FORM



Application Forms for Multistoried construction 

SCHEDULE – 3  

FORM – I  

PART – I  

BUILDING PLAN APPLICATION FORM 

Form No.-________________  

Authorised Signature 

APPLICATION FOR PERMISSION FOR DEVELOPMENT OF BUILDING AND SUB-DIVISION OF LAND

From:                                                                                                                                                                                                                                                                                    For Office use only

Name and Address                                                                                                                                                                                                                                                              Regd. No

 (in Block letters)                                                                                                                                                                                                                                                                  Scrutiny Fee

Tel No.___________  

To  

THE CHAIRMAN,  

LOCAL PLANNING AUTHORITY

  ………...   

Madam/Sir

 I/We hereby apply for permission to undertake development and carry out:

(a) Construction of__________________storied building

(b) Re-construction of an existing building

(c) Alteration/addition to the existing building;

(d) Revalidation/renewal of plan for construction of all_________ storied building;

(e) Sub-division of land

(f) ___________(if any other please specify) 

In respect of Plot No._______ Khata No._________ Village_________ of________ Municipal Corporation/Municipal committee/NAGAR PANCHAYAT within the Urban Area of ………………. The said land building shall be used for___________________________ purpose.  

I/We enclosed herewith the following plans (4 copies in case of privately owned plots/ 8 copies in case of Govt. leased Govt. plots) and specifications duly signed by me and Architect/ Engineer/ Supervisor/ Group agency _________________bearing Regd.No.________Licence/Empanelment No._________ who has/have prepared the plans, designs etc. and who will supervise the developments.  

I/We the owner(s) of every part of the land/building to which this application relates, requests, permission for the above development may kindly be accorded. 

Place: 

Date- 

Signature of Owner(s)

Name of Owner(s) 

FORM – I

PART - II  

FORM FOR SUPERVISION 

I hereby certify that the development/erection/reerection/demolition or material  alteration in/of the building in respect of Plot No.___________ Khata No.______ Village/Mouza______of_____Municipal

Corporation/Municipality/Nagar Panchayat shall be  carried out  under my supervision and I certify  that all the materials (type and grade) and the workmanship of the work shall be generally in accordance with the general and detailed  specifications submitted along with  and that the work shall be carried out according to the sanctioned plans.  

Signature of      

 Empanelled Technical Person   
 

  Name of the Technical Person 

Address ________________    

  __________________

     __________________ 

Date: ____________ 

FORM NO.-II 

No.______,_______Municipal/ Nagar Panchayat Dated: __________  

Permission is hereby granted in favour of;  

Smt./ Shri________________________for  

(a) Sub-division of land

 (b) Institution of change of the use of land or building

(c) Construction of a____________ building

(d) Reconstruction of building

(e) Alteration of

(f) Alteration or additions in the existing building  

___________________(Specify)in respect of plot No.______________, Khata No.______________Village/Mouza.______________________ of __________________Municipal Corporation/Municipality/NAC within the Development Plan Area of_________________ subject to  following  additions/ restrictions.  

(a) The land/ Building shall be used exclusively for__________________________ purpose and the uses shall not be changed to any other use without prior approval of Authority.

(b) The development shall be  undertaken strictly according to plans enclosed with necessary permission endorsement

(c) Parking space measuring__________ sq. m. as shown in the approved plan shall be kept open and no part of it will be built upon.

(d) The land over which construction is proposed is accessible by an approved means of access of________m. width.

(e) The land in question must be in lawful ownership and peaceful possession of the applicant.

(f) The applicant shall free gift__________ m. wide strip of land in the_________ Municipal Corporation/Municipality/ Nagar Panchayat for the further widening of the road to the standard width.

(g) The permission is valid for period of three years with effect from the date of issue.

(h) Permission accorded, cannot be construed as evidence in respect of right title interest of the plot over which the plan is approved.

(i) Any dispute arising out of land record or in respect of right/ title/ interest after this approval the plan shall be treated automatically cancelled during the period of dispute.  

(j) Any other conditions. 

