-MANUFACTURER OF EX-PI- SIVES Purchasing Certificati6n Statement = Mailing Address.(Changes?=Notify e- &FELC of any changes.) The licensee orpetmittee named above stall use_a copy,of ihislicense roroff traasfeofexplosivesto verifytheid�tity andthelicensed.staus ofthelicensee oc - permitYee as provided by 27 CFRPart 555. sienatrtre ai ea�£i corn must fie an Arigaial = SAI�TORES;INOF3LD:FAIVrOUS FIREWORKS LLC sieuarure. Afaxed,scanned or e-mailed copy ofthedicena or petiriirvvitli a.- nature. `; -- - .•-•;:.:.:,. intended to be as original signatures acceptable. Thesigiaiure•mtisiltethatoftheFederal 143SUMMITTAVE; Explosives Ucensee(FEL)orarespotisiblepersoneft1e.1~EL Ic"fy':iliaf-lhisisatnie 5ERKEL8YkilrlGH1-S, NJ 07922 copy ofa Iicense or pamit issued to the liomsce orperrmrtee naoaed=a6ovef¢engageiir business or operations spiecified.aboveunder"'Type of Liceuseor.Pennit'j LicenseelPermitteeResponsiblePeisonSignature .P6s%6n/T-ffle Printed Name Date ATFFacn s:ae.i v�oe.tsP�i Previss';di:icaisCSsat�e sra�svrar�Fuac.,�saarsi:casrsc�-sFa�.e�mt�az�sccranrca:.a�e�x2�•ss.���waaF.vca�rs Rc�ased&Scr:��?AI?. Feedei=d Lspladves 3keme(FELj G3isMmer Semee Irrformadm Federal lxplosives;+tensing Center(F_.I.C) Tai free TelephoneliLumbe- (977)233-3352 - ATIF Homepage:www-2tEgov 2,414 Needy Road Fanhpuniber_ _ C304-)61644101 Martinsburg:WV 2f405-4431 E-mail: FF-1 C@w&goy - Change of address (27 CFR 555-54(a)(1))_ Licensees or-permittees may dtningthe m of their current license or permitrentove their business oroperations to a ne-,v location at which they intend regularly to carry on such business or operations. The licensee or permittee is required to give notification of the ne-,v location of the business or operations not less than 10 days prior to such removal with the Chief Federal Explosives Licensing Center. The license or permit will be valid for the remainder ofthe term of the original license or permit. ("Me Chiefs TELC,shall,if thelicensee or permittee is not gaalrSed,refer the request for amended license or permit to the Director of Industry Operations for dermal in accordance with§,555-54.) Right of succession (27 CFR 555.59)_ (a)Certain persons other than the licensee or permittee may secure the right to catty on the same explosive materials business or operations at the same address shown on,and for the remainder of-the term of-a current license or penniL Such persons are: (1)The surviving spouse or child,or executor,admimsbato,or other legal representative of a deceased licensee or permittee;and(2)A receiver or trustee in ban!-ruptcy,or an assignee for benefit of creditors_ (b)In orderto secure the right provided by this section,the person or persons continuing the business or operations shall furnish the lie-.rise or pennit for for that business or operations for endorsement of such succession to the Chief FELC,within 30 days from the date on which the successor begins to carry on the business or operations. (Condmeed on reverse side) Cut Frere jFederal Explosives Llce4sc/Peri nit(FEL)Inform tions Card I 1 Lie=d?emtitName:SANTORES WORLD FAkIOUS FIREWORKS LLC I Business Name: t 1 •. 1 LicenseA'ermit Number.6-NY-083-20-40-01080 j 1 License/Permit Type:20-MANUFACTURER OF EXPLOSIVES 1 1 I I a. 7 Expiratiom March 1,2024 � I I Pleaso Na e:tot Valid for the Sale or Mer Disposition of Explosives. I 1 1 ----------------------------------- W ARNPIGS i. As provided in TitieM of the Organized Crime ControlAct of 1970(US §842(1)),it is unlawful for any person;vho(3)is tinder indictment for.or ha: been corevicted in any court of,a crime punishable by imprisonment for a tem force eding 1}•ear_(2)is a fugitive from 3 usticc,(3)is an unlawful user ot.o addicted to any controlled substance(as defined in section 102 ofilk$Cotrtrojled$ubsrancesAcr(21 US.1-802)),(4)has been ad-tudicated as am enza. defective or has been committed to a mental insfitution,to slip,transport,or receive any explosive materials in interstate or foreign commerce,(5)is an ale::. other than an alien who is lawfully admitted for permanent residence(as That igrm s da_finzd in seruan I07(a)(20)of-Fie Immigmdon and Natrvall-wdo Act),ormeets errs other eseention under section 842(JW),(6)has-been discharged from the armed forces under dishonorable eondiiion,or(71 having beer. a citizen of fna[versos. FcderaY 1z dutatlon$'"r LTR 999M- aad gamrifs imuad under this part are not tr2nsferable to another person. Ill the event of the leave, sale,or other transfer of the business or operations covered by the license or permit,the successormust obtain the License or permit required by this part before commencing business or operations.. 