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HomeMy WebLinkAbout2015 Neville, Elizabeth From. - Neville, Elizabeth Sent Monday,August 03, 2015 2 45 PM To Greenport Fire Department(gfdfire@optonline net) Subject 8/30/15 Fireworks Display @Peconic Landing Importance: High 7d 72� 11 Fueworks Permrt Fireworks Permit Laserftche Appkca 20150 Follow-_20150 Documarts zip Dear Chief Breese, I am writing to you to obtain the approval of the Greenport Fire Department for the Fireworks display being held at Peconic Landing on August 30,2015 The first two (2)attachments above contain information on the application for this year's fireworks permit The third (3rd)attachment is a copy of last year's letter of approval for the 2014 event I need you to review the application and send me a similar letter for the 2015 event, if you so approve Thank you, Betty Neville Elizabeth A Neville, MMC Southold Town Clark PO Box 1179 Southold,NY 11971 Tel 631765-1800,Ext 228 Fax 631765-6145 Cell 631466-6064 1 Neville, Elizabeth From: Neville, Elizabeth Seat Monday,August 03, 2015 2 24 PM To. Duffy, Bill Subject. Emailing Fireworks Permit Follow-_20150803132056 Attachments Fireworks Permit Follow-_20150803132056 pcff Bill, Here is the follow-up information requested on the Fireworks Permit for Peconic Landing Please review and send mean e-mail as to whether or not you approve Thank you, Betty Neville Elizabeth A Neville, MMC Southold Town Clerk PO Box 1179 Southold, NY 11971 Tel 631765-1800, Ext 228 Fax 631765-6145 Cell 631466-6064 Your message is ready to be sent with the following file or link attachments Fireworks Permit Follow-_20150803132056 Note To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file attachments Check your e-mail security settings to determine how attachments are handled 1 CHIEF HARRY BREESE ;�� i (631)477-9801 -STATION 1 1ST ASST.CHIEF WAYNE MILLER (631)477-8261 -STATION 2 2NDASST CHIEF JEFFREY L.WEINGART (631)477-1943-CHIEFS OFFICE CHAPLAIN C KUMJIAN (631)477-4012-FAX TREAS/SECRETARY J KALIN THIRD STREET•P.O BOX 58 GREENPORT,NY 11944 r. Email:gfdfire@optonlme net www.greenportfd org Organized 1845 RECEIVED August 4,2015 AUG 5 2015 Re: Peconic Landing Fire Works :South-old'-Town Clerk Elizabeth A.Neville Southold Town Clerk Southold Town Hall 53095 Main Road, PO Box 1179 - Southold,New York 11971 To Whom It May Concern: Please be advised the;Greenport Fire Department and Chief Harry R Breese II are aware of and have reviewed the application and have no objections to the fireworks display to be held at Peconic Landing located at 1500 Brecknock Rd, Greenport, NY on-August 30, 20151. If you have any further questions`or`concerns please contact Chief Breese at 831-0985. Sincerely, Harry Breese If Chief Engineer- Cc: Bob Syron STATE OF NEW YORK- DEPARTMENT OF LABOR ECHNICIAN CF NCE n. CH RACIOPPO - •, ;, - to „ o E CARRIED '— OTECHNICS w n _N o C n � NYC&NYS CERTIFICATIONS REQUIRED IN NYC N "' r L u _ 0 3 W La! cr) a CJ L1J J d 7 � a STATE OF NEW YORK-DEPARTMENT OF LABOR PYROTECHNICIAN CERTIFICATE OF COMPETENCE S A r DISPLAY t P CARD CARRIED CHN CS EXPIRES 08/15 NYC&NYS CERTIFICAT}ONS REQUIRED IN NYC 1JECEIVED JUL 0 2015 STATE OF NEW YORK ' DMSION OF Southold Town Clerk DEPARTMENT OF LABOR SAFETY AND HEALTH LICENSE TO DEAL IN OR MANUFACTURE EXPLOSIVES Exptres 12131/2015 Pyro Engineenng, Inc dba Bay Fireworks 999 South Oyster Bay Rd,Ste 111 THIS LICENSE MUST BE Bethpage, NY 11714 POSTED IN YOUR PLACE OF BUSINESS Dennis P Brady Jr License No D.5731 is hereby boensed to deal in or manufacture exp{osN"In wmphance with the requirernarris