By Order   

Authorised Office

Memo No._________/                                          ,                                                                                                                                                                                                                                     Dated________

Copy along with ________ copies of the approved plans to

Smt./ Shri_______________________________________________. 

Authorised Officer

Memo No._________/                                         ,                                                                                                                                                                                                                                     Dated_________  

Copy with a copy approved plan forwarded to the Executive Officer, ………………….. Municipal Corporation/ Municipal committee/ Nagar Panchayat/ Executive Officer, Municipality for information.

Authorised Officer 

Memo No._________/                                     ,                                                                                                                                                                                                                                         Dated_________  

Copy forwarded to the Land Officer, G. A. Department/ Director of Town Planning, Arunachal Pradesh, Itanagar/ Enforcement Section  

Authorised Officer 

FORM-III  

APPLICATION FOR DRAWING OF ATTENTION

 Fro

_________________      

 _________________        

_________________

(Name and address of the applicant in block letters)  

TO  The Director Town Plnning/ CHAIRMAN,  Municipal Committee/ Nagar Panchayat     

Subject:  Statutory Notice   

Madam/ Sir, 
         I/We do bring to your kind notice that I/We had applied for permission to the …………………………….

 on________________ to  undertake development with respect to plot No._________ Khata No._______ Village/Mouza__________ of___________Municipal Corporation/Municipality/ Nagar Panchayat within Development Plan Area of_____________.My/ our application was registered vide No._______ Dated____________.  Two months have elapsed since the submission of my/our application and I/we have not received any communication with respect to the said application.  

Please take notice that if within a further period of one month from the date of receipt of this notice by you no communication either granting or refusing permission is received by me/ us, I/ we shall presume that permission as applied for has been granted in my/ our favour. 

Yours faithfully,   

Signature of the applicant(s)   

FORM-IV 

Form of Registered to be maintained 

Sl. No.  Name and  address of the applicant Date of permission with letter No Date of refusal with letter No Date of endorsement  to Enforcement Branch Branch 
Date of return from Enforcement  Bran
Date  of sending to record room Signature of the dealing Asst Signature of the S.O.   
                   

FORM-V

FORM   OF NOTICE FOR COMMENCEMENT OF WORK  

 (TO BE FURNISHED BY THE PLOT OWNER(S) AND THE BUILDER/ DEVELOPER) 

From:

___________    

_____________        

_____________

(Name and address in Block Letters)  

TO

 THE Chairman /VICE-CHAIRMAN 

………………..    

 ……………….  

Sir,   
 I/We  hereby give notice of the erection  of building in respect of plot No.______________ Khata No._______

Village__________ to be commenced on__________ as per the permission given in your letter No.  _______    

Dated _________ under the supervision, empanelled Architect/Engineer/ Structural Engineer__________________________,Regd.No_______ in accordance with the approved plan. 

 

Yours faithfully,    

Signature(s) of the Owner      

Signature of Builder / Developer

FORM – VI 

PART - I  

COMPLETION CERTIFICATE 

From

 ___________      

 ___________        

____________

 (Name and address in Block Letters)  

TO

The Director Town Planning/ CHAIRMAN/ VICECHAIRMAN, 

Sir,    

 I hereby certify that the development, of erection, reerection or for material alteration in respect of the building on Plot No.____________,Khata No.____________

Village/Mouza____________of___________________ Municipal Corporation/Municipality/NAC within the Development Area of__________ has been supervised by  me and has been completed on ________ according to the plans sanctioned vide No.________ dated _________.The work has been completed to my best satisfaction, the workmanship and all the  materials(type and grade) have been  used strictly, in accordance  with the general and detailed specifications. No provisions of the code, conditions prescribed or orders issued there under have been transgressed in the course of the work.  The land is fit for construction for which it has been developed or re-developed or the building is fit for use for which it has been erected, re-erected or altered, constructed and enlarged. I hereby also enclose the plan of the building completed in all aspects.  
Signature oF

