30A-020 (3) 37 CLEMENT ST BP-2016-1100
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 30A-020 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-2016-1100
Project# JS-2016-001879
Est. Cost: $42962.00
Fee: $279.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: KEITER BUILDERS 102457
Lot Size(sq. ft.): 64468.80 Owner: STARR ELISE L
zoning: SRO 13)/WP(60)/SI(0)/ Applicant: KEITER BUILDERS
AT: 37 CLEMENT ST
Applicant Address: Phone: Insurance:
35 MAIN ST (413) 586-8600 O WC
FLORENCEMA01062 ISSUED ON.•3/17/2016 0:00:00
TO PERFORM THE FOLLOWING WORK.REPLACE SKYLIGHTS, ROT REPAIR & NEW
ROOF
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:
FeeType: Date Paid: Amount:
Building 3/17/2016 0:00:00 $279.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File# BP-2016-1100
APPLICANT/CONTACT PERSON KEITER BUILDERS
ADDRESS/PHONE 35 MAIN ST FLORENCE01062(413)586-8600 Q
PROPERTY LOCATION 37 CLEMENT ST
MAP 30A PARCEL 020 001 ZONE SRO 13)/WP(60)/SI(0)J
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid n
Building Permit Filled out r
Fee Paid
Typeof Construction: REPLACE SKYLIGHTS,ROT REPAIR&NEW ROOF
New Construction
Non Structural interior renovations
Addition to Existing-
Accessory Existing-
AccessoryStructure
Buildinp-Plans Included:
Owner/Statement or License 102457
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO MATION 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
3 <
- /t(•�
Sign i g ficia 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.
Department use only
City of Northampton Situs of Permit'
2016 ' Building Department Gini Cut/Driyeway Permit
212 Main Street Sewer/Septic Availability
Room 100 Watedwe'li Avallabiltty
EgQrBUILDING INSPEGnONg
Northampton,htMA 01060
NC3HTHAMPTON MA 01060 Two Sets of Structural Plein
phone 413-587-1240 Fax 413-587-1272 Pl1WMe Ptens`
'Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Propertv Address: This section to be completed by office
s
37 Clement St, Florence, MA MapLot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Elise Starr 37 Clement St Florence, MA
Name(Print) Current Mailing Address: 413-586-5561
Please see attached signed contract Telephone
Signature
2.2 Authorized Agent:
Keiter Builders, Inc 35 Main St Florence, MA 01062
Name int) Current Mailing Address:
President, Keiter Builders, Inc. 413-586-8600
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by Rermit applicant
1. Building $42,961.88 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) /
5. Fire Protection
6. Total=(1 +2+3+4+5) $42,961.88 1 Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
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 O DON'T KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DON'T KNOW O YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DON'T 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:
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:
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? YEF O NO O
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aoolicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Z
Or Doors P11
Accessory Bldg. ❑ Demolition ❑ New Signs 0] Decks E–] Siding❑] Other[p]
Brief Description of Proposed
work: New roof, replace existing skylights, mise rot repair
Wn
Alteration of existing bedroom Yes X No Adding new bedroom Yes X
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet —
6a. if New house and or addition to existing housing` icomplete the following:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PER MIT
I, Elise Starr as Owner of the subject
property
hereby authorize Keiter Builders Inc
to act on my behalf, in all matters relative to work authorized by this building permit application.
Please see attached signed contract 03 14 16
Signature of Owner Date
I, Keiter Builders Inc 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.
Scott Keiter
P Name
President, Keiter Builders,Inc. 03.14.16
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:Scott Keiter CS-102457
License Number
51 A Hatfield St Northampton MA 01060 6.20.16
AddreG Expiration Date
President, Keiter Builders,Inc. 413.586.8600
Signature Telephone
9 Realstered Home Improvement Contractor Not Applicable ❑
Keiter Builders- Inc175168
Company Name Registration Number
35 Main Street Florence MA 01062 4 2g 17
Address Expiration Date
Telephone 413.586.8600
SECTION 10-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...... ❑
11. - Horne Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition Section 108.3.Q.
Definition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
Williamsburg, MA
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: 37ciementsStFlorence, MA01062
The debris will be transported by: Keiter Builders, Inc
The debris will be received by: valley Recycling
Building permit number:
Name of Permit Applicant Keeler Builders. Inc
Ylt-� Presideut, Keiter Builders,lite
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
a W Office of Investigations
I Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Uplicant Information Please Print Legibly
Name (Business/Organization/Individual): Keiter Builders, Inc
Address:35 Main Street
City/State/Zip: Florence, MAO 1062 Phone #:413.586.8600
Are you an employer? Check the appropriate box: Type of project(required):
1.11 I am a employer with 15 4. 0 I am a general contractor and 1
employees (full and/or part-time).* have hired the sub-contractors 6. ® New construction
2.0 1 am a sole proprietor or partner- listed on the attached sheet. 7. ® Remodeling
ship and have no employees These sub-contractors have 8. CJ Demolition
working for me in any capacity. employees and have workers'
9. 0 Building addition
[No workers' comp. insurance comp. insurance.*
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.0 1 am a homeowner doing all work officers have exercised their l I.[] Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.6 Roof repairs
insurance required.] t c. 152, §1(4), and we have no 13.� Other
employees. [No workers'
comp. insurance required.]
*Any applicant that checks box 41 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:Arbella
Policy# or Self-ins. Lic. #:9127440615 6.11.16
Expiration Date:
37 Clements St 03.14.16
Job Site Address: City/State/Zip:
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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
1 do herebyrtify the pains and penalties of perjury that the information provided above is true and correct.
