32A-267 (8) 2 GRAVES AVE BP-2021-0779
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32A-267 CITY OF NORTHAMPTON
Lot: -003 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: KITCHEN RENO BUILDING PERMIT
Permit# BP-2021-0779
Project# JS-2021-001319
Est.Cost: $40000.00
Fee: $260.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: KEITER BUILDERS 102457
Lot Size(sq. ft.): Owner: KUNICHIKA MICHAEL
Zoning: Applicant: KEITER BUILDERS
AT: 2 GRAVES AVE
Applicant Address: Phone: Insurance:
35 MAIN ST (413) 586-8600 () WC
FLORENCEMA01062 ISSUED ON:2/26/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:KITCHEN RENO
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.
14
Certificate of Occupancy Signatur:i
FeeTvpe: Date Paid: Amount:
Building 2/26/20210:00:00 $260.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
-44. ►J -0 6EAn CAcs.
mU . _--------1.1I 17111..Ke9 70 •V icrti mzcc 4,rev- 1-e-Z i
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The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
o m ``•, • ,' Massachusetts State Building Code,780 CMX MUNICIPALITY
0 0 n j Building Permit Application To Construct,Repair,Renovate Or Demolish a USE
Revised Mar?011
N 1 One- or Two-Famih'Dwelling
n This Section For Official Use Only
---Building etmit Number: 6�"�- a/ — 7-7 47 Date pplied:
&WO / 2-5) it/g 2-25-2ozi
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
2 av [
Gres Ave 3a A 1 _b
1.1 a Is this an accepted street?yes no Map Number Parce um er
1.3 Zoning Information: 1.4 Property Dimensions:
NA NA
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
NA NA NA
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 1 Private 0 Zone: _ Outside Flood Zone?
Check if yes Municipal la On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Michael Kurichika Northampton.MA 01060
Name(Print) City,State,ZIP
2 Graves Avenue mkurachika s;omai.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'-(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2:
Kitchen Renovation and drywall repairs i ;2 rooms
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Official Use Only
(Labor and Materials)
1.Building S 1. Building Permit Fee:$ S260 Indicate how fee is determined:
32.700
0 Standard City/Town Application Fee
2.Electrical S 2.500 51 Total Project Cost'(Item 6)x multiplier 40.000 x 6.50 1,000
3.Plumbing $ 2,000 2. Other Fees: S
4.Mechanical (HVAC) S 2 800 List:
5.Mechanical (Fire $
Suppression) Total All Fees: 0
Check No.1')l heck Amount: (M Cash Amount:
6.Total Project Cost: $ $40,000 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS-102457 6:`?O?2
Scott Keiter License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
'lc Matn StrPef
No.and Street Type Description
Florence,MA 01062 U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted l&2 Family Dwelling
City/Town.State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
4.13-586-8600 skeiteri/2keiterhuilders.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HTC)
Keifer Builders. Inc. HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
35 Main Street
etc �=k iisrbuld;.,>.;gym
No.and Street Email address
Florence. MA 0'1062 4.11_=,AF-86C)0
City/Town,State,ZIP Telephone
SECTION 6: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 El No . ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize Keiter Builders
to act on my behalf,in all matters relative to work authorized by this building permit application.
See attached signed contract 1/8;2021
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
cooained in this application is true and accurate to the best of my knowledge and understanding.
Y/ ✓
! /� —
President.Kell 1/8/2021
rint Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at
www.mass.gov'oca Information on the Construction Supervisor License can be found at www.mass.aovIdps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces NA Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system ` Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost" NA
\ The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
.1:
Boston,MA 02114-2017
'', `� www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): KeiterCo,poratc>i
Address: 35 Main Street
City/State/Zip: F 2,,;;�,: MA 01062 Phone#: E 3-58 -86 00
Are you an employer?Check the appropriate box: Type of project(required):
i. X I am a employer with 35 employees(full and/or part-time).*
7. ❑New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling
any capacity.[No workers'comp.insurance required.]
3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
9. ❑Demolition
10❑Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs
These sub-contractorsr;have employees and have workers'comp.insurance? p
6.❑We are a corporation and its officers have exercisedtheir right of exemption per MGL c. 14•p Other
152,§1(4),and we have no 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.
1.am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: AIM Mutual
Policy#or Self-ins.Lic.#: MCC20020005382020 Expiration Date: 6.111/2021
Job Site Address: 9•,,, ,Y,to,,,, City/State/Zip:rdortha mOton. MA
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL.c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
.1 do hereby ce fy under the pains and penalties of perjury that the information provided above is true and correct.
Signature: 6, A. Date:
Phone#: 413-586-8600
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#:
ACO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
�� 05/29/2020
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 have ADDITIONAL INSURED provisions or 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 Cyndie Henderson CISR,CPIA
NAME:
Webber&Grinnell PHONE (413)586-0111 FAX (413)586-6481
(A/C,No,Extl: (A/C,No):
8 North King Street E-MAIL chenderson@webberandgrinnell.com
ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC#
Northampton MA 01060 INSURER A: Selective Ins Co of S Carolina 19259
INSURED INSURER B: A.I.M.Mutual/A.I.M.