 Empanelled Technical Person   
 

   Name of the Technical Person 

ADDRESS ______________    

    ______________   

   _______________

Date: ____________ 

FORM – VI

PART - II  

CERTIFICATE FOR EXECUTION OF WORK AS PER STRUCTURAL SAFETY REQUIREMENTS 

With respect to the building work of erection, re-erection or for making alteration in the building on Plot No._____________

Khata No._________ Village/Mouza_________ of_______ Municipal Corporation/Municipality/Nagar Panchayat within the Development Plan Area of_______ I certify;  

(a) that the building has been constructed according to the sanctioned plan and  structural design( copy  of the drawings as executed enclosed),which incorporates the provisions of structural safety norms as specified in Part- 6 (Structural Design)  of the National Building Code of India, 2005 and other relevant codes; and

(b) that the construction has been done under my supervision and guidance  and adheres  to the drawings and specifications submitted and records  of supervision have been maintained.   

Any subsequent changes from the completion drawings shall be the responsibility of the owner   

Signature of owner  with date  

Signature of the Empanelled Engineer/Structural Engineer

with date and Empanelment No.

Name:     ______________      ___________________________ 

Address: ______________         __________________________

FORM-VIII

CERTIFICATE FOR STRUCTURAL STABILITY

With respect to the building work of erection, re-erection or for making alteration in the building on Plot No.______________Khata No.___________

Village/Mouza______of_

Municipal Corporation/Municipality/NAC within the Development Plan Area of_____________________, I certify that the structural plans and details of the building  submitted for approval satisfy the structural safety requirements for all situations including natural disasters like cyclone &earth quake etc., as applicable, as stipulated under Part- 6 (Structural Design) of the National Building Code of India, 2005 and other relevant codes; and the information given therein is factually correct to the  best of my knowledge. I undertake responsibility with regard to supervision of the work at each stage of construction,(after laying of foundation &after casting of each floor) and submit the report to …………………………………………………… regularly to effect that the building is being constructed conforming to the approved plan and as per the structural plan prepared by me.  I will be responsible and liable for action by Govt. if the plan/design contain misrepresentation or fraudulent information and the construction is made in deviation of approved plan or if there is any structural failure due to wrong /unsafe structural design ,use of low quality material and/or poor workmanship endangering the in-mates7public. 

Signature of owner                                                                                                               Signature of the Registered

With date                                                                                                                               Engineer/Structural

                                                                                                                                              Engineer with date and

                                                                                                                                              registration No.

Name: ____________________                                                                                  ________________________  

Address: ____________________                                                                              ________________________ 

FORM-VII

 PERIODIC PROGRESS REPORT 

 (To be submitted by the Empanelled Structural Engineer/ Architect/Engineer) 

From:

 ________________________

________________________  

TO

THE PLANNING MEMBER,

 ………………………………..

………………………………..  

Ref _____Municipaity/Nagar Panchayat approval letter No._________Dated ___________    

Madam/ Sir,   

I/We hereby certify that the construction of the building up to foundation, plinth/ground floor/floors of the building plot No._________ Village/Mouza __________ has been supervised by me/us and has been constructed strictly conforming to the sanctioned plan and structural design as per the provision of NBC, 2005.  The work has been done to my/our best satisfaction. All the materials used in construction of this building are strictly in accordance with BIS/ISI specifications and norms conforming to National Building Code, 2005 covering all the safety factors including earthquake and cyclone. I/we will be responsible and liable for action by Govt. if there is any structural failure and fire endangering the inmates and public.

Yours faithfully,  
     

 Signature of the Architect/Engineer  

Name      

Empanelment No.       

 Signature of Structural Engineer   

Name  

 Empanelment No. 

          FORM-IX

 No.__________________ /                                                                                                                                                                                                                                          Dated th___ 

REFUSAL OF PERMISSION FOR UNDERTAKING DEVELOPMENT OF PLOT NO. _______ IN MOUZA _______________ 

To,  

SMTI/SRI______________________  

 ________________________________  

________________________________  

 Your reply to this office letter No. ………………….Dt………….. has not been found satisfactory / You have failed to show any cause in response to this office letter No………………………… Dated …………………   
 Hence, in exercise of the powers under Sub-Section ………..of section-………………………….., permission to undertake development on plot No……………………………… Mouza……………………. Of ……………………/ Khurda/ Development Plan area is hereby refused on the following grounds.  