of the Labor Law and Mduslrral Cada Rutes Any change In the conditions under which this Rcense is granted may cause R to be revoked Eileen M Franko,Acting Director FOR THE COM pMSSIONER OF LABOR Every Pew man,deAmft or wav away any exp mmm must keep at the pnncrpal Place of buahress wrthn the state,a record of each transaction,Mdudmg 1) the NAME or TYPE and QUANTITY of explosnras SOLD,DELIVERED or GWEN Note No hcethse is needed to purchase smokeless powder,or black powder In quanbbes not exceeding five hounds for use u► firing antique firearms or arftcts or repkcas thereof However,dealers MUST post al such Uarsaotions on the'Dealer-Manufacturer Report of Expl Transachona' 2) the DATE OF EACH SALE,DELIVERY or GIFT 3) the NAME,LICENSE NUMBER,and BUSWESS ADDRESS of the purchaser,donee,or person to whom the explosn were dWmered and the fine,if any,represented by such person 4) the NAME,ADDRESS.and LICENSE NUMBER of the person TAtgNG THE EXPLOSIVES AWAY from the seller or donor 8H-882(5-98) !S Department oriustice reuel211 r�xplvbl<ve5 LicenSeyrermu lureau ofAloohol Tobacco Firearms and Explosives (I8 US.C Chapter 40) n accordwice with the provisions of Title XI Organized Crime Control Act of 1970 and the regulations issued thereunder(27 CFR Part 555) you may engage in ne aetivrt) specified in this Imonse or permit arthui the limitations of Chapter40,Title 18,United States Code and the regulations issued thereunder until the xpirnhon date shown THIS LICENSE IS NOT TRANSFERABLE UNDER 27 CFR W 83 See'WARNINGS"and"NOTICES'on reverse )ireet ATT ATF-Chiet FELC LxensorPamtt otrespondmce To 244 Need-,Road Number 6—NY-059-51-7E-001 2• Martin WV 25405-9431 hief Federal E losnca Liceumg Cerrter(FELCy� Expiration e Date May 1. 2017 Tame `'� DBA BAY FIREWORKS&INTNTL PYRO IMPORTER (IPI) Prerttses Address(am&=,) ',ow%the TFCC at least 10 days before the move) ` , i 899 SOUTH OYSTER BAY RD WFrE 111 BETHPAGE NY 11714 • ' vpe 0 s or Permit 51-IMPORTER OF EXPLOSIVES. Purchasing CertnGaatton>Staa ca3e>n Matting Address(Cha449,�TotiR the FELC of am changes) he licensee or perminee named sbovo shall use a ropy of but license dr petmato await a r arhaferor of aeplostvet to verrfi the tdeat&v and h � iterastauu ofhh"- ;or ermn1eeaspro%idedb%27CFRPart555 , PYIRO ENG IN EERIIJ'G INC apiro 4 faced scanned or a mmik d copy of the hoauRa o}p With a argue e aendedto be an engmal signature is acceptable The signature must bettutt ofthe Fada'il DBA BAY FIREWORKS& INTNTL PYRO IMPORTER xplosnes Licensee(FEL)or a regwatble person ofthe FEL I artily that dm is a true (IPI) -Vv of a license or permit umed to the boensee or permatee nauod above to eq`gage is Jho ins«�t��dicd �'I�of��or�„ 998 SOUTH OYSTER BAY RD SUITE 111 BETHPAGE, NY 11714 ,iomsoc?cnndtea Respon able Person Signature Posthon/Tttk Printed Name Date AIT rant 14W 1+Sithe 15 Fan 1 -etwuaEdam aoWete trtwammx4aeraienrerouaxoatnn Re%red Octaba2Ji11 Federal EMpiostves Lcatse(FEL)Customer Service Information ederal fsxplosnm Licensing Center(FELL) Toll-free Telephone Number (877)283-3352 ATF Homepage www att goti 44 Need% Road Fax Number (304)6161401 tartinsburg.WV 25405-9431 E-mail FELC g atf gm hwW of Address (27 CFR 555 54(x)(1)) Liceasees or portwttees may during theterm of thou current hxwe or permit rernme their business or operations to a ew location at which the,,intend regularh to tarn on such business or operations The hcerisee or permittee is re"red to gne notification ofthe am location of the usiness or operations not less than 10 da-,s prior to such romrnal wRb the Chwt federal Fxplosnes Licensing Conter