18D-040 (6) 375 KING ST-PRIDE BP-2019-0718
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18D-040 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT
Permit# BP-2019-0718
Project# JS-2019-001177
Est. Cost: $15000.00
Fee: $105.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT BOLDUC 038811
Lot Size(sq.ftp: 42209.64 Owner: Pride Convenience Inc
Zoning: HB(100)/WP(6)/ Applicant. ROBERT BOLDUC
AT. 375 KING ST - PRIDE
Applicant Address: Phone: Insurance:
246 COTTAGE ST (413)737-6992 Workers Compensation
SPRINGFIELDMA01104 ISSUED ON:12/20/2018 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMODEL 1,400 SQ FT OF INTERIOR SPACE
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeTvpe: Date Paid: Amount:
Building 12/20/2018 0:00:00 $105.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2019-0718 Q
APPLICANT/CONTACT PERSON ROBERT BOLDUC LIa
ADDRESS/PHONE 246 COTTAGE ST SPRINGFIELD (413)737-6992 I �q
PROPERTY LOCATION 375 KING ST-PRIDE '(
MAP 18D PARCEL 040 001 ZONE HB(100)/WP(6)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
CLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: REMODEL 1,4 0 S FT ONQJJ.PKOR SPACE
New Construction
Non Structural interior renovations
Addition to Existina
Accessory Structure
Building Plans Included:
Owner/Statement or License 038811
3 sets of Plans/Plot Plan
THE FOG ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INY9AMATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
I .
Versionl.7 Co nmer w i e1 .200(
�_ pa USe
City of Northampton lat#lam
Building Department DECx
212 Main Street vaile IIlty
y ti
Room 100 DEPT OF 13U1L
Northampton, MA 0106 NORTHAM l l ?uctu Plans
phone 413-587-1240 Fax 413-587-1272MP
Ot#ier
APPLICATION TO CONSTRUCT, REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO
/FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Pronertv Address: This section to be completed by office
375 KING ST Map Lot Ow Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
PRIDE CONVENIENCE INC 246 COTTAGE ST SPRINGFIELD MA 01104
Name(Print) Current Mailing Address:
i(413)737-6992
Signature Telephone ..
2.2 Authorized Aqent:
-----
DAVID SABOURIN 246 COTTAGE ST SPRINGFIELD MA 01104
Name(Print) Current Mailing Address:
(413) 737-6992
Signature . Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building $5,OW 00`' (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
$2,500.00 $15,000.00.
Construction from 6
3. PlumbingBuilding Permit Fee
$2,500.00:
4. Mechanical(HVAC)
$5,000.00.
5. Fire Protection
6. Total= (1 +2+3+4+ 5) I C2 Q D ICheck Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
'��v,t� SA�;�►,✓ c��i,U�# y/3 X133 - ��z�,
�sak3r✓Ui?i r✓ �PRI r.�6 57DR-65 , 00 wt
Versionl.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations [D Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑� Existing Ground Sign❑ New Signs 0 Roofing❑ Change of Use❑ Other❑
Brief Description REMODEL INTERIOR DUE TO DUNKIN DEPARTURE.CABINETRY,INSTALL NEW EQUIPMENT,
Of Proposed Work: ,KITCHEN HOOD AND SUPPRESION SYSTEM AND SUBWAY. REMOVE NON SUPPORTING WALLS.
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 213 I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 313 ❑
M Mercantile ❑� 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 513 ❑✓
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: Merchantile Proposed Use Group: Merchantile
Existing Hazard Index 780 CMR 34): 3,,. Proposed Hazard Index 780 CMR 34): '3
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(so
S(
1S` 4,400' 1 4,400`
2
2nd nd
3rd
3rd
4m
th -
4
Total Area(sf) 4,400, Total Proposed New Construction(so
,
4,400:
Total Height(ft) 21
Total Height ft 21
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public 0 Private ❑ Zone+ , Outside Flood Zone❑✓ Municipal ❑✓ On site disposal system❑
Versionl.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size 969 acre ..969 acre
Frontage
Setbacks Front
Side L: R:: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW U YES
IF YES, date issued: 02/26/1998
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES Q
IF YES: enter Book 5369 Page; 80 and/or Document# 980011571
B. Does the site contain a brook, body of water or wetlands? NO e DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Q , Date Issued: ;
C. Do any signs exist on the property? YES NO 0
IF YES, describe size, type and location: Ground and Wall Signs
D. Are there any proposed changes to or additions of signs intended for the property? YES ®i NO 0
IF YES, describe size, type and location: ,Change to face of signs to reflect new tenant/use
E. Will the construction activity disturb(clearing,grading, excavation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Versionl.7 Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Not Applicable
Company Name:
Responsible In Charge of Construction
Address
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) 7
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner of the subject property
hereby authorize to
act on my behalf, in all matters relative to work authorized by this building permit application.
