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HomeMy WebLinkAboutBuilding Permit #421-15 - 255 HAY MEADOW ROAD 11/3/2014 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 42-1 -IS Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page 74 Print 4PROPER,TiY�01/VNEFt - .__. . . �l?c✓I�c.•f Vic. `? ` ., r... �- C60) Prt i00Year,0ldStructurea yesAPNO, PARCEL� Z®NING�D.IS;TIRICT HistoncDstnct . yeNhe)$fiop3Village? ye_ TYPE OF IMPROVEMENT PROPOSED USE Resi ential Non- Residential ❑ New Building V6ne family ❑Addition ❑Two or more family ❑ Industrial ❑ Iteration No. of units: ElCommercial epair, replacement 0 Assessory Bldg ❑ Others: Demolition ❑ Other ❑iSeptec� M, ell? ry `5 ❑JFloodplain} ' ❑ilNetlands} _ , WatershedDistnct v �. ❑cW.ater/S,ewer } DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: JDey'an Oxk'tnoLeL*) Phone: Address: 'Q $5 14 CO.NTRACT.QR Name _ _o�•e �� _ Phone:: 47� -77f _ — .. i q -7;7 oL v S(. U Yrn1t�1�A►),Nll�jyl UT - - - Supervisor,�s Construct1on+License �'�-q7`>_ !6 HomeImprovemenLieense : - . 7 Exp', Date. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED fctOSST BASED ON$125.00 PER S.F. Total Project Cost: $ y 075. 4-5 FEE: Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access t e guaranty fund Si nature of Aden t/Owner g .. Signature of contractor. Plans Submitted ❑ Plans Waived ElCertified Plot Plan ❑ Stam ed Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ i COMMENTS i i CONSERVATION Reviewed on Signature y i COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes I Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit hPW TowL Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT : Temp Dumpster on.site yes no Located at'I N M6"'Street, r Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, roast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No . MGL Chapter 166 Section 21A—F and G m1n.$100-$1000 fine NOTES and DATA—(For department use IS ® Notified for pickup - Date f j Doc.Building Permit Revised 2010 I, Building ®epartment The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan.Or Proposed Interior Work ❑. ,Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products gOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm:pted with the building application Doc: Doc.Building permit Revised 2012 Location Jho C4 . No.A21 Date r . - TOWN OF NORTH ANDOVER : 40 Certificate of Occupancy $ f ' Building/Frame Permit Fee $ Foundation Permit Fee $ w ° A- Other Permit Fee $ TOTAL $ Check# Kzos 1 Ci(a 2L:,-; 28211 Building Inspector i v � t y`CLItlk i NORT#1 Town of E : Andover O No. �, • O : ^KL* h " ver, Mass, —441 COCKICKl WICK ��' U BOARD OF,HEALTH Food/Kitchen PER I T L D Septic System ~� THIS CERTIFIES THAT .......... . .`1/ ...... ............................ .................................................. BUILDING INSPECTOR ..rA .. ... ...�.4. ............ Foundation has permission to erect ............... .......... buildings on .. ...... ..... �► Rough tobe occupied .'... ..... .. ... .)......,b.&.1�.`�. .................................................. Chimney provided that the on accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS - ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO T S Rough Service ................. .... ...... ..................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): o 4e. Y)e!Y/&-r Address: A 7 GJc)bvm City/State/Zip: l m t ' Oh iftlA 01 ?R Phone #: !r7 - Are you an employer?Check 4 appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.`?I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling (( ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. EJ Building addition [No workers' comp.insurance comp.insurance.+ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.E]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.[1 Other employees. [No workers' comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: '2 55 h4ty ft'? clow City/State/Zip: /Y'/ 4,uorerl MA d1�,S 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 c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do herebnder the pains and penalties of perjury that the information provided above is true and correct. Si ature: Date: Phone#: fl'? - 7a f- 5, Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: P11 riswielts -Dapart Ment of Public zwety. card Of 8011ding Regulations and Standards f'snvkruc4irtk 5rtpt!rttser't' License, GS-081974 t3 JLIUNG;�F0N RA di t Expifit;on .. c-fr h1wr, NCiFS•'f �t'� X !<#tttlSdf J4:' =��"+ t�f�9c�.�1��un�arucr-�fX'�irs&t3uainess l{t�nii�tlon �" MF PROVE CtN+tTRACTOR ptctraf�on77567 Ty e ihdMdui l JIM, JOS'EM i MCNMY #�Ii�,fia2ENC�TC?h1,PJi1tiQl�ib? � t Zlnderscct•et+# ry a F P. ��—.ti...