Tho lxx mte or permitmill be valid for the mainder ofthe term of the ongirud license or permit (Me OuK FELL,shag,if the licensee or peruuttee is not gasified,refer Hie recptest for amerced hoense r permt to the Director of Indasrn Operatiom for denial m accordance with§555 54) rght of Succession (27 CFR 555 59) (a)Certain persona other than the hccnsee or permmee mm secure the right to cam on the same c%plosive materials .tsiness or operations at the same address shown on and for rho ro wiridor of the tt rm of a current]ecru or permit Such persons aro (1)The%irviving spouse child or executor administrator or other legal representative of a deceased hconsee or permittee and(2)A remm or trustee in banlruptc� or an assignee for =,fit of eredgm (b)In order to secure the right provided by this section the poeon or Persons continuing the business or operations shall furnish the license or :mint for for that business or operations for endorsement o2 such suc Lemon to the Chief FELC within 30 lova from the date on a bwh the successor begins to hIT) on the business or operations Kormnxedoareirrseside) _utnere=�_<-------------- Federal Ezplom es Ltcemse/Perrnrt(FEL)Information Card I License Permit Name PYRO ENGINEERING INC i RECEIVED I Bumness Name DBA BAY FIREWORKS&INTNTL PYRO I IMPORTER 0131) LiocwPermit Number 6-NY-o58-81-7E-oo129 JUL 3 0 9015 I Licerm'Pentlit Tipe 514MPORTER OF E"LOStVES l `c �':lald Town Clerk E�Ptratwm May 1,2D17 1 I I Please Note Not\aid for the Sale or Other Dupostion of Explosives--------------------------------- I I Neville, Elizabeth From: Duffy, Bill Sent Wednesday,July 29, 2015 4 26 PM To. Neville, Elizabeth Subject RE Fireworks Permit Application Hi Betty, I have an objection Penal law section 405 00(2) (a)states that an application for a fireworks display shall set forth the name of the person actually in charge of the display,who shall possess a valid certificate of competence as a pyrotechnician I did not see the certificate of competence as a pyrotechnician for Racioppo or Metz,who are listed as the persons in charge of the display If a certificate of competence as a pyrotechnician is provided, I would have no objection to the application Please feel free to call me with any questions regarding the foregoing Thanks, Bill From: Neville, Elizabeth Sent: Wednesday, July 29, 2015 1147 AM To: Duffy, Bill, Flatley, Martin, Fisher, Robert, Spiro, Melissa Cc: Doherty, Jill, Duffy, Bill, Ghosio, Bob, Jim Din¢io, Kiely, Stephen, Krauza, Lynne, Standish, Lauren, Louisa Evans, Neville, Elizabeth, Beltz, Phillip, Rudder, Lynda, Russell, Scott, Tomaszewski, Michelle, William Ruland Subject: Fireworks Permit Application FYI Elizabeth A Neville, MMC Southold Town Clerk PO Boz 1179 Southold,NY 11971 Tel 631765-1800,Ext 228 Fax 631765-6145 Cell 631466-6064 << File Fireworks Permit Applica_20150729103350 pdf>> � � 5 11 : ssA . M 1 Southold Town Board - Letter Board Meeting of August 11, 2015 RESOLUTION 2015-725 Item# 5.16 ADOPTED DOC ID: 11090 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 20157725 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON AUGUST 11, 2015: RESOLVED that the Town Board of the Town of Southold hereby approves the issuance of a fireworks permit by the Town Clerk to Peconic Landing @ Southold, for a fireworks display on August 30, 2015 at 9:OOPM (Rain Date: September 6, 2015) at 9:00 PM), on the Peconic Landing's property at 1500 Brecknock Road, Greenport, New York, upon the payment of a single fee of$100 and subject to the applicant's compliance with the requirements of the Town's policy regarding the issuance of fireworks permits. