Panchayat:Repo18/vol1-page0834

                                                                                                                   DECARATION
 I...............................hereby declare that the measurements,  specifications and other  details mentioned above are complete,correct and true to the best of my knowledge and belief and that I shall abide by the approved plan and the provisions in the Act and Rules in undertaking the construction. 
Place:                                                                                                                 Signature of the Applicant
Date :                                                                                                                 Name of the Applicant
                                                           

                                                                                                                 CERTIFICATE
Certificated that the site plan is prepared in accordance with the Kerala Panchayat Building Rules, 2011, Kerala Panchayat Raj Act, 1994, provisions contained in the Town Planning Schemes and road development proposals of the implementing agency.
                                                                                                                                              Signature
                                                                                                                                              Name 
                                         Place:                                                                                          Reg.No. 
                                         Date :                                                                                          Address
                                                                                                             (Registered Architect/ Engineer/ Town Planners Supervisor) 

                                                                                                                APPENDIX-A2
                                                                                                                     (see rule 133)
                                                                                                                  PROFORMA 
                                                              Intimation of intention to carry out construction/reconstruction/addition/alteration 
                                                                             (as per rule 133 of the Kerala Panchayat Building Rules, 2011)

   ..................................................................Gramapanchayat...................................................ward..............................................Village............................................taluk.

1. Name of owner in Capital Letters 

2. Address 
(i) Permanent 
(ii) To which communication is to be sent 
(iii) Telephone/Mobile Number 

3. Nature of development/Construction (please put Y mark in the appropriate box)
(i) Hut [  ]
(ii) New construction [  ]
(iii) Reconstruction [  ]
(iv) Alteration[  ]
(v) Addition / Extension[  ]

4. Details of plot: 
(i) Survey Number:................................ of...........................................village 
(ii) Extent . . ....................
(iii) Nature of ownership : .....................................................
(iv) Building No: of the nearest building : .....................................................    
 (v) Nearest road junction or landmark : ................................................... 

5. Occupancy (please put Y mark in the appropriate box). 
(i) Residential Group A1 [  ]
(ii) Non residential/Others[  ] (Please specify...........................................) 

6. (i) Total built-up Area of the building in sq.metres               
                                                                           existing.......................................         
                                                                          proposed...................................... 
                                                                           Total...............................................
   (ii) Total number of floors : ..............................

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