(×¾ÖÛúÖÃÖ ¯Ö¸ü¾ÖÖ®ÖÝÖß ¯ÖÏßÖÖ¾Ö ¤üÖÜÖ»Ö Ûú¸üŸÖÖ®ÖÖ †•ÖÔ¤üÖ¸ü / ×¾ÖÛúÖÃÖÛú / •Ö×´Ö®Ö¬ÖÖ¸üÛú µÖÖÓ“ÖêÛú›æü®Ö ¹ý.

200/- “µÖÖ Ã™òü´¯Ö

¯Öê¯Ö¸ü¾Ö¸ü ‘µÖÖ¾ÖµÖÖ“Öê ¯ÖÏן֖ÖÖ¯Ö¡Ö)

I, Shri. ____________________ (address)______________ intent to carry out development work in

the site of land bearing S.No./ Gat No./Hissa No./ C.T.S. No./Property No. _______________
admeasuring _______ sq.mt. of village________, Taluka ________, Dist. Pune in accordance with
section 18 of the Maharashtra Regional and Town Planning Act, 1966.

I have appointed / will be appointing the following Technical personnel / Firm for carrying out the
development and construction work on the aforesaid land.

Sr.N Date of Name of Technical Address Scope of work and responsibility in

o. appointment / personnel / Firm brief / Services rendered
Agreement (if
appointed)

1 Architect To prepare and submit the

necessary layout and building plans
and to verify that the development
on site is done in accordance with
the sanctioned plans.

2 To be Structural Engineer To study the strata and design the

communicated Structure considering various load
prior to combinations and also to check and
commencement verify the reinforcement on site
of work on site. before casting. To certify the design
adequacy of construction work at
foundation, plinth and completion
stages as regards to the stability,
based upon the certificates of the
Licensed Site Engineer / Supervisor
pertaining to quality and
methodology of executed
construction work.

3 To be Full time Licensed To verify quality and grade of

communicate Site Engineer / Site materials to be used on site, to
prior to Supervisor strictly follow design, plans and
commencement methodology as issued by the
of work on site. (Appointed by the consultants and observe standard
Owner / Developer / workmanship as per NBC while
(In Form B) Contractor) supervision. To observe all safety
measures while scaffolding /
shuttering / all other construction
elements and hygienic conditions on
site.

I undertake to submit the supervision memo of licensed engineer/supervisor as well as the

appointment letter of the licensed structural engineer, prior to sanction of plans/commencement of
actual work on site.

The above technical personnel / agencies have agreed to render their services as mentioned in brief

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as above and have signed and handed over their detail scope of work and responsibility to me. I
hereby undertake to intimate any change regarding aforesaid technical personnel / agencies or in
case of their resignation as soon as, if it occurs in future.

However as an Owner / Developer of the aforesaid development, I am fully responsible as per

Regulation No. 7.1 of Standard Development Control and Promotion Regulations for Regional Plans
Area to carry out the work strictly in accordance with the sanctioned plan and follow safety norms as
prescribed by Bureau of Indian Standards by appointing required technical personal / agencies as
above.

I herewith undertake to verify the foundation strata through concerned licensed technical agency on
site and handover the report of the same to the Structural Engineer for preparing structural designs.

I herewith undertake not to proceed with further development without obtaining plinth checking
certificate and also undertake not to occupy / allow to occupy the premises or part of it without
obtaining completion certificate for the same.

Name of the Owner / Developer

Place : Pune.
Date :
Signature of Owner / Developer

Address of Owner/Developer :

Telephone no. Fax No. :

E­mail ID :

Mobile No. :

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 (ÃÖ´ÖæÆü ÝÖéÆü ×®Ö¾ÖÖÃÖ ¯Ö¬¤üŸÖß“µÖÖ ¸êüÜÖÖÓÛú®Ö/²ÖÖÓ¬ÖÛúÖ´Ö ®ÖÛúÖ¿Öê ´ÖÓ•Öæ¸üß“µÖÖ ¯ÖÏßÖÖ¾ÖÖÃÖÖê²ÖŸÖ ¤üÖÜÖ»Ö Ûú¹ý®Ö ‘µÖÖ¾ÖµÖÖ“µÖÖ
†•ÖÖÔ“ÖÖ ®Ö´Öã®ÖÖ)
APPENIDX A -1

FORM FOR CONSTRUCTION OF BUILDING OR LAYOUT OF BUILDING / GROUP HOUSING

Application for permission for development under Section 18 of the Maharashtra Regional and
Town Planning Act, 1966

From _________________
(Name of the Owner)

To,

The Collector,
Dist________

Sir,

I intend to carry out the under mentioned development in the site/plot of land, on Plot
No……… Town and Revenue S. No……….City Survey No…………..Area ....... sq.m., Mauje …………situated
at Road / Street ………… Society …………. in accordance with Section 18 of the Maharashtra Regional
and Town Planning Act, 1966.

