HomeMy WebLinkAbout52851-Z TOWN OF SOUTHOLD
of�aur
BUILDING DEPARTMENT
SOUTHOLDY NY
flu, 1,
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFIC.A�TIQ_R5.,
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Date: 04/09/2026
Permit#: 52851
Permission is hereby granted to:
Peter Sack
267 Stewart Ave
Garden City, NY 11530
To:
legalize"as built" interior alterations to an existing single-family dwelling as applied for with flood
permit. Additional certification may be required.
Premises Located at:
2905 Bay Shore Rd,Greenport, lVY 11944
5CTM# 53.-6-4
Pursuant to application dated 03/26/2026 and approved by the Building Inspector.
To expire on 04/08/2028.
Contractors:
Required Inspections:
Fees: As Built Alteration $610.00
CO-RESIDENTIAL $100.00
Flood Permit $150.00
Total 860.00
M Building Inspector
rc OF SUTTT(JLD--BUILDING DEPARTMENT
TOWN
Town Tall Annex 54375 Main.Road P. 0. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 r tt t s'.//www.soutbol
Date Received
APPLICATION FOR BUILDING PERMIT
1� l
For Office Use Only
C/<
r I uil
PERMIT NO. Building Inspector-
.
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant is not the owner,an �.
Ow►nees Authorization form(Page 2)shall be completed.
Date:03-20-26
OWNER(S)OF PROPERTY:
Name:Danielle Sack SCTM#_�.000-
Na
53-06-04
Project Address:2905 gay Shore Rd, Greenport, NY 11944
Phone#:A% 6-734-5966 Email:daniellemsack@gmail.com
Mailing Address:2905 BayShore Rd, Greenport, NY 11944
CONTACT PERSON:
Name:Timothy Cloughen
Mailing Address:3 Manorview Way Manorville NY 11949
Phone#:631-255-7845 Email:tm.ploughen@gmail.com
DESIGN PROFESSIONAL INFORMATION:
Name:Jeff A Zahn
Mailing Address:215 Roanoke Ave, Riverhead NY 11901
Phone#:631-T2T-�0544 Email:jazcad@msn.com
CONTRACTOR INFORMATION:
Name:Jor e Gomez JGQ Construction
Mailing Address:26 Center Street, Greenport, New York 11944, United States
Phone#:631-574-5834 Email:info@jgqconstruction.com
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition FAIAlteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other
Maintain existinginterior alteration 327sf
Will the lot be re-graded? ❑Yes T No Will excess fill be removed from premises? ❑Yes T No
................
...............
PROPERTY INFORMATION
..........
Existing use of property:single family intended use of Property:single fam ily
Zone or use district in which premises is situated: Are there an y covenants and restrictions with respect to
this property? nYes �No IF YES, PROVIDE A COPY.
R he Box After Reading: The owner/contractor/design professional Is responsible for all drainage and storm water issues as provided by
Chapter 236 of the Town Code. APPUCATION IS HEREBY MADE to the Building Department for the Issuance of a Building Permit pursuant to the Building Zone
Ordinance of the Town of Southold,Suffolk,County,,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings,
additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code,
housing code and regulations and to admit authorized Inspectors on premises and In building(s)for necessary Inspections.False statements made herein are
punishable as a Class A misdemeanor pursuant to Section 210AS of the New York State Penal Law.
- MORM,
Application Submitted By(print name):Timothy ghen MAuthorized Agent 'owner
Signature of Applicant: Date:
CONNIE D.BUNCH
dl d Notary Public,State of New York
STATE OF NEW YORK) No.OIBU6185050
SS: Qualified In Suffolk County
COUNTY OF Commission Expires April 14,
being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the I-agent
(Contractor, Agent, Corporate Officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application;that all statements contained in this application are true to the best of his/her knowledge and belief; and
that the work will be performed in the manner set forth in the application file therewith.
Sworn before me this
day of
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
D a ni e l l e Sack 2905 Bay Shore Rd, Greenport, NY 11944
residing at
"do hereby authorize Timothy Clou hen to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
3/24/2026
Owner's Signature Date
Danielle Sack
Print Owner's Name
2
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