APPENDIX-A1/PDA

Application for Development Permission under Section 44 of the

Goa Town and Country Planning Act, 1974
---------------------------------------------------------------------------------------------------------------------
Date: __________
From:___________________________________________________
(Full name and address of the Owner/Owners of Land)
To,
The Member Secretary,
______________Planning and Development Authority,
______________, Goa.
Sir,
I/We intend to carry out the under mentioned development in the site or plot of land bearing
Chalta No.___ of P.T. Sheet No. ___/Survey No.____/Sub-divided Plot No._________ of
_________________ City/Village on _____________________ road, in _____________ward.
Particulars of proposed development:- ________________________________

I/We forward herewith the following:- *strike out which is not applicable.
1. Drawings:
(a) Site Plan 5 copies ( )
(b) Detailed Plans, Elevations and Sections 5 sets ( )
(c) Location Plan 5 copies ( )
(d) *Parking Layout Plan 5 copies ( )
(e) *Contour Plans in case of sloping sites 3 copies ( )
2. Documents duly authenticated/signed as prescribed:
(a) Questionnaire 3 copies ( )
(b) *Survey Plan 1 copy ( )
(c) Copy of Index of Land (Form-III/I & XIV/Form-B/D) 1 copy ( )
(d) Document showing ownership of land 1 copy ( )
(e) Certificate from the Architect/Engineer who has planned the
project and has signed the drawings 1 copy ( )
(f) Structural Liability Certificate from the Engineer responsible
for the Structural Design of the Project 1 copy ( )
(g) Affidavit from the Owner 1 copy ( )
(h) *Power of Attorney (if applicable) 1 copy ( )
(i) Conversion Sanad/Application for recommendation for conversion 1 copy ( )
(j) *NOC from other agencies, if applicable:-
(i) ______________________
(ii) ______________________
(iii) ______________________ 1 copy ( )
I/We request that the proposed development may be approved and that development
permission may be accorded.
Yours faithfully,
_________________________________
Signature of the Architect/Engineer/
___________________________ Town Planner
Name & Signature of Owner (Seal with Name, Address, Reg. No.)
 APPENDIX-A1/TCP
Application for Technical Clearance
---------------------------------------------------------------------------------------------------------------------
Date: _________
From:- ______________________________
(Name and address of Owner)
To,
The Deputy/Town Planner,
Town & Country Planning Department.
____________, Goa.
Sir,
I/We intend to carry out the under mentioned development in the site or plot of land bearing
Chalta No.____ of P.T. Sheet No. ___/Survey No.____/Sub-divided Plot No._________of
_________________ City/Village on_____________________ road, in _____________ward.
Particulars of proposed development:- _________________________________

