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HomeMy WebLinkAboutLomangino Family CelebrationELIZABETH A. NEVILLE, RMC, CMC TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PERMIT For PUBLIC DISPLAY OF FIREWORKS I, ELIZABETH A. NEVILLE, 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: Fireworks by Grucci~ inc A PERMIT FOR THE PUBLIC DISPLAY OF FIREWORKS by said organization in accordance with the provisions of Section 405.00 of thc Penal Law of the State of New York at 10:00 PM on Sunda¥~ Jllly 4~ 2010 on the property of Lomangino Family Celebration, 9205 Skunk Lane~ 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 feel 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 in to 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 least 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 display. ........ ................ Elizabeth A. Neville, Southold Town Clerk Suffolk County, New York (Town Seal) Date: July 2, 2010 THIS PERMIT IS NOT TRANSFERABLE 02/07 '10 FRI 14:55 FAX 631 765 6145 SOUTEOLD TOWN CLERK ~001 **$ TX REPORT TRANSMISSION OK TX/RX NO CONNECTION TEL CONNECTION ID ST. TIME USAGE T PGS. SENT RESULT 1185 02/07 14:54 01'35 3 OK 2869036 ELIZABETH A. NEVILLE, RMC, CMC TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MAIqAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown.northfork-net F A X To: From: Date: Pages: Tricia Thomson Logistics Assistant Lynda Rudder Deputy Town Clerk July 2, 2010 ~lncluding cover thc ~nsuranc~ [u ~,vvu, .....0 ~ry it _It ELIZABETH A. NEVILLE, RMC, CMC TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD F A X To~ From: Date: Pages: Tri¢ia Thomson Logistics Assistant Lynda Rudder Deputy Town Clerk July 2, 2010 ~ ~lncluding cover i~!,c~ thc insur~,OOO.O0 G~neral Llabfi~ '' ry ~; -- ~ it RESOLUTION 2010-477 ADOPTED DOC ID: 6019 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2010-477 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JUNE 29, 2010: RESOLVED that the Town Board of the Town of Southold hereby approves the issuance of a fireworks permit by the Town Clerk to Fireworks b.y Grucci~ Inc~ for a fireworks display on July 4~ 2010~ rain date July 5~ 2010~ at the property located at 9205 Skunk Lane~ Cutchogue, payment of a fee of $100, subject to the applicant's compliance with the requirements of the Town's policy regarding the issuance of fireworks permits, as amended, and subject to the approval of the Town Attorney. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Vincent Orlando, Councilman SECONDER: Albert Krupski Jr., Councilman AYES: Ruland, Orlando, Talbot, Krupski Jr., Russell ABSENT: Louisa P. Evans JUN~22-2010 09:54 From: To:631 76S 6145 June 8, 2OlO TO: Clau&ia Pagan COMPANY: ATO Eastern Service Area System Support Eastern SC 1701 Columbia Avenue College Park, GA 30337 E-MAIL: ~ PHONE: 40~-305-5602 FAX: 404-305-5672 TO: MelLnda Giddens COMPANY: FAA North Eastern Reg~oll ADDRESS: Operations Support Eastern Se~ce Center PO Box 20636 Atlanta, GA 30320-0631 CC- E-MAIL: Mel~ada.A.Giddens(~.faa.?v PHONE: 404-305-5610 FAX: 404-305-5612 CC- Ig-MAIL: Kobby. I~ext'~,fa~.gov PHONE: 404-305-5605 TOTAL PAGES: 1 Please be advised of the following Fireworks displays: Location: Latitude: Longdtude: Date: Rain Date: 'lime: Duradon: Lo~aangino F, mily Celeb~aeion 9205 Skunk Lane, Cutchogue, NY 41° 1.078" N 72° 26.950" W July 4, 2010 July 5, 2010 9:00 PM 16 - 17 The maximum altitude of the Fireworks ~ xaot exceed 1000 feet. In letter form, please acloaowledg¢ the receipt axed approval of ~ ~aotik~cation.. Thank you fox your prompt zeply. Thank You, Edward Rubio Log~s tics Manager Fr~tewo~ks by Gvacci, Ivac. Cell: 516-658-4486 F~eworks by Gruc~,Lt~c. One Grucd Lane Bzookhaven, NYll719 Office #: (631) 286-0088 Fax #: (631) 286-9036 g~m~: ERubio~grucci.com THE FIRST FAMILY OF FIREWORKS JUN-22-2010 09:S4 From: To:6~l