—r�rwn..l�r•�•,.rr�.nt.M...r•x+�+���.:,.+.w.,+i.i�:�:.+.:�.:.�-«.`....�..�.... OP ID: DO CERTIFICATE OF LIABILITY INSURANCE DA03/27/201 Y) 03/27/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT John J Walsh Ins Agency,Inc NAME: P O Box 4407 PHONE FAX A/C No Ext): A/C No): Salem,MA 01970-6407 E-MAIL David C Bruett ADDRESS: PRODUCER 9MCNA01 CUSTOMER ID#: INSURED McNary ConstructionINSURER(S)AFFORDING COVERAGE NAIC# Joseph McNary INSURER A:Travelers 767 Woburn Street INSURER B: Wilmington,MA 01887 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 19000,00 A X COMMERCIAL GENERAL LIABILITY 1-680-6621 P22-A-ACJ-13 02/08/2014 02/08/2015 PREMISES Ea occurrence $ 300900 CLAIMS-MADE II OCCUR MED EXP(Any one person) . $ 5900 PERSONAL&ADV INJURY $ 19000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (PER ACCIDENT) $ NON-OWNED AUTOS $ $ UMBRELLA LIAB L OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule if more space is required) Lowe's Companies, Inc. and any and all subsidiaries are additional insured with respect to commercial general liability. Waiver of subrogation applies per written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Lowe's Companies Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN and any and all subsidiaries ACCORDANCE WITH THE POLICY PROVISIONS. Attn:Vendor Insurance PO Box 1111 AUTHORIZED REPRESENTATIVE N Wilkesboro,NC 28656 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD STORE COPY INSTALLATION SERVICES CUSTOMER CONTRACT- MWORK- INT/EXT/PATIO DOOR Iwo LOWE'S OF SALEM, NH, STORE#2382 STORE PHONE: (603)681-4218 541 SOUTH BROADWAY SALESPERSON:JOSEPH CAVALLARO SALEM, NH 03079-4499 SALESPERSON ID: 897831 Document Print Date : 10/28/2014 This is only a Quote for the merchandise and services printed below.This becomes an agreement upon payment and issuance of a Lowe's receipt, upon which the entire agree- ment, including the specifically completed pages of this document, the Terms and Conditions included with this document, the applicable portion(s) of Lowe's receipt, and any other addenda or attachments hereto, shall be referred to herein as this"Contract." PLEASE READ THIS ENTIRE DOCUMENT INCLUDING THE "TERMS AND CONDITIONS." BEFORE SIGNING Lowe's Registration or Contractor License Number/Lowe's Contractor Name Lowe's Home Centers, LLC's MA HIC NO.: 148688 Lowe's Home Centers, LLC's FEIN: 56-0748358 Customer Name Home Phone S DEVAN RAMANUJAM 617-858-0592 O Customer Address Other Phone 255 HAY MEDDOW RD L City State/Province Zip/Postal Code D NORTH ANDOVER MA 01845 Installation Address T 255 HAY MEDDOW RD O Installation City Installation State/Province Installation Zip/Postal Code NORTH ANDOVER MA 01845 MERCHANDISE AND INSTALLATION SUMMARY MERCHANDISE SUMMARY �1 649 : 87548 : STK : 1 X4X8 RED OAK BOARD : 1 X4X8 RED OAK BOARD : BABCOCK LUMBER - QTY 1 1-4161 : 1161 : STK : 1X8X8FT SELECT PINE : 1X8X8FT SELECT PINE : PRECISION LUMBER - QTY 2 —IB302 : STK : PNE CASE 351 2-1/2X11/16X8' : PNE CASE 351 2-1/2X11/16X8' - QTY 3 X458 : 07526 : STK : RML 8-FT WHITE PVC BRICK MOULDING : RML 8-FT WHITE PVC BRICK MOULDING : EAST COAST MILLWORK DISTRIBUTI - QTY 3 %-238348 : 2828-8 : STK : 3/4X7.25X8 RF EMBOSD PVC TRM BRD : 3/4X7.25X8 RF EMBOSD PVC TRM BIRD : ROYAL MOULDINGS LIMITED - QTY 2 231056 : WFHVAUNIT : SOS : SOS 850 ARCH PELLA PATIO DOORS : 2-PANEL IN-SWING FRENCH DOOR PATIO : PELLA CORPORATION - QTY 1 231056 : WFHVAUNIT : SOS : SOS 850 ARCH PELLA PATIO DOORS : SCREEN : PELLA CORPORATION - QTY 1 Store 2382 Project No. 423927918 for DEVAN RAMANUJAM Page 1 of 8 ti STORE COPY Materials Price $ 3501.65 INSTALLATION DESCRIPTION Stock or SOS : SOS Door Type : Patio Select Location : Back Door Select New Door : Hinged/ French Number of Doors to Install : 1 Side Lights or Transoms : No Hidden Damage Description : None Number of additional holes bored for accessories : None Install Specialized Mortise Hardware : No Lead Safe Practices : No Total Linear Feet of Custom Trim to be Installed : 0 Deliver Door : No Customer Understands Scope of the Project : Yes Permit Required : Yes Who Will Obtain Permit : Lowe's Permit Fee : No Additional Miles Traveled over 20 : 0 Bring Up To Code Description : None Local Disposal Fee : Yes Describe Other Work Needed : Cut back wood siding Other Work Charge : Yes Comments : `wants Pella 850 french door Labor Charges $ 609.00 Detail Deduction -$ 35.00 Additional Specifications: Notation: Lowe's will not make structural modifications, paint or stain or remove/reinstall security system equipment. Customer is responsible to advise if prop- erty is governed by Historic