3. Alteration or Changes to the License or Permit. Alterations or changes in the original license or permit or in duplications thereof'violates 19 U.S.C. 1001,an offense punishable by imprisownent for not more than 5 years and/or a fine of not more than$250,000. NOTICES L Any change in trade name or control of this business or operations MUST be reported within 30 days of the changeto the ChieLFederaI Explosives Licensing Center(FELC),244 Needy Road,Martinsburg,LW 25405-9431. (27 CFR 555.56-55557). A licensee or permittee who reports a Change of Control must, upon expiration of the license or permit,Ste an ATF Form 5400.13/5400.I6. 2. Under§555.46,Renewal of LicensdPermit,if licensee or permittee intends to continue the business or operations described on a license or permit issued under this part during any portion of the ensuing year,the licensee or permittee shalt,unless otherwise notified in writing by the Chief,FELC,execute and file with ATF prior to the expiration ofthe license or permit an application for a license or permit renewal,ATF Form 5400.14/5400.15 Part III,in accordance with the instrncfions on the form,and the required fee. In the event the licensee or permittee does not timely file;an ATF Form 5400.14/5400.15 Part 174-the licensee or permittee must file an ATF Form 5400.1315400.16 as required by§555.45,and obtain the required license or permit before continuing business _ or operations. A renewal application will automatically be mailed by ATF to the"mailing address"on the license or permit approximately 60 days prior to the expiration date ofthe license or permit. If the anolication isnot received 30 days prior to the expiration date the licenses or permittee chnnld rnntar t tb=EE C Note: The user-limited permits are not renewable. 3. This license or permit is conditional upon compliance byyouwith the Clean Water Act(33 U.S.C.§.1341(a)). -'.. TMS LICENSE OR PF.-RIvIIT MUST BE POSTED AND KEPT AA/AIL'�BLE FOR 1NSPECTTON(27 CIIt 555.141). TFFcma ;0().l�tCJ�.iSPzn t Raised October 2011 Federal Explosives License(FEL)Customer Service Information (Continuedfi•om front) Discontinuance of Business (27 CFR 555.61)(-77 Cott 555128). Where an explosives materials business or operations is succeeded by a new licensee or perrnit:ee:.the records prescribed by this subpart shall appropriately reflect such facts and shall be delivered to the successor,or may be,within 30 days following bsuiness discontinuance.delivered to,tbe-A-TF Out-of-Business Records Center,244 Needy Road,Martinsburg,WV 254105,or to any ATF office in the division in which thebusinesszi*-as located. Where discontinuance of-the business is absolute,the records shall be delivered within 30 days followi ig the business discontinuance-to theATF-Out-o7 Business Records Center,234lNeedyRoad,14artinsburj,WVa4fl5,ortoany ATF o£lmcein Elled;tirisianin which tllr business tikes located_ Explosive materials must be stored in coniammancew9th requirements set.1"o.,h in 27 CYP,Part 55. Itis unlawful for arty person to store any explosive matenais in a manner not in conformity'%ith the regulations. TO REPORT LOST OR STOLEN EXPLOSIVES,YOU MUST IMMEDLATELY NOTIFY ATF: CALL TOLL FREE-(SM ATF BOMB X Cut Here 1 Federal Explosives Licansmg Center(FELC) Tolle,.number.