June 8, 2010 TO: ADDRESS: PHONE: FROM: I.,ynda Lomat~gino 9205 Skunk Lane Cutchogue, NY 11935 561-582-6688 Ed Rubio Attached please find the following documents for the Ffireworks Display l~sted below: 11 Application to Display Fireworks 2) Site Plan 3) Insm:a,~ce Certificate 4) FAA Notification Location: Laotude: Longitude: Date: Rain Date: 'rime: Lomangh~o Family C~lebration 9205 Skunk Lane, Curchogue, NY 41 o 1.078" N 72° 26.950" W July 4, 2010 July 5, 2010 9:00 PM 16 ~ 17 If you have any questions or need any further information, please feel free to contact me. SJ~xcercly, Edward Rubio Logistics Manager F~reworks by Grucci, Inc. Cell 516-658-4486 1719 TIlE FIRST PAMILY OF FI REklgORKS {lf't]t-c #: (6311 286-0088 l'a.x #: (6311 286-9036 I'Mnail: ,t JUN~22-2010 09:54 From: To:631 765 6145 P.Tx? Jnne 8, 2010 TO: COMPANY: ADDRESS: PHONE: FROM: Fire Marshal Bob Fisher Bull~rig Dept. 54375 Route 25 P.O. Box 1179 Southhold,, NY 631-765-1802 Ed Rubio Dear Mr, Fisher: Attached please £md the following documents for the Fireworks Display listed below that WI ,~poke about previously: I) Application to Display Fireworks 2) Site Plan 3) Insurance Cel:tificate 4) FAA NofificaOon 5) Letter to Sponsor: Location: Latitude: Longitude: Date: Raha Date: 'lime: Lomangino Family Celebration 9205 Skunk Lane, Cutehogue, NY 41° 1.078" N 72° 26.950" W J~ly 4, 2010 July 5, 2010 9:00 PM 16 - 17 If you have any questions o/: need any further iaformati0n, please feel free to contact me. ~ Sincerely, Edward Rubio Logistics Manager Fireworks by Gmcci, Inc. (.'ell 516-658-4486 I~,r,,oM~avv,,, NY { 171¥ ~ ~fficc #: (631) 286-0088 F.x ~: (631) 286-903fi · 'rile Fll~ST FAMILY OF FIREWORKS ny4 Page I of 2 Section 405.00 Permits for public displays of fireworks. 1. Definition of "permit authority." The term "permit authority," as used in this section, means and includes the agency authorized to grant and issue the permits prov!ded in this section, which agency in the territory within a state park shall be the state agency having custody and control thereof, in the territory within a county park shall be the county park commission, or such other agency having jurisdiction, control and/or operation of the parks or parkways within which any fireworks are to be displayed, in a city shall be the duly constituted licensing agency thereof and, in the absence of such agency, shall be an officer designated for the purpose by the legislative body thereof, in a village shall be an officer designated for the purpose by the board of trustees thereof and in the territory of a town outside of villages shall be an officer designated for the purpose by the town board thereof. 2. Permits for public displays. Notwithstanding the provisions of section 270.00, the permit authority of a state park, county park, city, village or town may upon application in writing, grant a permit for the public display of fireworks by municipalities, fair associations, amusement parks or organizations of individuals. The application for such permit shall set forth: (a) The name of the body sponsoring the display and the names of the persons actually to be in charge of the firing of the display. (b) The date and time of day at which the display is to be held. (c) The exact location planned for the display. (d) The age, experience and physical characteristics of the persons who are to do the actual discharging of the fireworks. (e) The number and kind of fireworks to be discharged. (f) The manner and place of storage of such fireworks prior to the display. (g) A diagram of the grounds on which the display is to be held showing the point at which the fireworks are to be discharged, the location of all buildings, highways and other lines of communication, the lines behind which the audience will be restrained and the location of all nearby trees, telegraph or telephone lines or other overhead obstructions. (h) Such other information as the permit authority may deem necessary to protect persons or property. 