1…………………………………………………………………………………

2………………………

3…………………

4………………………

Two copies of the plans are retained in this office for record and reference and the rest are returned herewith.  

BY ORDER  
AUTHORISED OFFICER 

Memo.No……………………./                                                                                                                                                                                                                                                           Dated……………………   
Copy to Municipal Commissioner, /Director of Estates, / Director town Planning  (in case of lease plots).   

AUTHORISED OFFICER 

FORM - X  

OCCUPANCY CERTIFICATE 

The work of erection, re-erection or for material alteration undertaken in respect of Plot No._____

illage/Mouza _______________________ is completed under the supervision of_______________ Architect (Empanelment No._____)____Structural Engineer (Empanelment No.__) Supervisor_ (Empanelment No. ________________) as per the Completion certificate submitted. On inspection it is observed that the erection, re-erection or alteration undertaken with respect to above plot(s) conform/ do not conform the approved plan and the conditions imposed vide letter No.____________dt_____________.The building is permitted/not permitted for occupation for___________ occupancy subjected to the following

1

2.

3. 

One set of completion plans duly certified is returned herewith.   

BY ORDER    

Authorised Officer 

FORM-XI  
INDEMNITY BOND FOR BASEMENT 

This  Indemnity Bond is executed by Shri/Smt_________________ S/O,D/O,W/O

Shri/Smt_____R/O___in favour of …………………….. Authority

Whereas the  executant has submitted to the concerned Authority the plans for,sanction of basement over Plot No.___________ Mz / Vill_____________ under the provisions of the Act  and  and Rules and Building Regulations  made there under:-  

And whereas the concerned Authority has agreed to sanction the aforesaid construction subject to the conditions that the owner shall indemnify  the concerned Authority in the event of any loss or damage being cause to the adjoining building on account of the construction of the said basement either  at the time of digging of its foundations or in the course of its construction or even thereafter  and also against any claim of any concern thereto.  

And whereas the executant has agreed to execute an indemnity bond to the above affect and also to abide by the terms imposed by the concerned Authority to the grant of sanction for construction of the basement.

Now this deed witnesses:  

1. That in consideration of the sanction of the plans by …………………………. for construction of the basement the executant undertakes that he/she shall at all times keep authority free from any liability, loss or damages/flowing from any injury or damage caused to the adjoining built-up properties or to any person as a consequence of the construction of at the time of digging of its foundations or during the course  of its construction or at any time thereafter.

2. The owner agreed and undertakes that in the event of any claim being made by any person or persons against the concerned Authority either in respect of the sanction granted by the concerned Authority to the owner for the construction of basement or in respect of the construction or manner of construct ion of the basement by the owner of the consequences flowing from the said sanction the executant shall be responsible and liable and not authority.

3. The executant agrees and undertake to indemnify the concerned Authority fully in respect of any amount which the concerned Authority may be required to pay to any person either by way of compensation or  on any other account as a result of any claim or suit or any other proceedings concerning the sanctioning of the construction of the basement of the making thereof and also in respect of the costs and expenses which the concerned Authority may incur on defending any action. 

4. Without prejudice to the above undertaking  the executant hereby binds itself to pay to authority to the full extent any amount which  authority may be required to pay to any person in connection with, relating  to or concerning the sanctioning of the basement or the making thereof.

5. The owner agrees and undertakes that this bond shall remain in full force and effect till the executant faithfully observes/performs the undertaking herein before contained

In witness whereof the executant above named has signed this bond on this__________ day of___________ at___________________

Indemnifier

 Witness:  

(Signatures)_____________________  

1. Name_________________________  

Full Address____________________  *

(Signatures)  

2.  Name_________________________  

Full Address____________________  

(Signatures)  

*****