Samalkot Municipality
TOWN PLANNING SECTION
BUILDING APPLICATION FORM
BA No.: 1066/0036/B/SLO/SPB5/2025 Date of submission : 02 July, 2025
Sub: Building Application for grant of permission for Construction of Building Permission Notice u/s 209 & 227 of APM
Act, 1965 / 428 & 433 of HMC Act, 1955.
A ADDRESS OF THE APPLICANT
1 Name (In Full) RASAMSETTI VARUN S/O SATYANARAYANA
2 Firm Name -
3 Door No./Flat No. 15-6-31,
4 Road/Street Satyanarayanapuram
5 Locality / Mandal NA
6 City Samalkot PIN 5 3 3 4 4 0
7 District Kakinada
8 Phone / Mobile No. 9848342197
9 E-mail varunrasamsetti@[Link]
B LOCATION OF THE PROPOSED SITE
1 Ward No. Block No. Ward15 6
2 LRS Location satyanarayanapuram
3 LRS No. NA
4 RS / TS No. 1A-1A
5 Plot No. NA
6 Premises No./Door No. 15-6-31
7 Road/Street NA
8 Locality Satyanarayana puram Block – 5
9 City/ Town District Samarlkota Kakinada
C DETAILS OF BUILDER / LICENSED PERSONNEL
# Name Address License No. Validity
1 VENKATA DURGA PRASAD 01/ARCT/2022/KAUDA
LAVETI (Architect)
2 - - - -
D DETAILS OF PROPOSED CONSTRUCTION
Site Area (sq. mtr.) As per Documents 265.84
1
As on Ground 242.33
2 Total Floor Area (sq. mtr.) 82.71
3 Tot-lot Area (sq. mtr.) 00.00
4 No. Of Units 1
E DETAILS OF BUILDING
1 No. of Blocks 1 Total Built-up Area (sq. mtr.) 82.71
Height
# Building Name Use Sub Use Type No. of Floors Bifurcation of Floors
(mtr.)
1. VARUN Residential Individual NA 3.25 Floor BUA
(RAMISETTI) Residential Floor Name
(sq. mtr.)
Building
GROUND 82.71
FLOOR
F AUTOCAD FILE
1 AutoCAD File [Link]
G APPLICATION CHECKLIST
# Description Yes/No Remarks
1. Whether Self Certification Applicable for this proposal? Yes -
2. The Proposed Site is not in in land uses where residential uses are No -
prohibited in master plan land uses and zoning regulations and
building rules 2017.
3. The Proposed Building is not in unauthorised Layout. Yes -
4. The Proposed Building is not in CRZ areas. No -
5. The Proposed site not Group Development Schemes. No -
6. Is CLU is applicable? No -
7. Whether proposed site has VLT/Assessment number? Yes -
8. Whether proposed construction is an Educational building? No -
9. Whether The Proposed Building Is Already Constructed Without No -
Approval But Satisfying Present Rules
10. Whether the building is pre-certified from IGBC (Indian Green No -
Building Council) or LEED India or TERI or GRIHA following the G.
O. Ms. No. 30 Dated: 28.01.2014 to avail incentives under rule 145.
11. Whether the proposal falls in Urbanisable Land use zone? No -
12. Whether ECBC is complied for commercial buildings or other No -
Non-Residential Buildings proposals having plot area more than
1000 Square Meters or built up area of 2000 Square Meters or if the
building is a Multiplexes, Hospitals, Hotels, and Convention Center
with irrespective of built up area.?
13. Do you want to apply NOC from NMA?. No -
14. Whether NMA NOC is available with you for proposed construction No -
sites?.
15. Do you want to apply NOC from AAI? No -
16. If you are in Airport vicinity, Do you have NOC from AAI? No -
17. Whether any Approved Plan given in proposed site? No -
18. Whether site falls under Approved Layout/LRS/Plot part of LRS No -
Layout but not regularized ?
19. Whether 10% of EWS/LIG on the project site or 25% of total No -
number of units provided within a radius of 5km from the project site
in Group Housing/Development projects?
20. Whether Environmental Clearance is required for proposed No -
bulding?
21. Whether the Land is converted Agriculture to Non- Agriculture Land No -
as per NALA act, 2016?
22. Whether the proposal comes under Building penalization scheme No -
case?
23. Is water connection available.? No -
24. Whether the site falls under un-approved layout and any building No -
plan approval is given or any building exist prior to 1985 on this
site?
25. Whether Proposed site is located in the vicinity of Oil / Gas pipe No -
line?
26. Whether edge of the proposed building is within 30 mts distance No -
from the railway property boundary?
27. 50m within the limits of the Local Authorities. The boundary of the No -
river shall be as fixed and certified by the Irrigation Department and
Revenue Department?
28. Whether the proposed site is located within the distance of above No -
100m and upto 200m from the protected Monuments as notified
under Archaeological monuments and Ancient sites?
29. Whether the proposed site is located in the vicinity of defense No -
establishments within the distance of 500 mtr?
30. Whether the proposed site falls under Un approved Layout in which No -
building approval given?
31. Whether the plot is affected by road widening? No -
32. Whether the height of the industrial building is greater than 10 mtr? No -
33. Whether the height of the building is greater than 18 mtr? No -
34. Whether the height of the industrial building is greater than 18 mtr.? No -
35. Whether the buildings of Educational, Cinema Theatres, Functional No -
halls & other Assembly buildings where plot area is greater than 500
sq.m or height is greater than 6m?
36. Whether the size of the plot is above 300.00 [Link] height No -
above 10m ?(G.P in CRDA, MRDA and UDA areas and in all
Municipalities/Nagar Panchayats).
37. Whether the Commercial building height is greater than 15 mtr? No -
38. Whether the size of the plot is above 300 [Link]?(G.P in CRDA, No -
MRDA and UDA areas and in all Municipalities/Nagar Panchayats).
H DOCUMENT CHECKLIST
Primary
# Name of the Document Attachment
1. Photographs showing access roads.
2. Latest Encumbrance Certificate issued by Registration Department.
3. Master plan/ILUP extract indicating the site.
4. Self-Attested copies of Ownership Documents-lease-deed/sale deed etc. giving the
physical description of the plot/property.
5. A Declaration cum undertaking and Indemnity bond by the
Owner/Builder/Developer/LTP in the prescribed Form (Annexure-3).
6. Sign Drawing Plan Pdf And Apllication Form Of Owner
7. Sign Drawing Plan Pdf And Apllication Form Of LTP(For High rise Structural
Engineer, Architect, and Town Planner)
8. Self-Attested Copies of Link Documents.
Additional
# Name of the Document Attachment
1. Up to Date property tax receipt.
2. Self Certification Proforma (Annexure-9)
I hereby declare that I am the owner/ PAH in possession of the plot on which the work is proposed and that the statement made in
this form are true and correct to the best of my knowledge.
I SIGNATURE
1 Signature of the Applicant Or Firm RASAMSETTI VARUN S/O SATYANARAYANA
2 Signature of the LTP VENKATA DURGA PRASAD LAVETI (Architect)