3. Applications for permits. All applications for permits for the public display of fireworks shall be made at least five days in advance of the date of the display and the permit shall contain provisions that the actual point at which the fireworks are to be fired shall be at least two hundred feet from the nearest permanent building, public highway or railroad or other means of travel and at least fifty feet from the nearest above ground telephone or telegraph line, tree 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 into the air as nearby as possible in a vertical direction, unless such fireworks are to be fired from the shore of a lake or other large body of water, when 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 concluded shall be immediately disposed of in a way safe for the particular type of fireworks http://wings.buffalo.edu/law/bclc/web/NewYorkdny4.htm 6/22/2010 ' ny4 Page2of2 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 the 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 least two sodaacid or other approved type fire extinguishers of at least two and one-half gallons capacity each shall be kept at as widely separated points as possible within the actual area of the display. The legislative body ora state park, county park, city, village or town may provide for approval of such permit by the head of the police or fire department or both where there are such departments. No permit granted and issued hereunder shall be transferable. After such permit shall have been granted, sales, possession, use and distribution of fireworks for such display shall be lawful solely therefor. 3-a. Notwithstanding the provisions of subdivision three of this section, no permit may be issued to conduct a public display of fireworks upon any property where the boundary line of such property is less than five hundred yards form the boundary line of any property which is owned, leased or operated by any breeder as defined in subdivision four of section two hundred forty-four of the racing, pari-mutuel wagering and breeding law. 4. Bonds. Before granting and issuing a permit for a public display of fireworks as herein provided, the permit authority shall require an adequate bond from the applicant therefor, unless it is a state park, county park, city, village or town, or from the person to whom a contract for such display shall be awarded, in a sum to be fixed by the permit authority, which, however, shall not be less than five thousand dollars, conditioned for the payment of all damages, which may be caused to a person or persons or to property, by reason of the display so permitted and arising from any acts of the permittee, his agents, employees, contractors or subcontractors. Such bond shall run to the state park, county park, city, village or town in which the permit is granted and issued and shall be for the use and benefit of any person or persons or any owner or owners of any property so injured or damaged, and such person or persons or such owner or owners are hereby authorized to maintain an action thereon, which right of action also shall accrue to the heirs, executors, administrators, successors or assigns of such person or persons or such owner or owners. The permit authority may accept, in lieu of such bond, an indemnity insurance policy with liability coverage and indemnity protection equivalent to the terms and conditions upon which such bond is predicated and for the purposes herein provided. 