(877)283-3352 1 t 2441v7eedy Road Fax number:(304)61644 t f Martinsbur„WV-25405-9431 E-mail: FELC@ofgov T ( E ! I jHotline Numbers Arson Hotline: 1-888=ATF-FIRE(1-888-283 3.173) t 1 Bomb Hotline: 1-888_ATF-BOMB(I-888-283-2662) t 1 Report Illegal Fireiams Activity: 1-800-4-TF-GUNS(I-800-283-4867) r 1 Firearms Theft Hotline: 1-888930-9275 t m Report Stolen,Hijacked or Seized Cigarettes 1-800-659-6242 t 1 Other Criminal Activity: 1-888-NIT—TIPS (1-888-283-8477) t 1 I —------------------------- -- . —sl I N ARNR' GS i_ 3s pro-,ided in TilleM of the Organized Crime Con`,rolAct of 1970(U.5 V 842{i))-it is unla-,tiTitl for any person who(1)isunder indictme-ni io or it az been convict-ed in any court of,a crime punishable by imprisonment for a'erm--ceeding 1 Fear,(2)is a fugitive fro-justice,(3)is an unlawful user a-.o:- addicted to any controlled substance(as defazed La section 102 of'LJre Controlled SrrbstarzcesAct(3I US.C.802)),(4)has been atiiudicaied i s a mens_: defeat:•e or has been committed to a mental institution,to ship,transport,or receive any explosive materials in interstate or foreign commerce,(5, s an other than an alien who is lav Firily adrnitted for permanent residence(a;that rel-n iv defmad in section 2 01"(20)of 7f se Immigration and.NanuraLwtio.- .4ct),or meets avr other e,Keeption under section 842(1)(5),(6)has been discharged from the armed forces under dishonorable conditions,or(,Tj 11aviIIg i ec- a ci.¢cr of rs+cUniccd Smits_hes rcnoumccd the oitize_shia o#'ina�neroa�. rederar Red intron:i F 40ra 859-92-Lieonsecs SEI pdrmits iscuad under this part are not transferable to another Imull. In tht;uYent of the tease. sale,or other transfer of the business or operations covered by the license or permit,the successor mast obtain the license or permit reclatrcd tn- this part before commencing business or operations.. 3. Alteration or Changes to the License or Permit Alterations or changes in the original license or permit orin duplications thereof-violates 18 U.S.C. 1001,an offense punishable by imprisonment for notmore than 5 years and/or a fine of not more than 5250.000. \OTICES 1. Any change in trade name or control of this business or operations MUST be reported within 30 days of the change to the Chief:Federal Explosives Licensing Center,(FELC),244 Needy Road,Martinsburo,WV 25=!05-9431. C37 CFR 5».56-555.57). A licensee or permittee who reports a Change of Control must, upon expluation of the license or permir.file an ATF Form:5400.13154 00-16- 2. Under§555A6-Renewal of LicenselPerrlit,ifa licensee or permittee intends to continue the business or operations described on a license orpermit issued under this part during any portion of the ensuing year,the licensee or pennittea shall,unless othem4se notified in-,uniting by the Chief,FELC,execute and file with ATF prior tothe expiration ofthe license or permit in application for a license or permit renewal,ATF Form 5400.14/5400.15 Part Ll,in adcordance with the instructions on the form!,and the required fee. In the event the licensee or peuninee does rot timely file an ATF Form 5400.1415400.15 Part L''I�..the licensee or permittee must file an ATF Form 5400.13/5400.16 as required by y§555.45,and obtain the required license or permit before continuing business or operations. A renewal application will automatically be mailed by ATF to the"mailing address"on the license or permit approximately 60 days prior to the expiration date ofthe license or permit. If the application isnot reeeivred 30 days prior to the expiration date the licensee os rP^*�r PP chn,lld nntartthe_ r r' Note. The user limited permits are not renevrable. 3. This license or permit is conditional upon compliance byyou with the CIean Nater Act(33 U.S.C-§.1341(a)). ^. THIS LICENSE OR PERMT MUST BE POSTED AND I,'EPT AVAILABLE FOR INSPECTION(27 CFR 5».101). Ir Fcnn:Wj-al-V54 M.15?m I Rcviscd Ouober201? Federal Explosives License(FEL)Customer Service Inforrrration• (Continued from front) Discontinuance of Bu,iness (27 CFR 555.61,)(37 CFR 555128). Where an explosives materials business or operations is succeeded by a ttevv licensee or permittee,the records prescribed by this subpart shall appropriately reflect such facts and shall be deiivrered to the successor,or may be,within 30 days following business discontinuance-delivered