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ANNEXURES TO GOMs.NO. 168 MA & UD, DATED: 07.04.2012

ANNEXURES TO GOMs.NO. 168 MA & UD, DATED: 07.04.2012

ANNEXURES TO GOMs.NO. 168 MA & UD, DATED: 07.04.2012

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350APPENDIX – IXToThe Commissioner,FORM FOR SUPERVISION OF BUILDING WORK(Notarised under taking to be executed on Rs.100/- N.J. Stamp Paper)Date dd mm yyyy……………………….(ULB)Sir / Madam,I hereby certify that the erection, re-erection or material alteration or demolition at House/ Premises No/ Plotas given below shall be carried out under the supervision of a qualified person and I certify that all the materials (Type andgrade and the workmanship of the work shall be generally in accordance with the general and detailed specificationssubmitted along with, and that the work shall be carried out according to the sanctioned plans.(Use CAPITAL LETTERS only)ANAME OF THE APPLICANTB LOCATION OF THE PROPOSED SITE1 Plot No.2 Sanctioned Layout No. / LRS No.3 Survey No. Village4 Premises / Door No.5 Ward No. Block No.6 Road/ Street7 Locality8 Circle Division9 City/ Town DistrictC DETAILS OF OWNER / DEVELOPER / LICENCED TECHNICAL PERSONNELSl.No.Name Licence No. Signature1 …………………………………………………….Owner / Owners / Lessee / Authorised Agent2 …………………………………………………….Builder / Developer3 …………………………………………………….Architect/ Engineer/ Surveyor4 …………………………………………………….Structural EngineerWitness:1)NameSignature2)Sworn & signed before me.Notary

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