5. Local ordinances superseded. All local ordinances regulating or prohibiting the display of fireworks are hereby superseded by the provisions of this section. Every city, town or village shall have the power to enact ordinances or local laws regulating or prohibiting the use, or the storage, transportation or sale for use of fireworks in the preparation for or in connection with television broadcasts. http://wings.buffalo.edu/law/bclc/web/NewYork/ny4.htm 6/22/2010 Resolution 2010-474 Board Meeting of June 29, 2010 (d) A copy of the contract with fireworks display company; and All applications shall require the approval of the Fire Chief of the District in which the display will take place and the Fire Marshal before being presented for approval by the Town Board. 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 determined by the Town Board to cover the Town's costs for monitoring and enforcing compliance with the Penal Law. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Albert Kmpski Jr., Councilman SECONDER: Vincent Orlando, Councilman AYES: Ruland, Orlando, Talbot, Kmpski Jr., Russell ABSENT: Louisa P. Evans Updated: 6/30/2010 10:43 AM by Lynda Rudder Page 2 RESOLUTION 2010-474 ADOPTED DOC ID: 6016 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2010-474 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JUNE 29, 2010: RESOLVED that the Town Board of the Town of Southold hereby amends Resolution No. 2008-536 dated May 20~ 2008 to read as follows: RESOLVED that the Town Board of the Town of Southold hereby adopts the following POLICY regarding the issuance of fireworks permits: The Town may grant a permit for the public display of fireworks by municipalities, fair associations, amusement parks, persons or organizations of individuals. Penal Law Section 405.00(2). An "organization of individuals" is a religious, civic, or comparable organization. Op. Atty. Gen No. 2007-3. Fireworks permits shall indicate that the display must be concluded by 10:00 p.m. if held Sunday-Thursday, 11:00 p.m. if held Friday or Saturday, and there shall be no time restriction if held on July 4. No person shall engage in or allow the manufacture, assembly, storage or display of any fireworks or pyrotechnics display without first obtaining a permit issued by the Town Clerk. A completed application for display of fireworks must be received by the Town Clerk a minimum of 30 days prior to the date of display. The permit application for any fireworks or pyrotechnics display shall be accompanied by the following: (a) a copy of a valid certificate of competency as a pyrotechnician for the individual supervising the firing of the display; (b) Certificate of Insurance naming the Town of Southold as additional insured with coverage limits of $2,000,000 for public liability and $2,000,000 for property damage; (c) Detailed diagram showing location of fireworks discharge and minimum separation distances in accordance with the applicable requirements of Penal Law Section 405(2); Page 1 of I Cooper, Linda From: Verity, Mike Sent: Friday, July 02, 2010 9:06 AM To: Cooper, Linda Subject: RE: Fireworks Linda, I reviewed the application and I have no reservations about issuing the permit. Thanks, Mike From: Cooper, Linda Sent: Thursday, July 01, 2010 2:08 PM To: Verity, Mike Subject: Fireworks Carol told me you called and okay'd the permit. Would you please email your approval to me just so I have it for the files. (you know how it is) Linda J. Cooper Deputy Town Clerk Town of Southold 631-765-1800 Life may not be the pa~ty we hoped for, but as long as we are here, we might as well dance! If you really want to be happy, nobody can stop you 7/2/2010 JUL-O1-2010 tO:tO From= To=631 765 6~45 P.2/8 CERTIFI THIS CERTIFICATE IS IS8UED AS A MATTE CERTIFICATE DOES NOT AFFIRMATIVELY BELOW. THIS CERTIFICATE OF INSU~AN INSURED Fireworks By Grucci, Inc, and/cz By Grucci, Inc. and/or philny Elf One Gruc¢i Lane Brookhaven NY 11719 OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE H~LDER, THIS NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY T~E POLICIES DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), ~UTHORIZEO :)DITIONAL INSURED, the policy(isa) must be endorsed, If SUBROGATION I$ WAIV~I S). yrotechniq~e PHONE INBUR_~.