I forward herewith the following plans and statements (Item i to viii) wherever applicable, in
quadruplicate, signed by me (Name in block letters) …………..and the Architect / Licensed Engineer /
Structural Engineer/Supervisor, (License No………….), who has prepared the plans, designs and a copy
of other statements / documents as applicable.

i) Key plan (Location Plan);

ii) Site Plan (in quadruplicate) of the area proposed to be developed;
iii) a detailed building plan (in quadruplicate) showing the plan, section and elevations of the
proposed development work;
iv) Particulars of development in Form enclosed (to be submitted for development other than
individual buildings);
v) An extract of record of rights, property register card (any other document showing
ownership of land to be specified) along with consent of co­owners where third party
interest is created.
vi) Attested copy of receipt of payment of scrutiny fees;
vii) Latest property tax receipt;
viii) No Objection Certificate, wherever required.
I request that the proposed development/ construction may be approved and permission
accorded to me to execute the work.

Signature of Owner / Developer

Name and address of Owner
Dated______
Address of Owner ­­­­­­­­­­­­­­­­­­­­­­­

I, .............. (Name of the Architect / Licensed Engineer) shall be responsible for Item no. i to iv only
as listed hereinabove.

Signature of Architect / Licensed Engineer / Structural Engineer/Supervisor

Dated______

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 (¸êüÜÖÖÓÛú®Ö ®ÖÛúÖ¿Öê/•Ö×´Ö®Öß“µÖÖ ×¾Ö³ÖÖÝÖÞÖßÃÖÖšüß ¯ÖÏßÖÖ¾ÖÖÃÖÖê²ÖŸÖ ¤üÖÜÖ»Ö Ûú¹ý®Ö ‘µÖÖ¾ÖµÖÖ“µÖÖ†•ÖÖÔ“ÖÖ ®Ö´Öã®ÖÖ)
APPENIDX A -2

FOR SUB-DIVISION OF LAND AS PLOTTED LAYOUT

Application for permission for development under Section 18 of the Maharashtra Regional and
Town Planning Act, 1966

From ___________________
(Name of the Owner)

To,
The Collector,
Dist________

Sir,
I intend to carry out the under mentioned development in the site/plot of land, bearing S.
No. /Gut No. …………… City Survey No.……………………, Mouje ………………….., situated at Road / Street
……………………… in accordance with Section 18 of The Maharashtra Regional and Town Planning Act,
1966.
I forward herewith the following plans and statements (Item 1 to 6) wherever applicable,
in quadruplicate, signed by me (Name in block letters) …………………………… and the*Architect
/Licensed Engineer / Structural Engineer (License No……………………….), who has prepared the plans,
designs and a copy of other statements / documents as applicable.
(1) Key Plan (Location Plan);
(2) A site plan (in quadruplicate) showing the surrounding land and existing access to the land
included in the layout;
(3) A layout plan (in quadruplicate) showing ­
(i) Sub­divisions of the land or plot with dimensions and area of each of the proposed
subdivisions and its use according to prescribed regulations;
(ii) Width of the proposed streets; and
(iii) Dimensions and area of open spaces provided in the layout for the purpose of
recreational open space or any like purpose.
(4) An extract of record of rights property register card (any other document showing
ownership of land to be specified) along with consent of co­ owners where third party
interest is created.
(5) Attested copy of Receipt for payment of scrutiny fees.
(6) No Objection Certificate, wherever required.
I request that the proposed layout may please be approved and permission accorded to me
to execute the work.

Signature of Owner
Name of Owner ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
Address of Owner­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
Dated­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
*(As applicable to either)

I, .............. (Name of the Architect / Licensed Engineer) shall be responsible for Item no. (1) to (3)
only as listed hereinabove.