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Louisa P. Evans, Justice SECONDER:Robert Ghosio, Councilman AYES: Ghosio, Dinizio Jr, Ruland, Doherty, Evans, Russell Generated August 12, 2015 Page 23 RECEIVED JUL 2 9 2015 ®�QSIIFFOL� Southold Town Clerk ELIZABETH A.NEVILLE,MMC ��► �, Town Ball,53095 Main Road TOWN CLERK P.O.Box 1179 y Southold,New York 11971 REGISTRAR OF VITAL STATISTICS p ® Fax(631)765-6145 MARRIAGE OFFICER ® aQ� Telephone(631)765-1800 RECORDS OF MANAGEMENT OFFICER d `�► southoldtown northfork.net FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION PERMIT TO DISPLAY FIREWORKS 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: DISPLAY IS TO BE SPONSORED BY Peconic Landing at Southold Inc. PRINCIPAL OFFICE AT 1500 Brecknock Road, Greenport, NY 11944 DATE&TIME OF;DISPLAY Augur '10, 7015 @ 9:00 pm EXACT LOCATION°OF DISPLAY Peconic Landing property SUFFOLK COUNTY TAX MAP NUMBER FOR SITE RAIN DATE&TIME September 6 2-015 @ 9:00 pm The following persons are to be in charge of the actual shooting of the fireworks: Name Age Experience Physical Condition Christopher Racioppo oi�89 5 years + Health: Excellent Edward Metz 2/26/80 10 years + Health:Excellent (Additional names and information may be submitted on an attached sheet Number and type of fireworks is as follows: 1.3G Fireworks 2.5t1 max= 648. Cakes= 20. Manner and place of storage of fireworks prior to display: Delivery will be day of 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. r �CIJ/1 I d �'i so vc� 0/C/ FEE; $100 Name of Org nation See policy,4or additional information 13y Signature of pplic —) 2 ;�i&-� Date of pplicatlon Federal Explosives License/Permit U.S.Department of Justice (18 U.S.C Chapter 40) Bureau of Alcohol,Tobacco,Firearms and Explosives nunmrm,ltrmt�nunuutmutmmimrn In accordance with the provisions of Title XI,Organized Crime Control Act of 1970,and the regulations issued thereunder(27 CFR Part 555),you may engage in the activity specified in this license or permit within the limitations of Chapter 40,Title 18,United States Code and the regulations issued thereunder.until the expiration date shown. THIS LICENSE IS NOT TRANSFERABLE UNDER 27 CFR 555.53. See"WARNINGS"and"NOTICES"on reverse. Direct ATF ATF-Chief,FELC License,Permft Correspondence To 244 Needy Road Number • • • Martinsburg,WV 25405-9431 Chief,Federal E� losiiveess Licenlsing,Center(FELdC,/�op�� Expiration i'IJ��1/.1/t �'�` /�• /'�"� Date May0 17 Name DBA BAY FIREWORKS&INTNTL PYRO IMPORTER (IPI) Premises Address(Changes?Notify the FELC at least 10 days before the move.) 999 SOUTH OYSTER BAY RD SUITE 111 BETHPAGE NY 11714- Type of License or Perrot 51-IMPORTER OF EXPLOSIVES Purchasing Certification Statement Mailing Address(Changes? Notify'the FELC of am'changes.) The licensee or permittee named above shall use a copy ofthis license or permit to assist a transferor of explosives to verify the identity and the licensed status ofthe licensee or permittee as provided by 27 CFR Part 555. The signature on each cony must be an original PYRO ENGINEERING INC signature. A faxed.scanned or e-mailed copy ofthe license or permit with a signature intended to be an original signature is acceptable. The signature must be that of the Federal DBA BAY FIREWORKS& INTNTL PYRO IMPORTER Explosives Licensee(FEL)or a responsible person ofthe FEL. I certify that this is atrue (IPI) copy of a license or permit issued to the licensee or permittee named above to engage in the 999 SOUTH OYSTER BAY RD SUITE 111 business or operations specified above