Kelly Survey Residential,
Commercial and Industrial
Land Surveying and Planning
609-517-5177
http://www.kellysurveyors.com/
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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Provider Work Order
( * = Required Information )
Property Information
*Street Address:
*City:
*County:
*State: *Zip Code:
*Tax Lot:
*Block:
Settlement Date:
Deliver Plans By:
Listing Agent:
Listing Agent #:
Title Company Information
Company Name:
Address:
Phone:
Mortgage Company Information
Company Name:
Address:
Phone:
Survey Information
*Survey Reason: Refinance Resale Other
*Property Type: Residential Commercial
*Survey Type: Full Land Survey without Property Corners Set.
NOTE: IF YOU ELECT A FULL SURVEY WITHOUT PROPERTY CORNERS SET YOU MUST READ THE WAIVER BELOW DOWNLOAD, SIGN AND MAIL OR FAX THE WAIVER AFTER YOU SUBMIT THIS ORDER.
Full Land Survey with Property Corners Set.
NOTE: NO NEED OF WAIVER.
  Add Tidelands Survey
Add FEMA Elevation Certificate to land survey.
FEMA Elevation Cert Only.
Ordered For
Buyer's Name:
Street Address:
City:
State: Zip Code:
Phone:
Ordered By
*Name:
*Company Name:
*Street Address:
*City:
*State: *Zip Code:
*Phone:
Fax:
*E-mail:
Comments:
WAIVER: This is to advise that I have been made aware of my right to have corner markers set as part of a survey to be performed on the aforementioned property. In addition, I have been made aware of the potential impact of signing the waiver including: (1) the possible need for a future survey as a result of physical improvements to the property, such as a fence, addition, deck, pool, or shed and (2) the potential inability of the ultimate user to identify the actual boundary of the property which could result in a boundary dispute with an adjoining property owner and/or property improvements not accurately situated on my property. The right to have corner markers set is hereby waived, and you are directed to perform the land survey without the setting of corner markers as provided by the regulation (N.J.A.C. 13:40-5.2) of the State Board of Professional Engineers and Land Surveyors.
 
*Click here to download and to Acknowledge Waiver.
Waiver must be signed and returned for orders requesting NO property corners only.

 
 
  Steven R. Kelly, Licensed Professional Land Surveyor and Planner
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