Keiter Corporation INSURER C:
Attn:Scott Keiter INSURER D:
35 Main Street INSURER E:
Florence MA 01062 INSURER F:
COVERAGES CERTIFICATE NUMBER: Master Exp 2021 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 ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DDIYYYY) LIMITS
X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE X OCCUR DAMAGE TO REN FED 500,000
PREMISES(Ea occurrence) $
MED EXP(Any one person) $ 15,000
A S2265567 06/01/2020 06/01/2021 PERSONAL SADVINJURY $ 1.000,000
GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY n JECT 1-7 LOC PRODUCTS-COMP/OP AGG $ 2.000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
(Ea accident)
X ANY AUTO BODILY INJURY(Per person) $
-
A OWNED SCHEDULED A9105217 06/01/2020 06/01/2021 BODILY INJURY(Per accident) $
AUTOS ONLY _ AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per accident)
Medical payments $ 5,000
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000
A EXCESS LIAB CLAIMS MADE S2265567 06/01/2020 06/01/2021 AGGREGATE $ 5,000,000
DED X RETENTION$ 0 $
WORKERS COMPENSATION X STATUTE X ERR-
AND EMPLOYERS'LIABILITY
Y
B N
ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A MCC20020005382020 06/11/2020 06/11/2021 E.L.EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED? 1,000,000
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule.may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
""Evidence of Insurance"" ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE '"-D
NI
1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
��, r �;,, The City of Northampton
`�1,
K-,
Building Department
212 Main Street
RhIED suAE��' Northampton, Massachusetts 01060
Phone (413) 587-1240
Pax (413) 587-1272
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVAT ION PROJECTS)
In accordance with the provisions of MGL c40, s54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility as defined by MGL c 111, s150A.
The debris will be disposed of in: Va,UeY Re'cv"cling
Location of Facility Northampton,MA
The debris will be transported by:
Name of Hauler Keiter Builders
.1
Signature of Applicant: r-,,�i, Date: 1,;8;2,
DocuSign Envelope ID:7C199A45-1182-4F3E-BCAA-45C001457261 11
Contractor's profit and overhead, and any supervisory labor will not be credited back Owner with any deductive Change
Orders (work deleted from Agreement by Owner).
Contractor shall include a Contingency in the total price for its sole and exclusive use to cover additional costs for items,
conditions, or events that are uncertain or not completely foreseeable at the time the Scope of Work was created. These
costs shall include,but are not limited to,incomplete designs,scope errors,estimating inaccuracy,price escalations(<5%),
and subcontractor defaults. Contractor shall charge for profit and overhead at the rate of fifteen percent(15%)on all work
performed under the Contingency.Any Contingency money left unused shall be credited to the Owner at the completion of
the work. Contingency shall not be used for alterations or deviations from the Scope of Work.
ESCALATION CLAUSE
The parties agree if, during the performance of this Agreement,the price of building material significantly increases
(>5%),through no fault of Contractor, Owner shall be responsible for the price increase of such material. Contractor shall
provide written notice to Owner of any claim for payment of a price increase of building material through a Change
Order. Such price increase shall be documented through quotes, invoices,or receipts and shall be equitably adjusted by an
amount reasonably necessary to cover any such significant price increase.
RATES CHARGED FOR ALLOWANCE-ONLY AND TIME-AND-MATERIALS WORK
Project Manager: $95.00 per hour; Site Supervisor: $85.00 per hour; Lead Carpenter: $75.00 per hour; General Carpentry:
$68.00 per hour; Subcontractor: Amount charged by Subcontractor.Note: Contractor will charge for profit and overhead at
the rate of fifteen percent(15%)on all work performed on a time and materials basis(on both materials and labor rates set
forth in this Agreement) and on all costs that exceed specifically stated Allowance estimates in the Agreement.
PEOPLE AUTHORIZED TO SIGN CHANGE ORDERS
` lowing people are authorized to sign Change Orders:
(Please fill in line(s)above at time of signing Agreement)
PERMITS
To perform this work,Keiter Builders,Inc.,or subcontractors hired by Keiter Builders,Inc.,will obtain,on Owner's behalf,
the following permits(if required):
X Building Permit X Electrical Permit - Smoke Certificate
X Plumbing Permit Demolition Permit X Certificate of Occupancy or
Certificate of Completion
IT IS THE OBLIGATION OF CONTRACTOR TO OBTAIN THESE PERMITS AS YOUR AGENT. IN THE
EVENT THAT CONTRACTOR DOES NOT OBTAIN THESE PERMITS,AND THE OWNER OBTAINS THEM,
OR IF CONTRACTOR IS NOT REGISTERED WITH THE BOARD OF BUILDING REGULATIONS,OWNER
WILL NOT BE ENTITLED TO OBTAIN ANY BENEFITS FROM THE GUARANTEE FUND ESTABLISHED
UNDER MASSACHUSETTS GENERAL LAWS CHAPTER 142A.