under"Type of License or Permit." BETHPAGE, NY 11714- Licensee Permittee Responsible Person Signature PositioNTitle Printed Name Date ATF rorm-,m.14 s=i.is r`art I Previous Edition is Obsolete PYRO EY090FUNDINCGipSOUTH OYSTER SAT FUISUM 111I1TC5NP•L50817F•r91t9:Ng1.2011:51•a1PoRTEROFnPlO3NFE Revised October 2011 Federal Explosives License(FEL)Customer Service Information Federal Explosives Licensing Center(FELL) `Toll-free Telephone Number: (877)283-3352 ATF Homepage;is%%w.atf gov 244 Needy Road Fax Number: (304)616-4401 Martinsburg.WV 25405-9431 E-mail: FELGa atfgov Change of Address (27 CFR 555.54(x)(1)). Licensees or permittees may during the term of their current license or permit remove their business or operations to a new location at which they intend regularly to cam,on such business or operations. The licensee or permittee is required to give notification of the new location ofthe 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 of the term of the original license or permit. (The Chief,FELC,shall,if the licensee or permittee is not qualified,refer the request for amended license or permit to the Director of Industry Operations for denial 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 cam 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 permit. Such'persons are: (1)The surviving spouse or child,or executor,administrator,or other legal representative of a deceased licensee or permittee;and(2)A receiver or trustee in bankruptcy,or an assignee for benefit of creditors. (b)In order to secure the right provided by this section,the person or persons continuing the business or operations shall furnish the license or permit 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. (Continued on reverse side) Cut Here X Federal Explosives LicensplPermit(FEL)Information Card I License Permit Name:PYRO ENGINEERING INC I I I I I I Business Name: DBA BAY FIREWORKS&INTNTL PYRO I IMPORTER(IPI) I I License Permit Number:6-NY-059.51.7E-00129 I I u License'Permit Type:51-IMPORTER OF EXPLOSIVES I I Expiration: May 1,2017 I I I Please Note; Not Valid for the Sale or Other Disposition of Explosives,--------------------------------- I I ELIZABETH A.NEVIL1LlE,MMC �� o � Town hall,53095 Main Road TOWN CLERK P.O.Box 1179 c �3 Southold,New York 11971 REGISTRAR OF VITAL,STATISTICS Fax(631)765-6145 MARRIAGE OFFICER �j \s RECORDS MANAGEMENT OFFICER a� Telephone(631)765-1800 FREEDOM OF INFORMATION OFFICER �� www•southoldtownny.gov OFFECE OF THE TOWN CLERK TOWN OF SOUTHOLD To: ✓William Duffy,Town Attorney ,,chief Flatley,Southold Town Police Department &/Robert Fisher, Fire Inspector Melissa Spiro, Land Preservation Coordinator From: Elizabeth A. Neville,Southold Town Cler Dated: July 29, 2015 Re: Fireworks Permit for Peconic Landing at Southold, Inc. Transmitted is an application for a Fireworks Permit by Peconic Landing at Southold, Inc.for event on August 30, 2015. Please advise whether or not you have any objections to the issuance of this permit. Thank you. Deane F. ll8��1Il��>m Director of Resident Services PECONIC ®ING 1500 Brecknock Road Greenport,NY 11944 Tel:(631)477-3800-Ext.373 Fax:(631)477-3900 0m,LPL r �twr�... dradigan@peconiclanding.com LP www.peconiclanding.com INSTRUCTIONS FOR DISPLAY OF FIREWORKS Name of body sponsoring fireworks display. The date and time of day at which the fireworks display is to be held. 3. The exact location planned for the fireworks display,including TAX MAP NUMBER. �4! The age,experience and physical characteristics of the persons who are to do the actual discharging of the fireworks. The number and kind of fireworks to be discharged. The manner and place of storage of such fireworks prior to the display. 