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Home My WebLink About2012ELIZABETH A. NEVILLE, MMC TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS OF 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 1, ELIZABETH A. NEVILLE, Town Clerk of the Town of Southold, Suffolk County, New Y~rk, being an officer duly designated by the Town Board of the Town of Southold for this purpose, do hereby GRANT TO: MATTITUCK LIONS CLUB STRAWBERRY FESTIVAL 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 THURSDAY~ JUNE 14~ & FRIDAY~ JUNE 15~ 2011 AT 9:30 P.M.~ on the northeast side of Strawberry Fields, Route 48, Mattituck, New York. ON CONDITION THAT the bond (indemnity insurance) required shall continue in full rome and effect in favor of the Town of Southold, and PROVIDED that the aclual 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 deflagratinn will fall into such lake or body of water; that any fireworks that remain unfired a~er the display is conducted shall be immediately disposed of in a way safe for the particular type of fireworks remaining; that no frreworks display shall beheld 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 tiring 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 display. Elizabeth A. Neville, Town Clerk (Town Seal) Town of Southold Dated: June 5, 2012 Suffolk County, New York THIS PERMIT IS NOT TRANSFERABLE . RESOLUTION 2012-480 ADOPTED DOC ID: 7913 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2012-480 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JUNE 5, 2012: RESOLVED that the Town Board of the Town of Southold hereby approves the issuance of a fireworks permit by the Town Clerk to the Mattituck Lions~ for fireworks displays on Thursday~ June 14 and Friday~ June 15~ 2012 in coniunction with the Mattituck Lions' Strawberry Festival~ on the northeast side of Strawberry Field~ Mattituck~ New York upon the 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 and subject to the approval of the Town Attorney. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Albert Krupski Jr., Councilman SECONDER: Jill Doherty, Councilwoman AYES: Ruland, Talbot, Doherty, Krupski Jr., Evans, Russell ELIZABETH A. NEVILLE, MMC TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS OF 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 To~ From: Dated: Re: Martin Finnegan, Town Attorney Chief Flatley, Southold Town Police Department Robert Fisher, Fire Inspector Melissa Spiro, Land Preservation Linda J. Cooper, Deputy Town Clerk May 22, 2012 Fireworks Permit sponsored by Mattituck Lions Club Transmitted herewith is an application for a Fireworks Permit for June 14 & 15, 2012 by the Mattituck Lions Club for the Strawberry Festival. Please advise if you have any objections to a permit being issued. Thank you. cc: Southold Town Board ELIZABETH 3,. NEV~LI.E 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 ~ u,ho'd E od ..et OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION PERMIT TO DISPLAY FIREWORKS $outhold Town Clerk APPLICATION IS HEREBY MADE, pursuant to the provisions of Section 405.00 of the Penal Law of the State of New York, for a permit to display fireworks as hereinafter specified: mSPLAY IS TO RE SPONSORED B¥ /4 44; Lot. PRINCIPAL OFFICE AT ~[~ t~e~ 5'~ t~., t°~ t~ ** DATE & TIME OF DISPLAY ~-o,~ ]c(,~ ~ [~'~'t EXACT LOCATION OF DISPLAY /ffo~ ~ ~ ~ SUFFOLK COUNTY TAX MAP NUMBER FOR SITE RAIN' DATE & TIME /(./~ ~(fl ~ The following persons are to be in charge of the actual shooting of the fireworks: Name Age Experience Physical Condition (Additional names and information may be submitted on an attached sheet Number and type of fireworks is as follows: Manner and place of storage of fireworks prior to display: ~rt,,,/~(~/ t..~:t( t~. 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. By Name o~ Signature of Applicant Dale of ~pplication Certificate of Insurance 109590 Issue Date: 4/4/2012 PRODUCER Deborah Mertino Combined Specialties International, Inc. 205 San Madn Ddve, Suite 5 Novato, California 94945 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR LATER THE COVERAGE AFFORDED BY THE POi.lClES BELOW. INSURERS AFFORDING COVERAGE INSURED American Fireworks Display LLC P. O Box 980 Oxford, NY 13830 iINSURER A: Underw~tem, Lloyd's London INSURER B: INSURER C: INSURER D: CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS ; LTR DATE (DD/MM/YY) I OATE (D_.D/MM/YY) A ~G,E~ .E,R~A~., .LI~A~B, L I T'f C$1-756238-12 3,,7~012 i 3/,7~U,3 E~.CH ACCIDENT MEDICAL EXP (any ~le pemom) $5.000 AUTOMOBILE LIABILITY ANY AUTO ANY OWNED AUTO SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS EXCESS LIABILITY FOLLOWING FORM WORKERS COMPENSATIO~ AND EMPLOYERS' LIABILITY ,THER COMBINED SINGLE LIMIT (Each acodent) PROPERTY DAMAGE , (Per persen) EACH ACCIDENT AGGREGATE WCSTATUTORY OTHER LIMITS EL EACH ACCIDENT ~ E+L. DISEASE*EA EMPOYER E.L DISEASE-POUCY LIMIT Reithoffer Shows; Town of Southold, NY and Mattituck Lions Club are Additional Insured as respects the June 14 & 15, 2012 Fireworks Displays at Mattituck Strawberry Fest, Sound Avenue, Mattituck, NY REVISED 5/21/2012 CERTIFICATE HOLDER Reithoffer Shows 9022 V~ggins Road Gibsonton, FL 33534 STATE OF NEW YORK DIVISION OF DEPARTMENT OF LABOR SAFETY AND HEALTH LICENSE TO DEAL IN OR MANUFACTURE EXPLOSIVES American FireworKs Display PO Box980 Ox~rd, NY 13830 Kevln Jon Fntschler Expires: 4/30/2013 THIS LICENSE MUST BE POSTED IN YOUR PLACE OF BUSINESS License No D-5171 the DATE OF EACH SALE DELIVERY or GIFT the NAME LICENSE NUMBER and BUSINESS ADDRESS of the purchase, aonee ~)r person to whom STATE OF NE~ YORK - DEP~TMEN"r OF LABOR ~X~RE$ ~3 NYC & NY$ CERTiFiCATIONS REQUIRED IN NYC STATE OF NEW YORK - DEPARTMENT OF LABOR ~N CERTIRCATE OF COMPETENCE PY~O~rECHN~C~AN CERTIFICATE OF C~D~TTENC~ ~~E CAmED rulED