to the ATF Oat-o€-Business Records Cente,_4".Needy Road,lSartinsburg_WV 25405,or to any ATF ogee in the divisim in wiich the business-,vas located. Where discontinuance of-the business is absolute,the records shall be delivered within 30 days following the business discontinuance to the A=Out-or Bushress Records Center.244 Needy Road,N- anrsburp Gv7V 25405 or to any ATF ofce in the division in which the business-ass located. Exllosive materials must be stored in wnibrmancewith requirements set fo.h in 27 CFR,Part 55. It is unlavvful for any personto store any explosive materials in a manner not in conformitymiththese re=ilations. TO REPORT LOST OR STOLEN EXPLOSIVES,YOTJ MUST D)IMEDL4TELY NOTIFY ATF- CN L L TF:G.NLL TOLL FREE-(888)ATF-BO1VYB >;Cut Here 1 Federal Explosives U=smg Cerner(FELC) Tolt4-number:(877)283-3352 1 i 2441\reedy Road Fax trumber:(304)616-4401 1 Martinsburg,.r.�i 2:5405-9131 E-mail: 1 ELC�¢ fgov 1 t I i ! i 1 ATF Hotline Numbers r l _4-Son Hotline: I-s88=arP-N.*RE(1-Esa-agar9S73) t 1 1 1 Bomb Hotline: 1-588_4TF-BOi12B(1-883-293-2662) l t Report Illegal Fireums Activity: 1-goo-?"fI.-Gi1NS(I-800-283-486i� t 1 Firearms Tl:ell Meda= 1-888-930-9275 i 1 R-Tort Stolen,Hijacked or SaL,-ed Ciga t- 1-800-659-6242 k 1 Other Criminal Activity: 1-388-0.'i'F-TIPS (1-888-293-8477) 1 1 1 ----------------- I'f Noncarrow, Denis To: mail@northforkcc.com Cc: Franke, Diana; Sabrina Born (sabrina.born@town.southold.ny.us); Mudd,Jennifer Subject: Fireworks app` " HI George, We have a fireworks app here from the NFCC.We can't run it to the fireworks committee without a check. Not sure what you would like us to do. Thank you George. Denis Noncarrow Southold Town Clerk. Town of Southold, New York www.southoldtownny.gov denisn southoldtownny.gov 631-765-1800 CONFIDENTIALITY NOTICE: This communication with its contents may contain confidential and/or legally privileged information. It is solely for the use of the intended recipient(s). Unauthorized interception, review, use or disclosure is prohibited and may violate applicable laws including the Electronic Communications Privacy Act. If you are not the intended recipient, please contact the sender and destroy all copies of the communication. 1 Franke, Diana From: Franke, Diana Sent: Thursday,June 1, 2023 12:13 PM To: Lillian McCullough; Blasko, Regina; DeChance, Paul; Flatley, Martin; Ginas,James; McCullough, Lillian; McGivney,Julie; Mirabelli, Melissa; Norklun, Stacey; Squicciarini, James;Visser III, Fredric Cc: Sabrina Born (sabrina.born@town.southold.ny.us); Noncarrow, Denis Subject: Special Event: NF Country Club Fireworks! Attachments: Spc Ev NF Country Club.pdf Importance: High Good Afternoon, Attached, please find an application for a fireworks permit for The North Fork Country Club, submitted on ,06/01/2023 Please review and send me your comments and/or recommendations. Thank you, "avff Account Clerk Southold Town Clerk's Office (631)765-1800 Ext 1228 1 \ SHTC Southold Town Clerk I ` May 31/23 Check No. 048705048705' Invoice No Inv-�Date PO umber' Reference Audit No Gross Amt Disct/HB Net Amt 5242023 May24/23 N/A PJ1993 100.00 0.00 100.00 Distribution: 01-1300-00 Southold Town Clerk 100.00 100.00 0.00 100.00 J � 1 North Fork Country-Club Detach BeforeDepositing �, w �• SHTC Southold Town Clerk May 31/23 Check No. 048705048705 Invoice No Inv'.Date PO Number Reference Audit No Gross Amt Disct/HB Net Amt 5242023 May24/23 N/A .PJ1993 100.00 0.00 100.00 Distribution: 01-1300-00 Southold Town Clerk 100.00 100.00 0.00 100.00 i North Fork Country-Club Detach Before Depositing 1= f, j. ;� Q'666 214' _,.. .- .01111#. V =:: _ t�. rth Fo k G � .: : �' - - _ - - K. - �..,,.,' -- , t h ue NY X1935 • -. -._::::.- _ _ - o. ..-._....__T. •f'i 11 4,. f•+, ;y - 'f +3• 133112 .048705 :l XA v U NDRED-0OCC�RS &�O=GENTS - ..`.- P �x r� j,. ut n ....... .. .. . r " .- -- _P-O Hox.. 1.79.. -.__., . .. ...