Form ID

Publication date

Location of premises

Certificate

Construction of a 4 Hour Rated Firewall

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
HIP Southworks Inc.
Address of Owner
700 Rupert Street, Unit A, Waterloo, ON N2V 2B4
Name of Contractor
Melloul-Blamey Construction Inc.
Address of Contractor
700 Rupert Street, Unit A, Waterloo, ON N2V 2B4
Name of Certifier
MartinSimmons Architects Inc.
Address of Certifier
200-113 Breithaupt Street, Kitchener, ON N2H 5G9

Identification of Premises

64 Grand Avenue South, Cambridge, Ontario N1S 2L8

Office to which claim for lien must be given to preserve lien

See Part A