143-22 Exhibit to Resolution Authorizing Fireworks at Rock Spring Club for Juneteenth 2022.pdf

West Orange Fire Department Fire Prevention Bureau 415 Valley Road, West Orange, New Jersey 07052 (973) 325-4175 Fax (973) 669-1080 fireprev@westorange.org APPLICATION FOR PERMIT The Uniform Fire Code states: “Permits shall be required and obtained from the local enforcing agency for the activities specified in this section, except where they are an integral part of a process or activity by reason of which a use is required to be registered and regulated as a life hazard use. Permits shall at all times be kept in the premises designated therein and shall at all times be kept in the premises designated therein and shall at all times be subject to inspection by the Fire Official.” [N.J.A.C. 5:70-2.7(a)] Applicant Name: Oe U < Galea Avéuc Yn 700 day's Date:__ MAY 5, 2022 Organization/Company/Vendor Name: GARDEN STATE FIREWORKS Address of Organization/Company/Vendor: 383 CARLTON ROAD MILLINGTON, NJ 07946 Phone No. 908-647-1086 Fax No. 908-647-6258 Emergency Contact No. 908-464-1080 Block/Lot No.. Registration No. Fed ID No.. Location of Activity;_ ROCK SPRING CLUB GROUNDS Date of Activity: JUNE 17, 2022 Time of Activity: The above named applicant hereby requests permission to conduct the following activity at the above indicated location: FIREWORKS DISPLAY For keeping, storage, occupancy, sale, handling or manufacture of the following items: 1.3G FIREWORKS UN0335 State quantities for each category to be stored or used. State the method of storage and uses. SEE LIST OF MATERIALS. FIREWORKS WILL BE KEPT ON LOCKED DELIVERY TRUCKS UNTIL LOADED. | hereby acknowledge that | have read this application, that the information given is correct and that | am the owner, or duly authorized to act on the owner's behalf, and as such hereby agree to comply with the applicable requirements to the Fire Code, Township he specific conditions imposed by the Fire Official. Applicapf Signature Fire Official Signature Fee Amount Permit Type