--. .,._--• - -_ „ — - r :(• Y O I IGNATURE Qi `A TH R ZED 5 °F c lie 04B 70 5its 0 2 140666 7 5000 20 76 1 5n• 4 Franke, Diana From: Visser III, Fredric Sent: Thursday, June 1, 2023 12:49 PM To: Franke, Diana Subject: RE: Special Event: NF Country Club Fireworks! Hello, I have no problem or opposition with North Fork Country Club fire work show. Thank you, Fredric Visser, Fire Marshal Town of Southold Phone: (631)765-1802 Web: https:Hsoutholdtownny.gov/1736/Fire-Marshal Email: Fredv@southoldtownny.gov PO Box 1179 54375 Main Road Southold, NY. 11971 From: Franke, Diana<dianaf@town.southold.ny.us> Sent:Thursday,June 1, 2023 12:13 PM To: Lillian McCullough <lilianm@southoldtownny.gov>; Blasko, Regina <rblasko@town.southold.ny.us>; DeChance, Paul <pauld@southoldtownny.gov>; Flatley, Martin <mflatley@town.southold.ny.us>; Ginas,James <jginas@town.southold.ny.us>; McCullough, Lillian <lillianm@southoldtownny.gov>; McGivney,Julie <juliem@southoldtownny.gov>; Mirabelli, Melissa <melissa.mirabelli@town.southold.ny.us>; Norklun,Stacey <Stacey.Norklun@town.southold.ny.us>;Squicciarini,James<jacks@southoldtownny.gov>;Visser III, Fredric <fredv@southoldtownny.gov> Cc: Born, Sabrina <sabrina.born @town.southoId.ny.us>; Noncarrow, Denis<denisn@southoldtownny.gov> Subject:Special Event: NF Country Club Fireworks! Importance: High Good Afternoon, Attached, please find an application for a fireworks permit for The North Fork Country Club, submitted on 06/01/2023 Please review and send me your comments and/or recommendations. Thank you, �lal�?ll c9lrm e Account Clerk Southold Town Clerk's Office (631)765-1800 Ext 1228 1 Franke, Diana From: Flatley, Martin Sent: Thursday,June 1, 2023 12:25 PM To: Franke, Diana Subject: RE: Special Event: NF Country Club Fireworks! I have no objections to this application being approved. Martin Flatley, Chief of Police Town of Southold Police Department 41405 State Route 25 Peconic, N.Y. 11958 Tel: 631-765-3115 The information contained in this electronic message and any attachments to this message are intended for the exclusive use of the addressee(s)and may contain information that is privileged,confidential and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient,you are hereby notified that any review,retransmission,conversion to hard copy, copying,reproduction,circulation,publication, dissemination or other use of,or taking of any action,or omission to take action,in reliance upon this communication by persons or entities other than the intended recipient is strictly prohibited. If you have received this communication in error,please(i)notify us immediately by telephone at 631.765.2600, (ii)return the original message and all copies to us at the address above via the U.S. Postal Service, and(iii)delete the message and any material attached thereto from any computer,disk drive, diskette, or other storage device or media. From: Franke, Diana <dianaf@town.southold.ny.us> Sent:Thursday,June 1, 2023 12:13 PM To: Lillian McCullough <lilianm@southoldtownny.gov>; Blasko, Regina <rblasko@town.southbld.ny.us>; DeChance, Paul <pauld@southoldtownny.gov>; Flatley, Martin <mflatley@town.southold.ny.us>; Ginas,James <jginas@town.southold.ny.us>; McCullough, Lillian <lillianm@southoldtownny.gov>; McGivney,Julie <juliem@southoldtownny.gov>; Mirabelli, Melissa <melissa.mirabelli@town.southold.ny.us>; Norklun,Stacey <Stacey.Norklun@town.southold.ny.us>;Squicciarini,James<jacks@southoldtownny.gov>;Visser III, Fredric <fredv@southoldtownny.gov> Cc: Born, Sabrina<sabrina.born@town.southold.ny.us>; Noncarrow, Denis<denisn@southoldtownny.gov> Subject:Special Event: NF Country Club Fireworks! Importance: High Good Afternoon, Attached, please find an application for a fireworks permit for The North Fork Country Club, submitted on 06/01/2023 Please review and send me your comments and/or recommendations. Thank you, dailn a Account Clerk Southold Town Clerk's Office (631)765-1800 Ext 1228 z Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 06/01/23 Receipt#: 311150 Quantity Transactions Reference Subtotal 1 Fireworks NFCC2 $100.00 Total Paid: $100.00 Notes: Payment Type Amount Paid By CK#048705 $100.00 North, Fork Country Club Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: North, Fork