Signature of Architect / Licensed Engineer / Structural Engineer/Supervisor

Dated­­­­­­­­­­­­­­­­­­­­­­­­­­­­­

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¤êüÜÖ¸êüÜÖß“Öê ¯Ö¡ÖÖ´ÖÞÖ¯Ö¡Ö)
APPENDIX ' B'

FORM OF SUPERVISION

To,

The Collector,

Dist ­­­­­­­­­­­­­­­

Sir,

I hereby certify that the development/erection/re­erection/demolition or material alteration

in/or Building No____________ on / in Plot No. ____________ in Block No.________________
situated at Road / street ___________________ City Survey No. __________________ shall be
carried out under my supervision and I certify that all the materials (types and grade) and the
workmanship of the work shall be generally in accordance with the general specifications submitted
along with, and that the work shall be carried out according to the sanctioned plans*. I shall be
responsible for the execution of the work in all respects.

Signature of the Licensed Site / Supervising Engineer ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­

Name of Licensed Site / Supervising Engineer

(in block letters) ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­

License No. of Licensed Site / Supervising Engineer ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­

Address of Licensed Site / Supervising Engineer along with­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­

Mobile No. & e­mail ID ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­

Date:

* and as per the design, working plans and methodology as issued by the consultants.

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APPENDIX ' F'

FORM FOR INTIMATION OF COMPLETION OF WORK UPTO PLINTH LEVEL

To,

The Collector,

Dist___________

Sir,

The construction up to plinth / column up to plinth level has been completed in Building No
______________Plot No ______________, Revenue Survey No.____________, City Survey
No.________________, mauje ______________, situated at Road/Street
________________,Society____________ in accordance with your permission No _________ dated
___________________ under my* supervision and in accordance with the sanctioned plan.

Please check the completed work and permit me to proceed with the rest of the work.

Yours faithfully,

Signature of Architect / Licensed Engineer / Structural Engineer/Supervisor

Name:
(In Block Letters)
Address:
E­mail ID:
Mobile No.:
Date:

*/the supervision of the Licensed Site Engineer / Site Supervisor

Enclosed –
Certificate by Architect (Format – F1 attached)
Certificate by Structural Engineer (Format ­ F2 attached)
Certificate by Supervisor (if the Architect is not undertaking supervision) (Format – F3
attached)

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 (¾ÖÖßÖã×¾Ö¿ÖÖ¸ü¤ü µÖÖÓ®Öß ´ÖÓ•Öæ¸ü ‡´ÖÖ¸üŸÖß“µÖÖ •ÖÖꟵÖÖ¯ÖµÖÕŸÖ“Öê ²ÖÖÓ¬ÖÛúÖ´Ö ¯ÖæÞÖÔ —ÖÖ»Öê²ÖÖ²ÖŸÖ ªÖ¾ÖµÖÖ“µÖÖ ÃÖæ“Ö®ÖêÃÖÖê²ÖŸÖ
•ÖÖê›üÖ¾ÖµÖÖ“Öê ¯ÖÏ´ÖÖÞÖ¯Ö¡Ö)

APPENDIX ' F-1'

FORM FOR CERTIFICATE OF COMPLETION OF WORK UPTO PLINTH LEVEL
(ARCHITECT/ LICENSED ENGINEER / ARCHITECTURAL CONSULTANT)
To,
The Collector,
Dist ­­­­­­­­­­­­­­­
Sir,
The construction up to plinth / column up to plinth level has been completed in Building No
______________Plot No ______________, Revenue Survey No.____________, City Survey
No.________________, mauje______________, situated at Road/Street
________________,Society____________ in accordance with your permission No _________ dated
___________________ as per the sanctioned drawings and working drawing details given. I have
verified the marginal distances and dimensions of the plinth on _______ and the same are found to
be in accordance with the sanctioned plan. All issues related to supervision, materials, workmanship,
and execution are the sole responsibility of the Supervising Engineer and visits made by the
Architect/ Licensed Engineer/ Architectural Consultant are not for supervision since I am not
responsible for supervision and quality of work.
This certificate is issued in conjunction with the certificates of the Licensed Site Engineer/
Site Supervisor certifying the quality of work.