I/We forward herewith the following:- * strike out which is not applicable.
1. Drawings:
(a) Site Plan 5 copies ( )
(b) Detailed Plans, Elevations and Sections 5 sets ( )
(c) Location Plan 5 copies ( )
(d) *Parking Layout Plan 5 copies ( )
(e) *Contour Plans in case of sloping sites 3 copies ( )
2. Documents duly authenticated/signed as prescribed:
(a) Questionnaire 3 copies ( )
(b) *Survey Plan 1 copy ( )
(c) Copy of Index of Land (Form-III/I & XIV/Form-B/D) 1 copy ( )
(d) Document showing ownership of land 1 copy ( )
(e) Certificate from the Architect/Engineer who has planned the
project and has signed the drawings 1 copy ( )
(f) Structural Liability Certificate from the Engineer responsible
for the Structural Design of the Project 1 copy ( )
(g) Affidavit from the Owner 1 copy ( )
(h) *Power of Attorney (if applicable) 1 copy ( )
(i) Conversion Sanad/Application for recommendation for conversion 1 copy ( )
(j) *NOC from other agencies, if applicable:-
(i) ______________________
(ii) ______________________
(iii) ______________________ 1 copy ( )
I/We request that the proposed development may be approved and that development
permission may be accorded.
Yours faithfully,
_________________________________
Signature of the Architect/Engineer/
___________________________ Town Planner
Name & Signature of Owner (Seal with Name, Address, Reg. No.)
 APPENDIX-A2
Application to Municipal Council for Building Licence
---------------------------------------------------------------------------------------------------------------------
Date: __________
From:- ______________________________
(Name and address of Owner)
To,
The Chief Officer,
__________ Municipal Council,
_____________, Goa.
Sir,
I/We hereby give notice that I/We intend to erect/re-erect/add to/alter/execute the following
works in the site or plot of land bearing Chalta No.____ of P.T. Sheet No. ___/Survey
No.____/Sub- divided Plot No.___ of _____________ City/Village
on_____________________road, in _____________ward.
Description of construction:- __________________________________________
I/We forward herewith the following:- *strike out which is not applicable.
1. Drawings duly approved/technically cleared by PDA/TCPD:
(a) Site Plan 3 copies ( )
(b) Detailed Plans, Elevations and Sections 3 sets ( )
(c) Location Plan 3 copies ( )
(d) *Parking Layout Plan 3 copies ( )
(e) *Contour Plans in case of sloping sites 1 copy ( )
2. Documents duly authenticated/signed as prescribed:
(a) Questionnaire duly authenticated by PDA/TCPD 2 copies ( )
(b) *Survey Plan 1 copy ( )
(c) Copy of Index of Land (Form-III/I & XIV/Form-B/D) 1 copy ( )
(d) Document showing ownership of land 1 copy ( )
(e) Certificate from the Architect/Engineer who has planned the
project and has signed the drawings 1 copy ( )
(f) Structural Liability Certificate from the Engineer responsible
for the Structural Design of the Project 1 copy ( )
(g) Affidavit from the Owner 1 copy ( )
(h) *Power of Attorney (if applicable) 1 copy ( )
(i) Conversion Sanad/Application for recommendation for conversion.1 copy ( )
(j) *NOC from other agencies, if applicable:-
(i) ______________________
(ii) ______________________
(iii) ______________________ 1 copy ( )
I/We hereby declare that I/We am/are the owner/owners/authorized agent of the property to
be built upon.
Yours faithfully,
_________________________________
Signature of the Architect/Engineer/
________________________ /Town Planner
Name & Signature of Owner (Seal with Name, Address, Reg. No.)
 APPENDIX-A3
Application to Village Panchayat for Building Licence
---------------------------------------------------------------------------------------------------------------------
Date: ________
From:- ______________________________
(Name and address of Owner)
To,
The Sarpanch,
Village Panchayat of ___________,
________________, Goa.
Sir,
I/We hereby give notice that I/We intend to erect/re-erect/add to/alter/execute the following
works in the site or plot of land bearing Survey No.____/Sub-divided Plot No.____ of
_________________ Village on_____________________ road, in _____________ward.
Description of construction:- __________________________________________
I/We forward herewith the following:- *strike out which is not applicable.
1. Drawings duly approved/technically cleared by PDA/TCPD:
(a) Site Plan 3 copies ( )
(b) Detailed Plans, Elevations and Sections 3 sets ( )
(c) Location Plan 3 copies ( )
(d) *Parking Layout Plan 3 copies ( )
(e) *Contour Plans in case of sloping sites 1 copy ( )
2. Documents duly authenticated/signed as prescribed:
(a) Questionnaire duly authenticated by PDA/TCPD 2 copies ( )
(b) *Survey Plan 1 copy ( )
(c) Copy of Index of Land (Form-III/I & XIV/Form-B/D) 1 copy ( )
(d) Document showing ownership of land 1 copy ( )
(e) Certificate from the Architect/Engineer who has planned the
project and has signed the drawings 1 copy ( )
(f) Structural Liability Certificate from the Engineer responsible
for the Structural Design of the Project 1 copy ( )
(g) Affidavit from the Owner 1 copy ( )
(h) *Power of Attorney (if applicable) 1 copy ( )
(i) Conversion Sanad/Application for recommendation for conversion 1 copy ( )
(j) *NOC from other agencies, if applicable:-
(i) ______________________
(ii) ______________________
(iii) ______________________ 1 copy ( )
I/We hereby declare that I/We am/are the owner/owners/authorized agent of the property to be
built upon.

Yours faithfully,
_________________________________
Signature of the Architect/Engineer/Town
Planner/
__________________________ /Landscape Architect/Urban Designer
Name & Signature of Owner (Seal with Name, Address, Reg. No.)
 APPENDIX-A4
Application for recommendation for conversion sanad
---------------------------------------------------------------------------------------------------------------------
Date: ___________
From:- ______________________________
(Name and address of Owner)
To,
The Member Secretary,
____________________ Planning and Development Authority,
__________________, Goa.
OR
To,
________ Town Planner,
__________ Taluka Office, Town and Country Planning Dept.,
_______________, Goa.
Sir,
I/We intend to carry out the under mentioned development in the site or plot of land bearing
Chalta No.____ of [Link] No. ___/Survey No.____/Sub-divided Plot No.____of
____________ City/Village on __________ road, in __________ward.
Particulars of proposed development:- _________________________________
I/We forward herewith the following:-
(a) Survey Plan indicating the area to be converted 5 copies ( )
(b) Location Plan 1 copy ( )
(c) Copy of Index of Land (Form-III/I & XIV/Form-B/D) 1 copy ( )
(d) Document showing ownership of land 1 copy ( )
(e) Power of Attorney (if applicable) 1 copy ( )
I/We request to issue “Recommendation for Conversion” to enable me/us to apply for
Conversion Sanad from appropriate Revenue Authorities.