~,~,~NeW Hampshire Insurance Co I, subject to righls to [he Ii COVERAGES CERTIFIC, THiS i$ TO CERTIFY THAT THE POLICIES OF INSUI PERIOD INDICATED, NOTWITHSTANDING ANY RE, WHICH THIS CERTIFICATE MAY DE ISSUED OR MA TE NUMBER: 1745137407 REVISION NUMBER: ~NCE LISTED EELOW HAVE SEEN ISSUEO TO THE IN~UR~D F~AMED ABOVE FOR THE POLICY JIREMENT, TERM OR CONDITION OF ANY CONTHACT DR OTHER DOCUMENT WITH RESPECT PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT > OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAiD CLAIMS. ~:~OrLYINJURY(Perpe'~3~) e ii WC STATU- Additional Insured: Sou:hazes Was~ CERTIFICATE HOLDER Southern Waste Systems 790 Hilbrath Drive L~tana FL 33462 ACORD 25 (2009/09) .y 5, 2010 CANCELLATION BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DE (ERED IN ACCORDANCE WITH THE POLICY PROVI~IONS. of New Tr © lg88-2009 ACORD CORPORATION. All ~i[ghts reserved, ~ ACORD name and logo are registered marks of ACORD JUL-01-2010 10:10 From: To:631 765 6145 P.1/2 TO: Lynn OF: TEL: FAX: 631-765-61, DATE: July 1, 2010 FROM: Tricia Thom Logistics As #of Pages: 2 (including this one~ Please see the attached Certi Fireworks By Gmeci, Inc. One Gmcci Lane Brookhaven, NY 11719 THE FIFI~WORI~ BY istant [cate of Insurance as per your request. Office #: (631) 286-0t Fax #; (631) 286-91 [RST FAMILY OF FIREWORKS ~36 JUL-01-2010 16:i0 From: To:631 765 6145 STATE OF NEW YORK - DEPARTMENT OF L PYROTECHNIClAN CERTIFICATE OF COMPETI ~'~~,i~U~,E~, F_XPIRF~ 03J'13 D IN NYC & NY~ GERTIFICATIOI~ REQUIRE II[ll BOR ~NLY Rudder, Lynda From: Sent: To: Cc: Subject: Cochran, Carlisle Thursday, July 01, 2010 10:40 AM Rudder, Lynda Tomaszewski, Michelle RE: Fireworks application for 7/4 I have no objection to the approval of the permit. Chief ..... Original Message ..... From: Rudder, Lynda Sent: Thursday, July 01, 2010 9:40 AM To: Fisher, Robert; Tomaszewski, Michelle; Cochran, Carlisle; Flatley, Martin; Doroski, Melanie; Spiro, Melissa; Finnegan, Martin; Krauza, Lynne Subject: Fireworks application for 7/4 Importance: High To: Martin Finnegan, Town Attorney Chief Cochran, Southold Town Police Department Robert Fisher, Fire Inspector Melissa Spiro, Land Preservation From: Lynda M Rudder, Deputy Town Clerk Dated: July 1, 2010 Re: Fireworks Permit for Lomangino Family Transmitted herewith is the application for Fireworks Permits for: Lomangino Family, Cutchogue, New York on July 4th Please advise if permits may be issued. Thank you. cc: Southold Town Board Rudder, Lynda From: Sent: To: Subject: Spiro, Melissa Thursday, July 01, 2010 9:51 AM Rudder, Lynda; Fisher, Robert; Tomaszewski, Michelle; Cochran, Carlisle; Flatley, Martin; Doroski, Melanie; Finnegan, Martin; Krauza, Lynne RE: Fireworks application for 7/4 Hi, 9205 Skunk Lane (tax map number 104-3-16.1) is not Town preserved land. Since this is not preserved land, I have no comment on this application. Melissa ..... Original Message ..... From: Rudder, Lynda Sent: Thursday, July 01, 2010 9:40 AM To: Fisher, Robert; Tomaszewski, Michelle; Cochran, Carlisle; Flatley, Martin; Doroski, Melanie; Spiro, Melissa; Finnegan, Martin; Krauza, Lynne Subject: Fireworks application for 7/4 Importance: High To: Martin Finnegan, Town Attorney Chief Cochran, Southold Town Police Department Robert Fisher, Fire Inspector Melissa Spiro, Land Preservation From: Lynda M Rudder, Deputy Town Clerk Dated: July 1, 2010 Re: Fireworks Permit for Lomangino Family Transmitted herewith is the application for Fireworks Permits for: Lomangino Family, Cutchogue, New York on July 4th Please advise if permits may be issued. Thank you. cc: Southold Town Board To:~3l 765 6145 rE OF LIABILITY INSURANCE ~FORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY T NOT CONST TUTE A CONTRACT BETWEEN THE ISSUING NSURER{S);! FICATE HOLDER. NAL INSURED, the policy(isa) must be endor~ert, If SUBROGATION )9 WAI~ , ~g_0.R.