Contractor's obligation to obtain permits is limited to those permits directly related to performing the work Contractor
agrees to do. To the extent that other permits or governmental or regulatory agency approvals, such as,but not limited to,
zone changes,variances, special permits, site plan approvals, or approvals of conservation commissions, are required to be
obtained before Contractor can obtain their permits, it is the Owner's obligation to satisfy such requirements and to meet
those requirements at the Owner's cost.
a!.
Contractor Owner
DocuSign Envelope ID:7C199A45-1182-4F3E-BCAA-45C001457261
ARBITRATION
THE CONTRACTOR AND THE HOMEOWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE
EVENT THE CONTRACTOR HAS A DISUPUTE CONCERNING THIS CONTRACT, THE CONTRACTOR
MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVIED
BY THE SECRETARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS
REGULATIONS AND THE CONSUMER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS
PROVIDED IN MASS.GENERAL LAWS,C.142A.
KEITER BUILDERS,INC. (CONTRACTOR) OWNER
12/30/2020 12/29/2020
By Scott Keiter,President Date Date
Date
NOTICE
THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO
ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE
ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE
PARTIES. THE RIGHT TO INITIATE ALTERNATIVE DISPUTE RESOLUTION SHALL END TWO YEARS AFTER
THE DATE OF THIS AGREEMENT.
DISPUTE RESOLUTION AND ATTORNEY'S FEES
Any controversy or claim arising out of or related to this Agreement involving an amount less than$5,000(or the maximum
limit of the Small Claims court)must be heard in the Small Claims Division of the Municipal Court in the county where the
Contractor's office is located. Any dispute over the dollar limit of the Small Claims Court arising out of this Agreement
shall be submitted to an experienced private construction arbitrator that shall be mutually selected by the parties to conduct
a binding arbitration in accordance with the arbitration laws of the state where the project is located. The arbitrator shall be
either a licensed attorney or retired judge who is familiar with construction law. If the parties can not mutually agree on an
arbitrator within thirty (30) days of written demand for arbitration, then either of the parties shall submit the dispute to
binding arbitration before the American Arbitration Association in accordance with the Construction Industry Rules of the
American Arbitration Association then in effect. Judgment upon the award may be entered in any Court having jurisdiction
thereof.
The prevailing party in any legal proceeding related to this Agreement shall be entitled to payment of reasonable attomey's
fees, costs,and post judgment interest at the legal rate.
ENTIRE AGREEMENT, SEVERABILITY, AND MODIFICATION
This Agreement represents and contains the entire agreement and understanding between the parties. Prior discussions or
verbal representations by Contractor or Owner that are not contained in this Agreement are not a part of this Agreement. In
the event that any provision of this Agreement is at any time held by a Court to be invalid or unenforceable, the parties
agree that all other provisions of this Agreement will remain in full force and effect. Any future modification of this
Agreement should be made in writing and executed by Owner and Contractor.
MISCELE-AIEOUS
10 r
Contractor ` Owner
DocuSign Envelope ID:7C199A45-1182-4F3E-BCAA-45C001457261
This Agreement is a Massachusetts contract, contains the entire agreement between us, any representations or warranties
not expressly contained in it are not a part of the Agreement, and it is binding upon our heirs, executors, successors and
assigns. This Agreement may be modified only by an instrument in writing signed by both of us.
This Agreement is subject to and is intended to comply with the provisions of Chapter 142A of the Massachusetts General
Laws and its corresponding regulations.
YOU MAY CANCEL THIS AGREEMENT IF IT HAS BEEN SIGNED BY A P TY THERETO BY FORWARDING
YOUR INTENT TO CANCEL IN WRITING BY ORDINARY MAIL POSTE , BY TELEGRAM SENT OR BY
DELIVERY, NOT LATER THAN MIDNIGHT OF THE THIRD BUSINESS DA FOLLOWING THE SIGNING OF
THIS AGREEMENT.
By signing this Agreement, you acknowledge that you have received a complete and riginal copy of the entire Agreement
and attached Addenda. Contractor may not start work until after this Agreement has een signed.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. THIS IS A LEGALLY BINDING
AGREEMENT. IF THERE ARE ANY PROVISIONS WHICH YOU DO NOT UNDERSTAND, YOU SHOULD
CONSULT WITH AN ATTORNEY BEFORE SIGNING.
KEITER BUILDERS,INC. (CONTRACTOR) OWNER
r ', 12/30/2020 tif, ,, r, 12/29/2020
r i; ..,.f" b`," ... ar,-nn r3 z<na.. arx<rtx.,
by, Scott Keiter, President Date Date
Date
=i 11 €,,
Contractor Owner