_________________________
Name & Signature of Owner
 APPENDIX-A5
Application for Completion Order
---------------------------------------------------------------------------------------------------------------------
Date: __________
From:- _____________________________
(Name and address of Owner)
To,
Member Secretary,
_______________ Planning and Development Authority,
_______________, Goa.
OR
To,
__________ Town Planner,
_____________ Taluka Office, Town & Country Planning Dept.,
___________________, Goa.
Sir,
I/We hereby give notice that I/We have completed the development work situated at
______________ in Ward No. _________ in pursuance of the Development
Permission/Technical Clearance granted vide letter No. _____________ dated __________.

I/We am/are enclosing the following:-

(a) Completion Certificate issued by Architect/Engineer.
(b) Revised plans incorporating deviations made during the execution (if applicable).
(c) Structural Stability Certificate along with a full set of “as built” structural drawings for
records.
Kindly issue the Completion Order to enable me/us to obtain Occupancy Certificate.

Yours faithfully,

________________________________________________________
Signature, name and address of Owner or his authorized agent.
 APPENDIX-A6
Application to Municipal Council/Village Panchayat/Corporation for Occupancy Certificate
---------------------------------------------------------------------------------------------------------------------
Date: _________
From:- ______________________________
(Name and address of Owner)
To, To,
The Chief Officer, OR The Sarpanch,
__________ Municipal Council, Village Panchayat of ________,
___________, Goa. ____________, Goa.
Sir,
I/We hereby give notice that, I/We have completed the construction work situated at
______________ in ward No. _________ in pursuance of the sanction granted by the Municipal
Council//Village Panchayat vide Licence No. _____________ dated __________.
I/We am/are enclosing the following:-
(a) Completion Order issued by PDA/TCPD.
(b) Completion Certificate issued by Architect/Engineer/Town Planner/Landscape
Architect/Urban Designer.
(c) Revised plans incorporating deviations made during the execution (if applicable).
(d) Structural Stability Certificate alongwith a full set of “as built” structural drawings for
records.
Kindly issue Occupancy Certificate at the earliest.
Yours faithfully,

________________________________________________________
Signature, name and address of Owner or his authorized agent.
 APPENDIX-A7
Application for Registration/Renewal of *Architect/Engineer/Structural Engineer/Town Planner/
Landscape Architect/Urban Designer
---------------------------------------------------------------------------------------------------------------------
Date: __________
From:- _________________________________
(Name and address of the applicant)
To,
The Chief Town Planner,
Town and Country Planning Department,
Panaji, Goa.
Sir,
I, __________________________, desiring to be registered as required under the Goa Land
Development and Building Construction Regulations, 2010, hereby submit my application
alongwith the required processing fee:-
Name:-
Qualifications:-
Office address:- Office Tel:-
Residence address:- Residence Tel:-
I am enclosing the following documents in support of my
qualifications:
a)
b)
c)
OR
I am already registered under the Goa Land Development and Building Construction
Regulations, 2010, under Registration No. ________ dated ___________, validity of which is
expiring on __________.
Kindly issue Registration Certificate at the earliest/Renewal Order of my Registration
Certificate, to enable me to sign plans and documents as required under the Goa Land
Development and Building Construction Regulations, 2010.
Yours faithfully,

________________________
Signature of the applicant
* Strike out whichever not applicable
 APPENDIX-B1
Format of Questionnaire
---------------------------------------------------------------------------------------------------------------------
QUESTIONNAIRE
(To be duly filled and enclosed to the application for
Development Permission/Technical Clearance/Building Licence)
PART-A