12/17/2018
Signature of Owner Date
DAVID SABOURIN
I, , as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Name
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
ROBERT L. BOLDUC CS-038811
License Number
49 WOODSLEY RD LONGMEADOW MA 01106 10/31/2019
Address Expiration Date
;(413) 737-6992
Signature 112 Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes 0 No 0
r
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: 317,s7 ikivc,
The debris will be transported by:
The debris will be received by:
Building permit number:
Name of Permit Applicant
Date Signature of Permit Applicant
The Counitontt-eatlth tq':'ita.sacicusetts
Department of Industrial.•iccideuts
Office offit ve trgaitions
600 fVasitington .street
Boston,.Moss. 02.11.7
ivit"ito.inatss.gorldia3
Workers' Compensation Insurance Affidavit: Bit ilciers/Contractors/Electricii ii.c./ 'lumbers
A2pllcan.t Information Please Print Le ibl:v.._..
ikinae(Business/OrpnintimOndividual):
Address, n)M-v 1. �►�t"i" ?C.�1S _� ._
City/State/zlp: 0110,1 Phone#: IT3-1757-1.1M1.
Are ygu an employer?Check the appropriate box: Type of project(required):
i.J 'i arrt an employer with 4. ❑ 1 am a general contractor and 1 6. 0 New construction
employees(hull and/or art time).* have hired the sub-contractors j
2.Z 1 m asole proprietor or partner- listed on the attached sheet. 7. .1 Remodeling
ship and have no employees Thane sub-contractors have 8. !Demolition
marking for me in any capacity. employees and have workers'
[No workers'comp.insurance comp.trtsurance.$ 9. ►Building addition
i
requirtA 5.D We are a corporation and its 10. 1 Electrical repairs or additions
3. 1 am a homeowner doing all work officers have exercised their 11. 7 Plumbing repairs or additions
myself(No workers'comp. right of exemption perm MGL
insttrartee required)t c. 152,§1(4},and we have no 12. .E Roof repairs
rpyees.(no workerstnsurance requied.j 13. 1 Other
*Any spplteast that cheeb but:tit mutt atter till so tate seeten blow showtae their workers'eampausatton policy Information.
tuamsewtsere Wks submit Me al"Wt hm to dm nary ora doles ailwork toad then Arra outd4o coutrttcters must submit a new aMdavit iadieattnt;such.
tGi�tiTtn i l�wtt Yiail its Atli tidIIt#Infatit SAM jwrbt4 tba Mame of tho sub-nab%ders and sftto whether or not those entities have employers. it
tba b-cumttaecara iter kart'MM PLft.QMMb0r.
JAw an empk)w that Isprot+ldlitg workers'compensatim insurance for my employees.Below is thepolicy and joh site
informadom
Insurance Company Name: Au-mmto-rtvG s
Policy#or Self-ins.Lic.#: WC, tom► +ata.0=OC4 Expiration Date;
Job Site Address: City/Statemp:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration(date).
Failure to secure coverage as required under Section 25a of MGL 152 can lead to the imposition of criminal penalties of a line
up to$1,500.00 and/or one year imprisonment as well as civil penalties in the fours of STOP WORK.ODDER and a fine of
$250.00 a day against violator.He*sdvised that a copy of this statement maybe forwarded to the Office of Investigations of the
DIA for covers a verification.
Ido herby cert rt r the pains and pen ties ofperjury that the information provided above is true and correct.
si 11QhtrG: Date:
Print Name:.. iSpe-t" Phone#:
Of Bial use only . Do riot write In this area to he completed by city or toren offWal
City,or Town: Permit/llcense#:
1
Issuing Authority(circle one):
i.Bosrd of lfleath 2. Building Department 3.Clty]Town Clerk 4.Electrical Inspector 5.Plumbing inspector
6.Other
Contact person: Phone#: !
d