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 location of all nearby trees,telegraph or telephone lines or other overhead obstructions. 8. Such other information as the Southold Town Clerk may deem necessary to protect persons and property. Written permission of the property owner is required. An indemnity insurance policy with liability coverage and indemnity protection of$1,000,000.00 per person for bodily injury; $1,000,000.00 per accident; $1,000,000.00 property damage. 10. The Town Clerk of the Town of Southold must have the insurance policy in her possession before the fireworks permit is issued. The named insured must read: TOWN OF SOUTHOLD. 11. Application for a fireworks permit must be made at least five days in advance of the date of the fireworks disvlay. (The above instructions are in accordance with the Penal Law, Article 405 - Licensing and other provisions relating to fireworks.) Neville, Elizabeth From: Fisher, Robert Sent: Thursday,July 30, 2015 3:31 PM To: Neville, Elizabeth Subject: RE: Fireworks Permit Application Betty I have inspected the proposed site and foresee no problems with the location. I approve. Robert Fisher Fire Marshall,Town of Southold Robert.fisher@town.southold.nv.us (W)765-1802 -(C)786-9180 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. From: Neville, Elizabeth Sent:Wednesday,July 29,2015 11:47 AM To: Duffy, Bill<billd@southoldtownny.gov>; Flatley, Martin<mflatlev@town.southold.ny.us>; Fisher, Robert <Robert.Fisher@town.southold.nv.us>; Spiro, Melissa<Melissa.Spiro@town.southold.nv.us> Cc: Doherty,Jill<iill.doherty@town.southold.nv.us>; Duffy, Bill<billd@southoldtownny.Rov>; Ghosio, Bob <bob.ghosio@town.southold.nv.us>;Jim Dinizio<iim@iamesdinizio.com>; Kiely,Stephen <Stephen.kiely@town.southold.nv.us>; Krauza, Lynne<Iynne.krauza@town.southold.nv.us>;Standish, Lauren <Lauren.Standish@town.southold.nv.us>; Louisa Evans<Ipevans06390@Rmail.com>; Neville, Elizabeth <E.Neville @town.southold.nv.us>; Beltz, Phillip<Phillip.Beltz@town.southold.ny.us>; Rudder, Lynda <Ivnda.rudder@town.southold.nv.us>; Russell,Scott<scottr@southoldtownnv.eov>;Tomaszewski, Michelle <michellet@town.southold.ny.us>;William Ruland<rulandfarm@yahoo.com> Subject: Fireworks Permit Application FYI Elizabeth A. Neville, MMC Southold Town Clerk PO Box 1179 Southold,NY 11971 Tel.631765-1800,Ext.228 Fax 631765-6145 Cell 631466-6064 1 Neville, Elizabeth From: Flatley, Martin Sent: Wednesday,July 29, 2015 5:59 PM To: Neville, Elizabeth Subject: RE: Fireworks Permit Application Thanks Betty, I have no objections to this display taking place. Martin Flatley,Chief of Police Southold Town Police Department 41405 State Route 25 Peconic, New York 11958 631-765-3115 From: Neville, Elizabeth Sent:Wednesday,July 29, 2015 11:47 AM To: Duffy, Bill<billd@southoldtownny.gov>; Flatley, Martin<mflatley@town.southold.ny.us>; Fisher, Robert <Robert.Fisher@town.southold.ny.us>;Spiro, Melissa<Melissa.Spiro@town.southold.nv.us> Cc: Doherty,Jill<iill.dohertv@town.southold.nv.us>; Duffy, Bill<billd@southoldtownny.gov>;Ghosio, Bob <bob.ghosio@town.southold.ny.us>;Jim Dinizio<iim@iamesdinizio.com>; Kiely,Stephen <stephen.kiely@town.southold.nv.us>; Krauza, Lynne<Ivnne.krauza@town.southold.nv.us>;Standish, Lauren <Lauren.Standish@town.southold.nv.us>; Louisa Evans<Ipevans06390@gmail.com>; Neville, Elizabeth <E.Neville @town.southold.ny.us>; Beltz, Phillip<Phillip.Beltz@town.southold.nv.us>; Rudder, Lynda <Ivnda.rudder@town.southold.nv.us>; Russell,Scott<scottr@southoldtownny.gov>;Tomaszewski, Michelle <michellet@town.southold.ny.us>;William Ruland<rulandfarm@vahoo.com> Subject: Fireworks Permit Application FYI Elizabeth A. Neville, MMC Southold Town Clerk PO Box 1179 Southold,NY 11971 Tel.631765-1800,Ext.228 Fax 631765-6145 Cell 631466-6064 << File: Fireworks Permit Applica_20150729103350.pdf>> 1 Neville, Elizabeth From: Neville, Elizabeth Sent: Wednesday,July 29, 2015 11:47 AM To: Duffy, Bill; F1afley,4Aaf6n•_Eisher Robert;Spiro, Melissa Cc: Doherty,Jill; Duffy, Bill;Ghosio, Bob;James Dinizio; Kiely, Stephen; Krauza, Lynne; Standish, Lauren; Louisa Evans; Neville, Elizabeth; Beltz, Phillip; Rudder, Lynda; Russell, Scott;Tomaszewski, Michelle;William Ruland Subject: Fireworks Permit Application FYI Elizabeth A. Neville, MMC Southold Town Clerk PO Box 1179 Southold,NY 11971 Tel. 631765-1800,Ext.228 Fax 631765-6145 Cell 631466-6064 Fireworks Permit App{ica_20150— 1 * * * RECEIPT * * * Date: 07/29/15 Receipt#: 191396 Quantity Transactions Reference Subtotal 1 Fireworks 0729 $100.00 Total Paid: $100.00 Notes: Payment Type Amount Paid By CK#77141 $100.00 Peconic, Landing Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Peconic, Landing P. O. Box 430 1500 Brecknock Rd Greenport, NY 11944 Clerk ID: SABRINA Internal ID:0729 Diane Ike Ra igan t Director of resident Services JI M 1500 Brecknock RoadYGreenport,N119446,Tel:(631)477-3800-Ext.373 n _ Fax:(631)477-3900 ry f�t ro dradigan@peconiclanding.com www.peconiclanding.com INSTRUCTIONS FOR DISPLAY OF FIREWORKS l Name of body sponsoring fireworks display. /� The date and time of day at which the fireworks display is to be held. I The exact location planned for the fireworks display, including TAX MAP NUMBER. 4z The age, experience and physical characteristics of the persons who are to do the actual discharging of the fireworks. 1,5 " The number and kind of fireworks to be discharged. The manner and place of storage of such fireworks prior to the display. ,7"' 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 location of all nearby trees,telegraph or telephone lines or other overhead obstructions. 8. Such other information as the Southold Town Clerk may deem necessary to protect persons and property. Written permission of the property owner is required. ,9 An indemnity insurance policy with liability coverage and indemnity protection of$1,000,000.00 per person for bodily injury; $1,000,000.00 per accident; $1,000,000.00 property damage. 10. The Town Clerk of the Town of Southold must have the insurance policy in her possession before the fireworks permit is issued. The named insured must read: TOWN OF SOUTHOLD. 11. Application for a fireworks permit must be made at least five days in advance of the date of the fireworks display, (The above instructions are in accordance with the Penal Law, Article 405 - Licensing and other provisions relating to fireworks.) IX 4. NO ADMITTANCE s yy k PECONIC ca '; LANDING 10TH 9�n ANNIVERSARY 3 MAX SIZE = SHELLS 210 RAIDUS N�P� ��ogs r r !r 41 07 06.71 N 72 21 47.03 W OAYFIRMEWORKS 4 f l ® DATE(MMIDDIYYYY) A�o CERTIFICATE OF LIABILITY INSURANCE 07/09/2015 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(les)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). CONTACT PRODUCER Allied Specialty Insurance,Inc. NAME, 10451 Gulf Boulevard PHONE IA FAX No): Treasure Island,FL 33706-0814 EILSS: 1-800-237-3355 INSURER(S)AFFORDING COVERAGE MAIC d INSURER A:T.H.E.Insurance Company 12866 INSURED Pyro Engineering, Inc. INSURERS: dba: Bay Fireworks INSURERC: 999 South Oyster Bay Rd.,Suite 111 