1. Full name and address of the owner:

2. Details of the property:
(a) Chalta& PTS No./Survey No.
(b) Ward Name & No./Vaddo
(c) Town/Village
(d) Taluka & District
3. Is the property sub-divided? Yes/No
If ‘Yes’, give details of the sub-division, supported by the
document
4. Total area of the property __________ sq. meters.
5. Zone of the property as per ODP/ZP/RP
6. Intended use proposed in the Development
7. If the Zone indicated at (5) above is the result of subsequent
change of Zone, give details of approval and enclose certified
copy of the approval
8. Is the property accessible? Yes/No
If ‘Yes’, state –
(a) Width of the access __________ meters.
(b) Area of road widening:________ sq. meters
9. If the property is in the vicinity (within 100 meters) of the
Cemetery/Crematorium, give the distance from the boundary __________ meters.
wall of Cemetery/Crematorium
10. If the property is in the vicinity (within 100 meters) of the
National Highway/State bye-pass, give the distance from the __________ meters.
centre line of Highway/bye-pass
11. If the property is in the vicinity (within 50 meters) of the
Railway line, give the distance from the boundary of Railway __________ meters.
property
12. If the property is in the vicinity of the High Tide Line(within
1,000 meters) of the sea, give the distance from HTL __________ meters.
13. If the property is in the vicinity (within 100 meters) of the river
bank, give the distance from the river bank __________ meters.
14. If there are any underground, over ground, overhead telephones
/electricity lines affecting or crossing the plot/property or within
15
meters distance of the plot/property, show on the plan and
give:- __________ meters.
(a) Vertical clearance between the highest point of the
__________ meters.
Building and the electric lines
(b) Horizontal clearance between the proposed building and
existingelectric or any other lines

15. Whether any extra FAR is claimed on the basis of road

widening/ proposed road?
If ‘Yes’, state:- Yes/No
(a) Area under road widening _________ sq. meters.
(b) Whether such road widening area or area under
proposed road has been gifted to the local body? (If yes,
 submit relevant document) Yes/No

PART-B
( For buildings )
PLOT AREA
1. Area of the Plot __________ sq. meters.
2. Deduction for
(a) Area within road widening (proposed) __________ sq. meters.
(b) Area reserved for any other use __________ sq. meters.
Total of (a) + (b) __________ sq. meters.
3. Net effective area (1) – (2) __________ sq. meters.
4. Covered area occupied by the existing building, if any __________ sq. meters.

5. Plot coverage of the existing building (in %) __________ percentage

6. Covered area of the existing building that is proposed to be __________ sq. meters.
demolished
7. Plot coverage of the existing building that is proposed to be __________ percentage
demolished (in %)

8. Covered area of the proposed building __________ sq. meters.

9. Plot coverage of the proposed building (in %) __________ percentage

10. Combined covered area of the existing building to be __________ sq. meters.
maintained and that of the proposed building

11. Combined plot coverage of the existing building to be __________ percentage

maintained and that of the proposed building (in %)

FLOOR AREA:
12. Balcony area and covered area over footways floorwise and __________ sq. meters.
total on all floors

13. Balcony area and covered area over footways, floorwise and __________ sq. meters.
total on all floors, consumed for FAR purpose

14. Addition of set-back area and/or proposed road for FAR __________ sq. meters.
purpose

15. Addition of garage area for FAR purpose __________ sq. meters.

16. Floor area consumed on Ground Floor __________ sq. meters.

17. Floor area consumed on First Floor __________ sq. meters.

18. Floor area consumed on Second Floor __________ sq. meters.

19. Floor area consumed on Third Floor __________ sq. meters.

20. Floor area consumed on any other floor or floors and any other __________ sq. meters.
area consumed for FAR purpose

21. Existing floor area to be maintained __________ sq. meters.

22. Total floor area consumed: __________ sq. meters.

(13+14+15+16+17+18+19+20+21)
 23. Floor area permissible __________ sq. meters.

24. FAR permissible __________ sq. meters.

25. FAR consumed __________ sq. meters.

26. Mezzanine area __________ sq. meters.

27. Loft area __________ sq. meters.

28. Basement area __________ sq. meters.

29. Garage area __________ sq. meters.

30. Details of areas and use, floorwise: __________ sq. meters.

Floor (%) Use Total Built up Areas free FAR Net Floor FAR
Reference Area m2 Area m2
Bal. Bas. Park.

31. Parking Details

Floor Area Use No. of Car Parks/Parking area
Provided Required

32. Type of Zone to which the plot belongs to _________ Zone.

SETBACKS:

33. Front setback from the center line of the road __________ meters.

34. Side setbacks:

(a) __________ meters.
(b) __________ meters.