Country Club Pob 725 Main Road Cutchoque, NY 11935 Clerk ID: DIANAF Internal ID:NFCC2 sllFfo[��o _ DENIS NONCARROW =� G.y� Town Hall,53095 Main Road TOWN CLERK p P.O.Box 1179 ti Z Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Q Fax(631)765-6145 MARRIAGE OFFICERy RECORDS MANAGEMENT OFFICER ��l �a� Telephone 765-1800 FREEDOM OF INFORMATION OFFICER www.southoldtldtownny.gov OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PERMIT 2023 for PUBLIC DISPLAY OF FIREWORKS I, DENIS NONCARROW, Town Clerk of the Town of Southold, Suffolk County, New York, being an officer duly designated by the Town Board of the Town of Southold for this purpose, do hereby GRANT TO: NORTH FORK COUNTRY CLUB PERMIT FOR THE PUBLIC DISPLAY OF FIREWORKS by said organization in accordance with the provisions of Section 405.00 of the Penal Law of the State of New York on Sunday,July 2nd at 9:15pm with a rain date of September 3rd,2023.Location will be at 26342 Main Road Cutchogue New York. ON CONDITION THAT the bond (indemnity insurance)required shall continue in full force and effect in favor of the Town of Southold, and PROVIDED that the actual point at which the fireworks are to be fired shall be at least two hundred feet from the nearest building,public highway or railroad,or other means of travel, and at least fifty feet from the nearest above ground telephone or telegraph line, trees or other overhead obstruction;that the audience at such display shall be restrained behind lines at least one hundred and fifty feet from the point at which the fireworks are discharged and only persons in active charge of the display shall be allowed inside these lines;that all fireworks that fire a projectile shall be so set up that the projectile will go in the air as nearby as possible in a vertical direction unless such fireworks are to be fired from the shore or a lake or other large body of water, then they may be directed in such manner that the falling residue from the deflagration will fall into such lake or body of water;that any fireworks that remain unfired after the display is conducted shall be immediately disposed of in a way safe for the particular type of fireworks remaining; that no fireworks display shall be held during any wind storm in which the wind reaches a velocity of more than thirty miles per hour;that all persons in actual charge of firing the fireworks shall be over the age of eighteen years, competent and physically fit for the task,that there shall be at least two such operators constantly on duty during the discharge and that at last two soda acid or other approved type fire extinguishers of at least two and one-half gallons capacity each shall be kept at such widely separated points as possible within the actual area of the dis?1a and subject to any Executive Orders issued byorZd to the applicant's compliance with the requirements of the Town's posuance of fireworks permits. Applicant to Notify FAA 24 Hours before e (Town Seal) Denis Noncarrow, Southold Town Clerk Town of Southold,New York Dated: June. 6d',2023 THIS PERMIT IS NOT TRANSFERABLE Southold Town Board - Letter Board Meeting of June 6, 2023 RESOLUTION 2023-533 Item# 5.27 ADOPTED DOC ID: 19229 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2023-533 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JUNE 6,2023: RESOLVED that the Town Board of the Town of Southold hereby approves the issuance of a Fireworks Permit by the Town Clerk to Santore's Fireworks on behalf of the North Fork Country Club, for a fireworks display on Sunday, July 2, 2023 at 9:15 PM (Rain Date: Sunday, Sept. 3rd, 2023 at 9:00 PM) at 26342 Main Road, Cutchogue,New York upon payment of a single fee of $100.00 and subject to the applicant's compliance with any conditions and requirements of the Town of Southold policy regarding the issuance of fireworks permits. �L ;��,LI-1 I Denis Noncarrow Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Brian O. Mealy, Councilman SECONDER:Sarah E.Nappa, Councilwoman AYES: Nappa, Doroski, Mealy, Doherty, Evans, Russell Generated June 7, 2023 Page 41