INSURER D: INSURER E: Bethpage,NY 11714 1 INSURER F: COVERAGES CERTIFICATE NUMBER: 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 SUER POLICY NUMBER POLICY EFF MrOUC E(P LIMITS LTR A GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CPP0101284-05 02/15/2015 0211512016 DAMAGE TO MMTF X COMMERCIAL GENERAL LIABILITY PR MISES Ea oecurre rs $100,000 CLAIMS-MADE 1-x-1 OCCUR MED EXP(Arry one n) $ PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000 POLICY PRO- LOC $ A AUTOMOBILE LIABILITY COMBINED BIINED SIN LE LIMIT 1,000,000 CPP0101284-05 02/15/2015 02/1512016 ANY AUTO BODILY INJURY(Per pamon) $ ALLOWNEDSCHEDULED BODILY INJURY(Per neddent) $ AUTOS K 1 AUTOS K HIREDAUT03 X NONIED PROPERTY DAMAGE $ AUTOS (Per aeeiderd $ A UMBRELLA UAB I X OCCUR ELP0010292-05(VL) 0211512015 02115/2016 EACH OCCURRENCE $4,000,000 �( EXCESS UAB CLAIMS-MADE AGGREGATE $4,000,000 DED I I RETENTION $ A WORKERS COMPENSATION r-PTH- AND EMPLOYERS LIABILITY YIN WCP0005167-001 02/1512015 02115/2016 ANY PROPRIETORIPARTNERIEXECUTIVEE.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCWDED7 F-1 NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 Ifyes,describe under DESCRIPTION OF OPERATIONS beloW E.L.DISEASE-POLICY LIMIT $1,000,000 A EXCESS LIABILITY/OCCUR ELP0010296-05(GL) 0211512015 02/15/2016 EACH OCCURRENCE$9,000,000 AGGREGATE$9,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,AddlUsnal Remarks Schedule,H more space Is required) DISPLAY DATE: 08/30115 RAIN DATE: 09/06116 LOCATION:Peconic Landing d@ Southold Inc,Greenport NY RE:GENERAL LIABILITY,THE FOLLOWING ARE NAMED AS ADDITIONAL INSURED IN RESPECTS TO THE OPERATION OF THE NAMED INSURED ONLY:Town of Southold;Peconic Landing at Southold Inc;Peconic Landing Housing Association Cooperative Inc;Bechnock Hall Foundation Inc CERTIFICATE HOLDER CANCELLATION Peconic Landing at Southold Inc Thirty(30)Days Notice of Cancellation Applies. 9 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1500 Brecknock Rd THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Greenport NY 11944 ACCORDANCE WITH THE POLICY PROVISIONS. AUTNO PRESENIA Cert#2194 ©1988-2010 ACOA CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD i 999 South Oyster Ray Road ® Suite 111 Bethpage, NY 11714 T: 516.597.5500 ® F:516.597.5507 E N G I N E E R I N G www.peifx.com www.bayfireworks.com World Class Productions / Date: 7/10/15 Greenport Fire Department Fireworks Symposium 236 Third Street at Wall Disney Ivoild Greenport,NY 11994 America's 4001h Anniversary Casinos•Bally's,Caesars,Claridge Dear Chief, Major Theme Parks NASA's 501h Anniversary Universal Orlando Resort Please be advised that Pyro Engineering Inc. dba Bay Fireworks will be Centennial I Milestone Events conducting a fireworks display at the following location: Sponsor: Peconic Landing at Southold,Inc. Location: 1500 Brecknock Rd.,Greenport,NY Major Sporting Events Date: 8/30/15 Rain Date: 9/6/15 Time: 9:00 pm We are respectfully requesting a"pumper"to be on site during the display time for this event. Major League Baseball *Please call our office at 516-597-5500 to confirm receipt of this U.S.Olympic Committee State Games of America Information. National Football League Minor League Baseball Thank you. PGA I LPGA Courses&Events Goodwill Games Sincerely, Concert Tours•Close Proximity �04Anne Tri010 112MJoanne@bayfireworks.com Ultra Music Fest•Miami Electric Daisy Carnival Las Vegas Katy Perry-One Direction Alice Cooper-Swedish House Mafia Stadium,Stage,Concerts Theatrical Events Theme Park Design-Consultation NATIONAL:800-606.3716 H NY CT PA IVID VA SC GA FL TX NV CA