35. Distance between two or more buildings on the same plot, if __________ meters.
any
36. Height of the Plinth __________ meters.

37. Use to which the building is to be put to floor-wise:

Basement Floor:
Ground Floor:
First Floor:
Second Floor:
Third Floor:
Upper Floors:

38. Plot owned by with reference to the ownership certificate of

land

39. Reference number and date of approval of sub-division of land,

if the plot in question is part of sub-division

40. Any other information

*PART C
( for sub-division of land )
1. Area of the Plot __________ sq. meters.

2. Deductions:
(a) Area reserved for road widening __________ sq. meters.
(b) Area reserved for any other purpose or un-developable __________ sq. meters.
3. Effective area of the Plot (1-2) __________ sq. meters.
 4. Open Space required to be provided __________ sq. meters.
5. Open space provided
(a) __________ sq. meters.
(b) __________ sq. meters.
6. Plot details:
Plot No. Area (in sq. meters)

7. Hierarchy of the roads used in the sub-division:

Road nomenclature Width Length Area served

Note: The roads with above nomenclature are to be indicated on the plans.

8. Usewise areas for below mentioned purpose, if the plots are

having area of five hectares and above:
(a) Schools __________ sq. meters.
(b) Community Centers __________ sq. meters.
(c) Public Utility areas __________sq. meters.

* Strike out whichever is not applicable.

We, hereby declare that the information furnished above is correct to the best of our
knowledge.
ARCHITECT/ENGINEER/STRUCTURAL ENGINEER/
/TOWN PLANNER/LANDSCAPE ARCHITECT/
/URBAN DESIGNER
OWNER OR AUTHORISED REPRESENTATIVE
______________________ ________________________
Signature Signature
Name: Name:-
Address:- Address:-
Reg. No.
Date: Date:
 APPENDIX-B2
Certificate of conformity with Regulations
———————————————————————————————————————
*CERTIFICATE OF CONFORMITY WITH REGULATIONS
I, ___________________________________________________________________________,
(Name and Reg. No. of the Architect/Engineer/Structural Engineer /Town Planner/Landscape
Architect/Urban Designer) having been appointed by __________________________________
(Name of the Owner)
do hereby certify that I have designed the project of ____________________________________
(Name of the Project)
in Plot No. ____,Chalta No._____ of P.T. Sheet No. _______/Survey No._______ in
_________city/village and that the same is in conformity with the Goa Land Development and
Building Construction Regulations, 2010.
Place:-
Date:-
[[

__________________________________________
Signature of the Architect/Engineer/Structural
Engineer/Town Planner/Landscape Architect/
/Urban Designer
Seal with Name, Address, Reg. No.
* to be issued on Letter Head
 APPENDIX -B3
Structural Liability Certificate
———————————————————————————————————————
*STRUCTURAL LIABILITY CERTIFICATE
I,______________________________________________________________ having been
(Name, address and Registration No. of the Engineer)
duly appointed as Engineer by Shri ______________________________________________for
(Name of the Owner)
carrying out structural design and supervision of the proposed construction of
_____________________________________________ .
(Name of the project)
The plans for which have prepared by___________________________________________.
(Name of Architect/Engineer/Structural Engineer/Town Planner/Landscape Architect/Urban
Designer) in Plot No. ______/ Survey No. _________/ Chalta No. ________ of P.T. Sheet No.
______, within the jurisdiction of Municipal Council of ____________ /Village Panchayat of
______.
I do hereby certify as under:-
1. That I shall be responsible for the structural design and stability of the said building.
2. That the structural work shall be executed by the owner, as per the structural
drawings prepared by me and under my supervision.
3. The provisions of the following BIS codes are made in the proposals;
——————————————————————————————————
——————————————————————————————————
——————————————————————————————————
——————————————————————————————————
This certificate is issued in respect of plans, one set of which is enclosed herewith, duly
signed by the Architect/Engineer/Structural Engineer who has prepared the same.
Place:-
Date:-
___________________________________
Signature of the Structural Engineer
Seal with Name, Address, Reg. No.
* to be issued on Letter Head
I, Shri ____________________________________________________ hereby confirm that
(Name and address of Owner)
I have appointed the Engineer, Shri ________________________ to carry out the structural
design and supervision of above mentioned project.
I further undertake to intimate him at the appropriate stage of construction of my project
______________________ to enable him to perform his functions as given in the above
certificate.
(Name of Project)
_____________________________________________
(Signature of Owner or his authorized representative)
 APPENDIX-B4
Affidavit to be sworn by the owner of the property and to be sworn before the Notary Public
———————————————————————————————————————
AFFIDAVIT
I, __________________________, son of ____________________, aged _____ years,
Indian National, marital status _______, occupation ________, resident of House No. _____,
____________________, Goa, do hereby state on oath as under:-
1. That I am the owner of the property bearing Plot No. ______, Chalta No. _____ of
P.T. Sheet No. ______, /Survey No. ________, situated at _________________, Goa.
2. That I intend to apply for development permission/technical clearance/building
permission/sub- division permission in respect of the said property.
3. That the ownership documents submitted by me alongwith the application are true
and correct.
4. That I have appointed Shri _________________________________ as the
Architect/Engineer to plan and design the said development.
5. That I have also appointed Shri _______________________________ as Engineer to
carry out the structural design of the said development.
6. That I am aware that it is my responsibility to ensure that the development is properly
supervised by the Architect/Engineer/Structural Engineer /Town Planner/Landscape
Architect/Urban Designer who have signed the plans.
7. That I am also responsible to execute the development as per approved plans.
8. That in the event of the above mentioned Architect/Engineer/Structural
Engineer/Town Planner/ Landscape Architect/Urban Designer disassociates from the
development, I shall appoint another Architect/Engineer/Structural Engineer/Town
Planner/Landscape Architect/Urban Designer to be responsible for the development
and intimate of such change to the Competent Authority.
9. That I shall not carry out any development until such time that appointment of
Architect/Engineer/ Structural Engineer/Town Planner/Landscape Architect/Urban
Designer is made.
10. That what is stated above is true to the best of my knowledge and belief.

