18D-040 (7) 375 RING ST-PRIDE BP-2019-0718
GIS 4: COMMONWEALTH OF MASSACHUSETTS
Man: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)
Cateeorv:rengvation BUILDING PERMIT
Permit# BP-2019-0718
Project# JS-2019-001177
Est.Cost,$25000.00
Fee:$245.00 PERMISSION IS HEREBY GRANTED TO:
Const Class: Contractor: License:
Use Group: ROBERT BOLDUC 038811
Lot Size(sq.ft.): 42209.64 Owner: Pride Convenience Inc
Zonmge 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.1212012018 0:00:00
TO PERFORM THE FOLLOWING WORKREMODEL 1,400 SO FT OF INTERIOR SPACE -
new equipment, kitchen hood, suppression system and subway, remove non supporting walls
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 ft 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,
FeeTvoe: Date Paid: Amount:
Building 12/20/2018 0:00:00 $245.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
_ w
Versionl.7 Commercial Building Permit May 15,2000
Department use only
City of Northampton Slate of Permit:
Building Department Curb CutlOrWeway Permit -
212 Main Street SeweMSepticAwllability
Room 100 Water/Well Awilability
Northampton, MA 01060 neo Sets of Structural Plain
phone 413-587-1240 Fax 413-587-1272 PlotSits Plarre
Other Specify
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 Property Address: This section to be completed by office
375 KING ST Map Lot Unit
Zone Overlay District
- --- -- Elm SL 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:
(413)737-6992
Signature Telephone
2.2 Authorized Anent:
DAVID SABOURIN 246 COTTAGE ST SPRINGFIELD MA 01104
Name(Print) Current Mailing Atltlress:
(413)737-6992
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed bennitapplicant
1. Building )['Z 60 00 (a)Building Permit Fee
2. Electrical $2,500.00 (b)Estimated Total Cost of rDrRJ
Construction from 8
3. Plumbing $2,500.00 Building Permit Fee
4. Mechanical(HVAC) ADD& i�EE IF �t 00
5. Fire Protection c S\t7p0 B00 176
6. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Building Permit Number Date
,ADHD-T6 Issued
Signature:
Building Commissioner/Inspector of Buildings Date
Versionl.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 36,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations El Existing Wall Signe ❑ Demolition Repairs❑ Additions ❑ Accessory Building
Exterior Alteration El Existing Ground Sign 0 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 Assembly13A-1 ❑ A-2 ❑ A-3 1:1111A
A4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S storage ❑ 5-1 ❑ S-2 ❑ 5B O
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(sl)
1' 4,400 1n 4,400
2. 2n°
30 3ra
4.
0
Total Area(so 4,400 Total Proposed New Construction(sl)
4,400
Total Height(h) 21
Total Height ft 21
7.Water Supply(M.G.L.c.40,§64) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑i Private ❑ Zane Outside Flood Zone[Z] Municipal M On site disposal system❑
Version 1.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column m be fillet in by
Building ueVa*Vnem
Lot Size .969 acre .969 acre
Frontage
Setbacks Front
Side L: R: L:—R:—
Rem
: R:Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
,arkv,)
#of Puking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DON'T KNOW Q YES O
IF YES, date issued: 02/26/1998
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES 0
IF YES: enter Book 5369 Page 80 and/or Document# 980011571
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO O
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 O NO O
IF YES, describe size, type and location: Change to face of signs to reflect new tenant/use
E. Wil 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 O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Version .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 36,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable EI
Name(Registrant) _. o
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 Responaibllity,
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiretion Date
9.3 General Contractor
Not Applicable 0
Company Name
Responsible In Charge of Constmotion
Atltlress
Signature Telephone
Vcrsionl.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes Q No Q
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
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 Omer Date
'......DAVID SABOURIN
.._. , 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 ofperIury.
PtlM 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 Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,125C(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 E) No