Form ID

Publication date

Location of premises

Certificate

Emergency Repairs of Dwelling and Entire Contents of Same Due to Fire Damages

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
John and Maureen Hengeveld
Address of Owner
42692 Cranbrook Rd., Brussels, ON
Name of Contractor
Winmar Stratford o/a 1525104 Ontario Limited
Address of Contractor
390 Douro St., Stratford, ON
Name of Certifier
John Prtenjaca
Address of Certifier
390 Douro St., Stratford, ON N5A 3S7

Identification of Premises

42692 Cranbrook Rd., Brussels, Ontario