District Regulations. Additional Specifications:Federal law requires Lowe's to provide you with the pamphlet Renovate Right: Important Lead Hazard Information for Families, Child Care Providers and Schools. By signing this Contract, Customer acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photograghs of the Premises where In- stallation Services will be performed and all work performed at the Premises related to this Contract, and irrevocably grants to Lowe's all right, title, interest in and to the photographs for use in all markets and media, worldwide, in perpetuity. Customer authorizes Lowe's to copyright, use and publish the photographs in print and/or electronically, and agrees that Lowe's may use such photographs for any lawful purpose, including, but not limited to, marketing, advertising, publi- city, illustration, training and Web content. By initialing here, Customer agrees to the foregoing. [Customer to initial to the left]. NOTICE TO CUSTOMER-PRICE CALCULATIONS: In order to properly perform the installation of certain Goods, the Contract Price may include more Goods than actually will be installed based on the measured square footage of the Project Area. As a result, the parties agree that the lump-sum Price stated in this Contract is calculated upon both the value of the estimated Goods required to fulfill the Contract (including waste), which may exceed the actual square footage Store 2382 Project No. 423927918 for DEVAN RAMANUJAM Page 2 of 8 STORE COPY of the Project Area, and the labor which may be estimated based on the amount of Goods required to fulfill the contract (including waste). By signing this Con- tract below, Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may not be refunded once the Installation Services are performed.. TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES where applicable SUB-TOTAL $4075.6 *TAX $ 0.0 DELIVERY $ 0.0 ORDER TOTAL $4075.6 BALANCE DUE Work is to commence upon reasonabl avail blity of Contractor which is anticipated to be [fill in date]. Estimated completion date is [fill in date]. NOTICE TO CUSTOMER All items listed in this contract and specification sheet(s) are to be installed under conditions agreed upon at time of purchase and at the price appearing on this contract form. This assumes sound existing substructures, superstructure and points of attachments. Extra labor or material incident to installation necessitated by defective substructures, superstructure, points of attachment, or the moving of fixtures or appliances to be billed at extra cost to.custom- er. IF THE CONTRACT TOTAL IS $1.000.00 OR LESS. Customer must pay in full. O PLETE THIS E TI N ONLY WHEN THE CONTRACT TOTAL EXCEEDS $1,000.00: ustomer to Pay in Full; OR m Customer to use the following payment schedule: (1) Deposit of $ to be paid upon signing contract. Any deposit collected at the time this Contract is signed will not exceed one-third (1/3) of the contract price; and (2) Payment of $ to be collected upon or after the commencement of work. I/We authorize Lowe's to do one of the following (check ap- propriate box below): Store 2382 Project No. 423927918 for DEVAN RAMANUJAM Page 3 of 8 a STORE COPY [_] Charge my/our credit card for the amount of the payment indicated above upon or after the commencement of work; or [_] Deposit my/our check for the amount of the payment indicated above anytime upon or after the commencement of work; and (3) Final payment of$100.00, to be paid upon completion of the installation to both parties' satisfaction. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL.YOU HAVE READ THE TERMS AND CONDITIONS CON- TAINED IN THIS CONTRACT AND WHICH FOLLOW THE SIGNATURE PAGE(s). BY SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH IN THIS CONTRACT. YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L. c 142A LOWE'S AND OW R HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CON- TRACT, THAT E'S MAY SUBMIT S CH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRET- ARY OFT ECUTIVE OFFICE 0 CONSUMER AFFAIRS AND BUSINESS EGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUB- MIT TO IT ATION ASP VIDED IN M.G.L. c.142A. BY Date: meeCCente s LLC .12 Y: Date: Owner BY: Date: Co-owner or Witness. THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY LOWE'S PURSUANT TO M.G.L. c 142A THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE SECTION ABOVE ISN T SEPERATELY SI ED BY T PARTIES. WITNESS OUR HAND ) AND SEAL(S) BELOW T ` DAY OF _ 1� Lowe's Home C s, LLC BY� (Seal) P it Name: Yr� RL (Seal) Address V\_ Owner n �vr H � 7 Store 2382 Project No. 423927918 for DEVAN RAMANUJAM Page 4 of 8