~S: ......................... i~s~;.c:~ry s_%~ce Funct - .e!.v_/lle COVERAGES CERTIFICATE NUMBER: 1123as5727 REVISION NUMBER: ,i ~ P.4/7 3LDER. THIS ~E POLICIES tUTHORIZED rights to the I. ."~l---c ~_ :: .... 23809 1'HIS IS TO CERTIFY THAT TI~E POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE iNSURED N~MED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY R[QUIREMENT TERM OR CONDITI~ OF ANY CONTACT OR OTHER DOCUME~ WITH RESPECT WHICH THI~ CERTIFICATE ~Y BE ISSUED OR ~Y PERTAIN, THE INSU~NCE ~FORDEO BY THE POLICIES DE~CRIBE~ HEREIN TO ALL THE T~R~, EXCLUSIONS AND CONDITIONS OF SUCH P~ICIES, LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID X C~M~RClAL OEN~L UAeI~ ~ISES t~ CERTIFICATE HOLDER ACORG Z$ (20g~109) CANCELLATION SHOULD ANY DF THE AnOVE DE~RIBED POLICIES EE C~NCEL~ 3 BEFORE THE EXPIRATrON DATE THEREOF, NOTICE WILL BE DEL -'RED © lg88-2009 ACORD CORPORATION. All ri~[[s reserved. The ACORD name and logo are registered marks of ACORD Site Location Maximum shell size 3" NFPA 1123 210' Salely Zone Latitude: 41° 1,078' N Longilude: 72° 26.950" W 'Lomangino Family Celebration - Cutchogue, NY July 4, 2010 - Fireworks by Grucci FIREWORKS BY ~dl Informa~ion contained on this document is copyright material and Ihe Jntelle¢tual property of F~eworks by Grucci Inc. ReproductJoi3 and/or circulation wi~ut approval of Fireworks by Grucci is profliblted. Rev 1 4/~8110 JUN-22-2010 09:52 From: To:631 765 6145 APPLICATION PERMIT TO DISPLAY FIREWORKS APPLICATION IS HEREBY MADE, pursuant to the provisions of Section 405.00 of the Penni State of New York, for a permit to display fireworks as hereinafter specified: DISPLAY IS TO BE SPONSORED BY Southern Waste Systems PRINCIPAL OFFICE AT 790 Hi~brath Drive Lantana. FL 33462 DATE & TIME OF DISPLAY July 4, 2010 9:00 pm EXACT LOCATION OF DISPLAY 41° 1.078" N 72° 26.950" W SUFFOLK COUNTY TAX MAP NUMBER FOR SITE RAIN DATE & TIME L.Juiy 5, 2010 ~ 9:00 pm The following persons are to be in charge of the actual shooting of the fireworks: Name Age Experience Physical Condition Steve Yalamas 47 17 Excellent Michael Sullivan 53 11 Excellent (Additional names and information may be submitted on an attached sheet Number and type of fireworks is as follows: Illuminatiorss = 100pcs 2 ~6"-- 100ocs 3"= 720ocs 4" = 500pC~ Law of the Manner and place of storage of fireworks prior to display: .In UN-Anoroved boxes stored box truck Attached hereto and made a part of hereof is a diagram of the grounds on which the display isiio be held. Also attached is a certificate or policy of insurance coverage. NOTICE: Written permission, with signature of the Property Own~ must be submitted with Application. __Fireworks by Gruc¢i Name of Organization Signature of Applicant 617/10 Date of Application JUH~22-2010 09:52 From: To:631T65 June 22, 2010 ~ TO: Linda Cooper COMPANY: Deputy Toven Clerk FAX: SX-"4405- FROM; Ed Rubio Dear Ms, Cooper: : Attached please find the followiag document~ for the Fizewor-ks Di~phy listed below that we spoke about previously: 1) Apphcation to Display Fireworks :2) Site Plan · 3) Insurance Certificate 4) FAA Notification 5) Lettex to Spo~asor Eveat: Location: Ladtude: Lon~tude: Date: Rain Date: Time: Duration: Lomangmo Family Celebration 9205 Skunk Lane, Cutchogue, 41° 1.078" N 720 26.950" W July 4, 2010 July 5, 2010 9:00 PM 16 - 17 If you have any questions Or x~eed any further reformation, please feel free to contact me. Edward Rubio Logistics Manager Fkeworks by Gruccl, Inc. Cell 516-658-4486 Fireworks by Gmcc~ Inc. ()ne (;rucci Lane Btookhavco, NY 11719 THE FIRST FAMILY OF FIREWORY~ Office #: (631) 286-0088 [:ax #: (631) 286-9036 E-mail: ERublo~gm¢ci.com