2024-0069 Office Use Only !!//
Permit#: a� `�'' 12o65 FIRE MARSHAL FIREWORKS APPLICATION
Permit Fee:$165.00
Invoice#: d'24" 00(1.5 KSEN SBz
Reviewed By:
Office of the Fire Marshal Fire- Marshal
742 Bay Road,Queensbury,NY 12804
518-761-8206/8205 www.queensbury.net
-Project Location: West Mountain;near Tubing Park Tax Map ID#:. 07; =l '��
Date of Display: 02/17/2024 Time of Display: Approx.9:00pm
Brief description of scope of project:
Fireworks Display at West Mountain ski area . maximun shell-4"
•
**PLEASE MAKE SURE TO INCLUDE A SKETCH
SHOWING THE LOCATION OF
THE PROPOSED WORK
OR PROJECT ON THE PARCEL**
FM Fireworks Application Revised 3/10/2023
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): Santore's World Famous Fireworks LLC
Mailing Address, C/S/Z: POBox 687 Stillwater NY 12170
Cell Phone:_(518 )470-0165(JeffWard) Land Line: (518 )664-9994
Email:jward@santorefireworks.com
•Property Owner(s): •
Name(s):
Mailing Address, C/S/Z: _ _
Cell Phone:_( ) Land Line:_r - ) - --
Email:
• Fireworks Contractor(s):
Name(s): Santore's World Famous Fireworks LLC
Mailing Address, C/S/Z: PO Box 687 Stillwater NY 12170
Cell Phone: (518 )470-0165 Land Line: (518 )664-9994
Email:terisa@santorefireworks.com
Please submit Workers' Comp documentation with this application
DECLARATION:
I acknowledge that this is not a permit but only an application for a permit and no work shall
commence prior to approval. All work will be in accordance with the approved plans and in
accordance with the Town of Queensbury and the NYS Fire and Building Codes.
If,for any reason, this application is withdrawn, 30% of the fee is retained by the Town of
Queensbury. After 1 year from the initial application date, 100% of the fee is retained.
I have read and agree to the above:
APPLICANT NAME: Santore's World Famous Fireworks LLC
APPLICANT SIGNATURE: 9.te Ct2dAdi DATE: 2/02/2024
PROPERTY OWNER NAME:
PROPERTY OWNER SIGNATURE: DATE:
FM Fireworks Application Revised 3/10/2023
Commercial General Liability
Policy Number: SI8ML00235-241 Policy Effective : 2/9/24
Company: Everest National Insurance Company
Named Insured: Santore's World Famous Fireworks LLC
HOLD HARMLESS INSURANCE
It is agreed that within the Limits,Terms and Conditions set forth in the policy,the
Company will defend,indemnify and hold harmless:
Town of Queensbury and the West Mountain
from any claim,demand, suit,loss, cost of expense, or any damage which may be
asserted,claimed against or from:
Aerial firework display taking place at West Mountain on February 17,2024.
by reason of any damage to property or bodily injury, including death,sustained by any
person whomsoever and which damage,injury or death arises by the negligence of:
Santore's World Famous Fireworks LLC
or by their agents,servants,and employees while acting in the course and scope of their
employment.
litstittLA.
Authorized Representative Signature
SANTO
-WORLD FAMOUS- .
FIREWORKS
February 2,2024
INFORMATION FOR FIREWORKS PERMIT
1. Sponsor-West Mountain-In charge-Santore's World Famous Fireworks.
2. Date__&Time_-Saturday,February 17,2024-at approximately 9:00 p.m. _ _ _ - _ __ --_
3. Location-Designated area of West Mountain near Tubing Park.
4. John L.P.Flanagan Age: 54 Hair:Brown
33 Peel Street Height: 5'6" Eyes:Brown
Selkirk,NY 12158 Weight: 170 lbs.
Mr.Flanagan has over 30 years experience and will be accompanied by one other
SWFF technician with at least five years experience.
5. 1.3 G(Formerly Class B Explosives)ranging from 1 '/2"-4".Breakdown as
follows: Opening of Display: 5-3"Salutes& 100-1 '''/"Multi-color finale
barrage.Main Body: 55-3",36-4"Color shells.Finale: 50-2"Color finale
barrage,40-2'A",40-3", 8-4"Color finale shells and 20-3"Salute finale shells.
6. The explosives will be stored in a licensed magazine at the SWFF facility until the
date of display.At that time the fireworks will be driven to site and loaded into
firing mortars.There will be a SWFF employee with the explosives at all times.
7. Diagram is attached.
7B.Proof of insurance is attached.
7C.Notification of Fire Marshall/Chief for site inspection and approval.A SWFF
employee is willing to view the site with such persons if necessary.
7D. Cleanup has to be provided by sponsoring organization.Immediately following
display, SWFF technicians will go over site to look for any unexploded debris.
SWFF crew will clean up all materials that are used in the display such as firing
mortars and bring them back to our own facility.
Main Office:PO Box 687,Stillwater,NY 12170(P)518-664-9994
Email:jward(2i santorefireworks.com
Visit Our Website at:www.santorefireworks.com