DEPONENT
 APPENDIX-B5
Structural Stability Certificate
———————————————————————————————————————
*STRUCTURAL STABILITY CERTIFICATE
I, ______________________________________________________________________having
(Name, address and Registration No. of the Engineer)
been duly appointed as Engineer by Shri __________________________________________
for
(Name of the Owner)
carrying out structural design and supervision of the construction of
________________________
(Name of the project)
in Plot No. ________/ Survey No. _________/Chalta No. _____ of P.T. Sheet No. ______,
within the jurisdiction of Municipal Council of __________/Village Panchayat of __________
and having given the Structural Liability Certificate at the time of obtaining building permission,
do hereby certify as under:-
1. That I have carried out the structural design of the above referred project with the following BIS
Codes;
———————————————————————————————————————
———————————————————————————————————————
———————————————————————————————————————
2. That the structural work has been executed by the owner, as per the structural drawings prepared
by me and under my supervision.
3. That the building is structurally safe and fit for occupation.
I am enclosing complete set of structural “as built” drawings for your records.
Place:-
Date:- _______________________________
Signature of the Structural Engineer
Seal with Name, Address, Reg. No.

* to be issued on Letter Head

 APPENDIX-B6
Completion Certificate
———————————————————————————————————————
*COMPLETION CERTIFICATE
I, ___________________________________________________________________________,
(Name and Reg. No. of the Architect/Engineer/Structural Engineer /Town Planner/Landscape
Architect/Urban Designer)
Having been appointed by _______________________________________________________
(Name of the Owner)
and having designed the project of
__________________________________________________
(Name of the Project)
in Plot No. ____, Chalta No. _____ of P.T. Sheet No. _______/ Survey No. _______ in
___________city/village, do hereby certify that the said project has been supervised by me and
has been built in accordance with the Licence No. ___________ dated ____________ and the
same is complete and fit for occupation.
Place:-
Date:-

________________________________________________
Signature of the Architect/ Engineer Structural Engineer/
Town Planner/Landscape Architect/Urban Designer
Seal with Name, Address, Reg. No.
* to be issued on Letter Head.
 APPENDIX-D1
141
Intimation to [Municipal Council/Village Panchayat/Corporation] about stages of
construction

Date: ___________
From:- _____________________________________
(Applicant’s name and address)
To,
The Chief Officer,
____________ Municipal Council,
_____________, Goa.
OR
To,
The Sarpanch,
Village Panchayat of _________,
______________, Goa.
Notice of commencement of the work
Sir,
I/We hereby give notice that I/We intend to commence the work in Survey No. ______ in
accordance with the plans, elevations and sections, sanctioned vide Construction Licence No.
_______ dated _______.
I/We request you to, therefore, to give necessary alignment.
Yours faithfully,

Signature of the Owner/Owners or

their authorized agent/agents.