Signature of Architect/ License Engineer/ Architectural Consultant

Name:
(In Block Letters)
Address:
E­mail ID:
Mobile No.:
Date:

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•ÖÖê›üÖ¾ÖµÖÖ“Öê ¯ÖÏ´ÖÖÞÖ¯Ö¡Ö)

APPENDIX ' F-2'

FORM FOR CERTIFICATE OF COMPLETION OF WORK UPTO PLINTH LEVEL
(STRUCTURAL ENGINEER)
To,
The Collector,
Dist ­­­­­­­­­­­­­­­

Sir,
This is to certify that I have designed the foundations for the proposed structure consisting
of.............. floors and as described in my enclosed Design Basis Report based upon the
recommendations given by the geotechnical consultant suggested by me and appointed by the
Owner/*my verification of strata based upon my judgment, and based upon the relevant Indian
Standard Codes, I further certify that with reference to the undertaking given by the Supervising
Engineer, work up to Plinth has been done as per my drawing and design (*Strike out whichever is
not applicable). On basis of this I hereby certify that to the best of my knowledge and belief the said
work up to Plinth is structurally fit for the super structure for intended purpose.
As a Consulting Structural Engineer my responsibilities are limited to providing Structural
Designs and Drawings in accordance with the provisions of the relevant prevailing Indian Standard
Codes and visits to site at specified stages called for by the Supervising Engineer for verification of
reinforcement laid. All issues related to supervision, materials, workmanship, and execution are the
sole responsibility of the Supervising Engineer and visits made by the structural Consultants are not
for supervision since I am not responsible for supervision and quality of work.
This certificate is issued in conjunction with the certificates of the Licensed Site Engineer/
Site Supervisor certifying the quality of work.

Yours faithfully,

Signature of Structural Engineer

Name:
(In Block Letters)
Address:
E­mail ID:
Mobile No.:
Date:

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 (»ÖÖµÖÃÖê®Ã›ü ÃÖÖ‡Ô™ü ‡ÓוÖ×®Ö†¸ü / ÃÖÖ‡Ô™ü ÃÖã¯Ö¸ü¾ÖÖµÖ—Ö¸üü µÖÖÓ®Öß ´ÖÓ•Öæ¸ü ‡´ÖÖ¸üŸÖß“µÖÖ •ÖÖꟵÖÖ¯ÖµÖÕŸÖ“Öê ²ÖÖÓ¬ÖÛúÖ´Ö ¯ÖæÞÖÔ
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APPENDIX ' F-3'

FORM FOR CERTIFICATE OF COMPLETION OF WORK UPTO PLINTH LEVEL
(LICENSED SITE ENGINEER / SITE SUPERVISOR)

To,
The Collector,
Dist ­­­­­­­­­­­­­­­

Sir,
The construction up to plinth / column up to plinth level has been completed in Building No
______________Plot No ______________, Revenue Survey No.____________, City Survey
No.________________, mauje ______________, situated at Road/Street
________________,Society____________ in accordance with your permission No _________ dated
___________________ as per the sanctioned plans and working drawing details given, Structural
drawing, details provided by the Structural Engineer. The Architect has verified the marginal
distances and dimensions of the plinth on _______. I have executed the said for work under my
supervision and used the proper quality / grade of materials as per details given by the structural
Engineer and as regards to workmanship as per standard practices laid down in relevant codes.

Yours faithfully,

Signature of Licensed Site

Engineer / Site Supervisor

Name:
(In Block Letters)
Address:
E­mail ID:
Mobile No.:
Date:

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×´ÖôûÞÖêÃÖÖšüß ªÖ¾ÖµÖÖ“µÖÖ †•ÖÖÔ“ÖÖ ®Ö´Öã®ÖÖ)
APPENDIX ' H'
FORM FOR COMPLETION CERTIFICATE
To,
The Collector/Authority ,

­­­­­­­­­­­­­­­.

Sir,
I hereby certify that the erection / re­erection or part/full development work in / on
building / part building No ____________ Plot No _________, Revenue Survey No.____________,
City Survey No.________________, mauje_____________, situated at Road/Street _________,
Society___________ has been supervised by me* and has been completed on ________ according
to the plans sanctioned, vide office communication No _______ dated _______. The work has been
completed to the best of my ** satisfaction. The workmanship and all materials (type & grade) have
been supervised by me* and are strictly in accordance with general and detailed specifications. No
provisions of the Act*** or the building Regulations, no requisitions made, conditions prescribed or
orders issued there under have been transgressed in the course of the work. I am enclosing three
copies of the completion plans. The building is fit for occupancy for which it has been erected /re­
erected or altered, constructed and enlarged.