,cf03.10.16
Si ature. President, I{etter Builders, Inc. Date:
Phone#: 413.586.8600
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License #
Issuing Authority (circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
DATE(MMUDD/YYYY)
'`� RQ® CERTIFICATE OF LIABILITY INSURANCE 7r10l2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER CONTNAME Cynthia Henderson, CISR _
Webber & Grinnell (PNNo.Ert)• (413)586-0111 J FAX
N21:(413)586^6481
8 North King Street AooE$:chenderson@webberandgrinuell.com
INSURERS AFFORDING COVERAGE NAIL<1
Northampton MA 01060 INSURER AA Arbella Insurance Group _J 17000
INSURED INSURER B
Keiter Builders, Inc, INSURERC:
Attn: Scott Keiter INSURER 0: u�
35 Main Street INSURER E:
Florence MA 01062 INSURER F
COVERAGES CERTIFICATE NUMBER:Master Exp 2016 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 ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP
T LIMITS
$ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED 300,000
A CLAIMS-MADE I X I OCCUR PREMISES a occurrence) $
8500064396 6/1/2015 6/1/2016 MED EXP(Any one person) $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
� PRO- �
POLICY u1 JECT 0 LOC PRODUCTS-COMP/OPAGG $ 2,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
8 acpiden
A ANY AUTO BODiLY INJURY(Per person) $
ALL OWNED % SCHEDULED 1020039381 6/1/2015 6/1/2016 BODILY INJURY(Per accident) $
AUTOS AUTOS �.
NON-OWNED PROPERTY DAMAGE
HIRED AUTOS B AUTOS (Per accident) $
Medical Payments $ 5,000
X UMBRELLA LIAB OCCUR EACH OCCURRENCE--J 110001000
A EXCESS LIAR CLAIMS-MADE AGGREGATE $ 11000,000
DED RETENTION$ 10,000 4600064399 6/1/2015 6/1/2016 g
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY Y/N SAT E ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000
A OFFICER/MEMBER EXCLUDED? N/A -
(Mandatory inNH) 9127440615 6/11/2015 6/11/2016 E.L.DISEASE-EA EMPLOYE $ 100,00
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500 000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached It 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
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
s1
C Henderson, CISR/CIN
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
INS095 ramenrn
STARR Febwary 29, 2016
er F WORK
lders, Inc.
treet
!"Mlrenec , MA 01062 KE 1 T OER
Office 413.586.8600
Fax 413.280.0124 B U I L D E R S c
scottkeiter@gmail.com
www.KeiterBuilders.com
License #: 102457
Project Customer
,. STARR � � i Lise Starr
37 CLEMENT STREET 37 Clement Street
FLORENCE, MA 01062 I Florence, MA 01062
MISC. REPAIRS
Ccs
C Description. — -_—_--
r �
Building Permit,
General Administration
Materials Running
Portable Toilet
Site Breakdown
Site Set-Up
Waste Removal
General Carpentry
Allowance. $1,000.00 Materials&80 Man Hours
-Selective rot repair
$: w
Gutters
Allowance; $1,800.00
Windows 12,36f
Skylights
(6)units FS-S06. $456.00+Flashing Kit$110.00
(1)unit FS-004. $269.00+Flashing Kit$92.00
(2)units FS-506. $456.00+Flashing Kit$110.00+,$72.00 Filler Kit(Windows in bonus room above garage)
Remove and dispose of existing skylights
Install new skiights to all manufacturer specifications
Repair and install interior drywall returns as required
Initial Here Initia4
STA R R February 29, 2016
Cost
Roofing 18,975.00
Roofing Contractor
See NRB proposal in the amount of$17,250.00
P
Staging&Ladders
Hauling,set-up,breakdown of staging and ladders to access damaged/rotten trim on backside of building
Rot Repair
-This scope of work does not include any work to the existing roof sheathing,insulation,ventilation systems,or structural members. In the event
that repair work is needed,this will be handled by a change work order. Time and material rates are as follows: Carpenter: $55/Hour. Material
marked up by 10
Project Total 42,961.88
Initial Here In { ere
/EQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN MASS. GENERAL LAWS,
A.
KEITEB�ILDERS, INC. OWNER
y Ott eiter, 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.
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.
MISCELLANEOUS:
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.
Owner understands and acknowledges that Keiter Builders, Inc. may use any photos taken during the course of
work for promotional purposes. This may include, but is not limited to, the following: Website, newspapers,
journals, magazines, posters, and flyers.
RIGHT TO CANCEL CONTRACT:
YOU MAY CANCEL THIS AGREEMENT IF IT HAS BEEN SIGNED BY A PARTY THERETO BY
FORWARDING YOUR INTENT TO CANCEL IN WRITING BY ORDINARY MAIL POSTED, BY
TELEGRAM SENT OR BY DELIVERY, NOT LATER THAN MIDNIGHT OF THE THIRD BUSINESS
DAY FOLLOWING THE SIGNING OF THIS AGREEMENT.
Initial Hers; 5 Initial
By signing this Agreement, you acknowledge that you have received a complete and original signed copy of the
entire Agreement and attached Exhibits. Keiter Builders, Inc. may not start work until after this Agreement has
been 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. OWNER
1
I
/ S7
3 1 I rJ
by,4St ei�er, resident Date T Date
Date
Initial HereInitiall, re
6 _
fi--cc,