163-22 Exhibit - Fireworks at Montclair Golf Club - 2022.pdf

DIVISION OF FIRE SAFETY STATE OF N.J. Montclair Golf Club, July 2, 2022 1. TOTAL NUMBER OF SHELLS ARE LISTED ON THE FIRE PERMIT APPLICATION 2. TOTAL, IF ANY, ARE LISTED ON THE FIRE PERMIT APPLICATION 4. DISPLAY TO BE HAND FIRED AND OR ELECTRICAL FIRE CERTIFIED OPERATOR IS: Gabe Auslander AND CREW 5. DELIVERY TO SITE WILL BE APPROXIMATELY 2:00 P.M.TO 3:00 PM UNTIL COMPLETION AT APPROXIMATELY 5:00 TO 7:00-P.M. 6. INSURANCE CERTIFICATE ISSUED AND ON FILE WITH THE PROPER OFFICIAL 7. AGREED AND UNDERSTOOD 8. AGREED AND UNDERSTOOD 9. Gabe Auslander AND CREWO 10. AGREED AND UNDERSTOOD 11. WE ATTEST TO THE UNDERSTANDING OF ALL RULES AND REGULATIONS AND THE DISPLAY WILL BE IN ACCORDANCE WITH NFPA 1123,1124 AND 1126 AND NJAC IFC 2015 CHAPTER 56. THE DISPLAY WILL BE IN COMPLIANCE WITH THE SAME cte Date: May 16, 2022 Display Company Representative

Arrayal Montclair Golf Club July 2, 2022 $24,000.00 Opening: 300 1”-2” Assorted Multi-Break Special Effect Shells 40 2.5” — Assorted Star Shells 30 2.5” Titanium Report & 4” —— Bumper Harvest Shell 4 5” Spangle Chrysanthemum 2 6” Color Changing Peony with Color Changing Pistol 2 6” Shell of Shells Chrysanthemum 1 8” Color Changing Chrysanthemum Body: 240 3” Assorted chrysanthemum Peony pattern & Reports 108 4” Santore Bros. Special Multi-Break & Custom designer Chrysanthemum 72 5” Assorted Color Chrysanthemum & Reports 18 6” — Large Spreading & Special Breaking Multi-Effect Shells 27 6” Assorted Chrysanthemum Peonies 18 6” — Fancy Assorted Pastel Color Special Effects: 15/30MM 100 Shot Criss Cross Magnesium Crossetti 500 Shot Assorted Color Comets (Pre-Boxed) 72 Shot White Glittering with Red Pistol 72 Shot V Cake Rapid Fire Bees 100 Shot W Cake Gold willow Comets 350 Shot Flash & Thunder Reports 200 Shot Falling Leaves Mixed Color 100 Shot Crazy Bees 120 Shot Falling Leaves assorted effects 120 Shot Zipper Z Cake ’ Brocade Tableau: 30 3” — Long Duration twinkling Brocade 12 4” Long Duration twinkling Brocade & 3” Long Duration twinkling Brocade 4 6” Long Duration twinkling Brocade

Montclair Golf Club July 2, 2022 $24,000.00 Page#2 Crossetti Tableau: 30 3” Fancy Crossetti 2 4” Fancy Crossetti & 5” Fancy Crossetti 4 6” Fancy Crossetti Pre-Finale: 1530MM 1150 Flying Fish, Whistles, Comets & Report Shells Grand Finale: 200 2.5” Assorted Colors Star Shells 120 3” Fancy Colors and Reports Mine shells with Color Crackling reports 3,750 Assorted Effects 60 3” Assorted Star Shells 180 3” Color and lightning Flashes 6,000 crackling effects 180 3” Assorted Color Strobing Stars 6,000 bright Flashes 120 3” Color and Multi- Salute, 750 Staccato effects 60 3” White Spiders 60 3” Fancy Gold Spider 150 3” Titanium Report 36 4” Assorted Chrysanthemum and Peony 24 5” Glittering Silver Color Changing Red, White and Blue 16 o” Color Changing Chrysanthemum By 8” Chrysanthemum with color Heart 60 3” Titanium Reports Volley Shell Size 1”-2” | 25"| 3” 4” 5” 6” 8” | 1530 MM | Assorted Total Effects Total Pieces, 300 | 270 | 1290 | 176 | 116 | 91 6 2,884 | 16,500} 27 5633 shots & Effects Total Progam Value $24,000.00

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 Tequired 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:_Garden State Fireworks Today's Date: May 16, 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. 908-4641080-Augie Santore Block/Lot No., Registration No. Fed ID No. Location of Activity: Date of Activity:_July 2, 2022; Rain Date July 3, 2022 Time of Activity;_9:00PM-9:30PM The above named applicant hereby requests permission to conduct the following activity at the above indicated location: Fireworks display. Montclair Golf Club Grounds 25 Prospect Ave. West Orange, NJ 07052 For keeping, storage, occupancy, sale, handling or manufacture of the following items: —Fireworks 1.3G UN0335-Shells are pre-loaded, See list of materials enclosed State quantities for each category to be stored or used. State the method of storage and uses. Fireworks are kept on locked truck until loaded into their mortars. | 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 Ordinance, as well as any specific conditions imposed by the Fire Official. Licey tU fuck Applicat Signature Fire Official Signature Fee Amount Permit Type