I have to request you to arrange for the inspection & grant permission for the occupation of
the building.

Yours faithfully

Signature of Architect / Licensed Engineer/

Structural Engineer/Supervisor

Details of Area for which completion is certified: __________________________________________

*/ the Licensed Site Engineer / Site Supervisor

**/ the Licensed Site Engineer's / Site Supervisor's
*** Maharashtra Regional & Town Planning Act 1966

License No. of Architect :

Address of Architect or Licensed Engineer
Structural Engineer/ Supervisor :
Name of Architect or Licensed Engineer
Structural Engineer/ Supervisor :
E­mail ID :
Mobile No. :
Date:
(Signature of Owner)
Name of Owner (in Block Letters)

Enclosed –
Certificate by Architect (in Format – H1)
Certificate by Structural Engineer (in Format – H2)
Certificate by Supervisor (if the Architect is not undertaking supervision) (in Format – H3)

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†•ÖÖÔÃÖÖê²ÖŸÖ •ÖÖê›üÖ¾ÖµÖÖ“Öê ¯ÖÏ´ÖÖÞÖ¯Ö¡Ö)

APPENDIX ' H-1'

FORM FOR COMPLETION CERTIFICATE
(ARCHITECT/ LICENSED ENGINEER / ARCHITECTURAL CONSULTANT)

To,
The Collector,
Dist ­­­­­­­­­­­­­­­

Sir,
I hereby certify that the erection / re­erection or part/full development work in / on
building / part building No / Wing No ____________ Plot No _________, Revenue Survey No./Gat
No./Hissa No.____________, City Survey No.________________, mauje_____________, situated at
Road/Street _________, Society___________ the said construction has been verified by me and
found completed on ________ according to the plans sanctioned, vide office communication No
_______ dated _______. No provisions of the Act or the building Regulations, no requisitions made,
conditions prescribed or orders issued there under have been transgressed in the course of the
work. I am enclosing three copies of the completion plans and required NOCs. All issues related to
supervision, materials, workmanship, and execution are the sole responsibility of the Supervising
Engineer and visits made by the Architect/ Licensed Engineer/ Architectural Consultant are not for
supervision since I am not responsible for supervision and quality of work.
The building is to the best of my knowledge & belief fit for occupancy for which it has been
erected/ re­erected or altered, constructed and enlarged; subject to availability, completion of
infrastructure.
This certificate is issued in conjunction with the certificates of the Licensed
Engineer/Supervisor certifying the quality of work.
Details of Area for which completion is certified: __________________________________________
Signature of Architect / Licensed
Engineer / Architectural Consultant
License No of Licensed Site / Supervising Engineer:
Address of Licensed Site / Supervising Engineer

Name of Licensed Site / Supervising Engineer

E­mail ID:

Mobile No. :
Date:

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APPENDIX H-2
FORM FOR COMPLETION CERTIFICATE
(LETTER BY CONSULTING STRUCTURAL ENGINEER)

Ref. No.:­
To, Date: ­ ­­/­­/­­­­­­­­­­­­
Collector / Authority.
Sir,
I have been appointed as Consulting Structural Engineer By M/S ………………………..for
preparing Structural Design and Drawings for the * New structure consisting of
……………………………………….floors / *Construction of ………additional floors over the existing structure
with………….floors, as described in my enclosed Design base report, based upon the Architectural
drawings and other Utilities And Services requirements given by the Owner/ Developer of the
development work of Building at S. No. ­­­­­­­­­­­­­­­­­­­­Hissa No. ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­Tahsil­­­­­­
­­­­­­­­District . ( * Strike out whichever is not applicable)
The following listed firms/persons are associated with the work

ARCHITECTS: ­ Mr.­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
OWNER/DEVELOPER: ­ Mr. ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
SUPERVISING ENGINEER

I hereby certify and confirm adequacy of the structural design for intended use represented through
my structural drawings issued from time to time.
I am enclosing herewith undertaking of the Licensed Supervising Engineer / Owner regarding
compliance with structural drawings and adherence to standard construction practices while
executing the construction work. On basis of this I hereby certify that to the best of my knowledge
and belief the said structure is structurally fit for the intended purpose.
I further confirm that the structural design is based upon relevant Indian Standard Coder especially,
1. IS – 456 – 2000 – Code of Practice for Plain & Reinforced Concrete Structure.
2. IS – 875 – 1987 – Code of Practice for Design Loads.
3. IS – 1893 – 2002 – Criteria for Earthquake Resistant Design of Structure.
4. IS – 800 – 1984 – Code of Practice for General Construction in Steel

As a Consulting Structural Engineer My responsibilities are limited to providing Structural Designs

and Drawings in accordance with the provisions of relevant prevailing Indian Standard codes, and
visits to site at specified stages called for by the Supervising Engineer for verification of
reinforcement laid. All issues related to Supervision, Materials, Workmanship and execution are the
sole responsibility of the Supervising Engineer and visits made by the Structural Consultants are not
for Supervision since I am not responsible for supervision and quality of work.
This certificate is issued on the clear understanding that my overall design responsibility for the
safety and proper performance of structural design ceases, the moment any addition and / or
alteration or any damage to the structural frame is caused by accident or by tampering with the
geometrical sections of structural members for any purpose whatsoever or due to overloading of the
structure or lack of maintenance or any act that is detrimental to the structure as a whole.
This certificate is issued in conjunction with the certificates of the licensed engineer / owner
certifying the quality of work.

Signature:­
Name of the Structural Consultant:­
LIC No – -------------------------------------
Enclosure,
1. Certificate from Licensed Engineer / Owner towards quality compliance of structural work
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APPENDIX ' H-3'
FORM FOR COMPLETION CERTIFICATE
(LICENSED SITE / SUPERVSING ENGINEER)

To,
The Collector,
Dist ­­­­­­­­­­­­­­­

Sir,
I hereby certify that the erection / re­erection or part/ full development work in / on
building / part building No/ Wing No ____________ Plot No _________, Revenue Survey No. ./Gat
No./Hissa No.____________, City Survey No.________________, mauje_____________, situated at
Road/Street _________, Society___________ the said construction has been supervised by me and
has been completed on ________ according to the plans and Architectural drawings and details
given, Structural design, details provided by the Structural Engineer and relevant verification by
other Consultants (if any) the work has been completed to the best of my satisfaction. I further
confirm that the workmanship and all the materials (type and grade) used have been strictly in
accordance with the relevant India Standard Codes and as specified in the execution drawings given
by the Architects, Structural Engineer and any other consultant.

Details of Area for which completion is certified: __________________________________________

Yours faithfully

Signature of Licensed Site /

Supervising Engineer
License No of Licensed Site / Supervising Engineer:
Address of Licensed Site / Supervising Engineer

Name of Licensed Site / Supervising Engineer

E­mail ID:

Mobile No. :
Date:
(Signature of Owner / Developer)
Name of Owner/ Developer (in
Block Letters)

C:\Users\Admin\Desktop\Final corrected formats-Dated-20141211.doc

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COVERING LETTER FOR APPLICATION FOR OCCUPANCY CERTIFICATE
(BY: OWNER / DEVELOPER)
To,
The Collector,
Dist ­­­­­­­­­­­­­­­
Sir,
The erection / re­erection or part/ full development work in / on building / part building No
/ Wing No____________ Plot No _________, Revenue Survey No. ./Gat No./Hissa No.____________,
City Survey No.________________, mauje_____________, situated at Road/Street _________,
Society___________ has been done under the supervision of licensed site engineer relying on the
plans / structural design and other specifications specified / recommended by Architect, Structural
Engineer and any other consultant (if any) .
I hereby apply by separate Form no. H for occupation certificate along with necessary certificates as
mentioned in Form no. H
It may be noted that while making the application, I have placed my reliance on:
1. Completion certificate issued by the Architect for the site
2. Completion certificate issued by the structural engineer for the site
3. Supervision / completion certificate issued by the Licensed Engineer for the site and
4. Various NOCs issued by concerned authorities.

This application is made on the clear understanding that my overall responsibility for the legality,
safety and proper performance of the building and development work ceases, the moment any
addition and / or alteration or any damage to the structure is caused by accident or by tampering for
any purpose whatsoever or due to overloading of the structure or lack of maintenance or any act
that is detrimental to the building / development as a whole.

Details of Area for which completion is certified: __________________________________________

Yours faithfully

(Signature of Owner / Developer)

Name of Owner/ Developer (in
Block Letters)

Name of Owner/ Developer

E­mail ID:

Mobile No. :
Date:

C:\Users\Admin\Desktop\Final corrected formats-Dated-20141211.doc