FORM - A
APPLICATION FOR SUPPLY OF WATER
To
The Municipal Commissioner,
------------------------ Municipality.
Sir,
I -------------------------------------------------- the Owner/Occupier of the under noted building hereby
request that you will arrange to supply me with water for domestic/non-domestic purposes in
house No.-------------------------Street. The Domestic/non-domestic purpose referred to is for -----
------------------------------ and the quantity of water likely to be consumed for such purpose is -----
-------------------------------------------------litres per day for water taken for domestic/non-domestic
purpose, I agree to pay charges at the rates specified in this bylaws. I further undertake to pay
the meter rent and for maintenance charges as fixed in the bylaws. In the event of my desiring
to terminate the contract for the supply of water herein provided for I undertake to give a
month’s notice in writing to the Executive Authority to that effect.
Signature of the Owner/
Occupier of the premises.
Dated:
Address:
----------------------------Municipality
Estimate For Pro. Repair/Laying to pipes in House No....................... Street
------------------------------------------------------------------------------------------------------------------------------
-------------------------------
Qty. Description of Materials Rate of ½ or ¾ Amount Remarks pipe materials as
per to per
------------------------------------------------------------------------------------------------------------------------------
-------------------------------
Rs. P. Rs. P.
Materials to be supplied by the Party:
G.I.Pipe M
G.I.Bend Each
G.I.Coupling
G.I.Reducers
G.I.Elbow
G.I.Union
Union Washer
1.Nails
Surfaces box(c1)6x6x4
Screw down tap ¾
Stop cock
Non-Return Valve
Screw down ferrule adjectable
G.I.Cover ferrule
G.I.Tee/G.I.Nipple
Saddle place for drain
G.I.Cover pipe for drain M
MISCELLANEOUS Each
Water Meter
Checknut
Testing charges
Meter fixing charges
Labour for work done by the plumber
Picking & Removal of B.T. Surface
Sq.m.
Cutting Cement concrete Surface
Truo to axis
Each work excavation & refilling
(E w to b done atleast for 1’6 Cu.m.
debth & 1’ & 3’ Width)
Labour charges for boring in main
Inclusive or charges for tools taping & Each
Threading if done by the plumber
Laying conveying G.I. Pipe to frenco
Within a farion conveying & Laying to M
Proper ground alignment with
Specialist including jointing.
Cutting & threading G.I. Pipe
Painting G.I. Pipe with Red-Oxide Joint
Painting one coat.
Boarding holes in Walls using Jumper &
Covering the same with the cement motor 1:4
Walls 0’9’
‘’1’ – 13/4" Each
"1 – 6"
Constution of Mancnery for pits for stop cock
Including fixing surface box, diameter
Conveyance of Materials and tools above one
Furlong within municipal limit
Fixing ‘L’ Neil in Walls
Estimating charges with plan & estimates Each
LS
DEPARTMENTAL CHARGES
Reformation WBM, Road 4’ thick
Now metal 1½ thick old metal Sq.m.
Reformation B.T. Surface damaged
Including WBM
Reformation of Cement concrete
Slabs only 1:2:4
Damage to Municipal Mains
Supervision charge 15% on the Total
Cost of Materials Each
Labour and Departmental Charges
TOTAL Rs
Signature of the House Owner
Licenced Plumber Junior Engineer Municipal Engineer
-------- Municipality -------- Municipality ----------- Municipality
MUNICIPALITY
WATER WORK DEPARTMENT
PLAN SHOWING THE PROPOSED SERVICE CONNECTION
Door No. ……………………………………………… Street
Existing ………………………………………………… Main
Proposed ………………………………………………. G.I..Pipe Line Approved in
No ………………….Date………..
Municipal Licenced plumber……………………..Municipality.
Junior engineer Municipal Engineer
……………..Municipality ………………Municipality
FORM B
Application for a new house-connection or for transferring, Metering, extensions, alternations
and repairs to an existing house connections ( under section 306 (7) (b) of the Tamil Nadu
District Municipality Act. )
To,
Date
The Commissioner,
……………….Municipality.
Sir,
I beg to give you notice that I Intend to effect (1) a new water supply house service connection
or (2) Transferring metering extensions, alternations and repairs to the existing connection in
house No. In Street
Ward and in accordance with the Under Section 306 (7) (b) by-law framed I forward herewith
Estimate in duplicate I have the work to be done and its cost Engaged of the said work
Rs…………….licensed plumber For carrying out I request that permission be accorded for
executing the said work.
Signature of the Owner
Address
COMPLETION CERTIFICATE
1. Work commenced on …
2. Work completed on …
3. Deviation if any …
4. Amount to be recovered if any on actuals …
5. Amount to be refunded if any on actuals … Certified that the work has been completed as
an estimates and land approved (with deviations as stated above) and hence balance of
Rs…………….. (in words).................... may be recovered from the party, refunded to the party
Ar completion report.
Overseer/Junior
Engineer……………………………………………………………………………..Municipal
Engineer ……………………………………………………………………………………………….
Amount of Rs..................... in Words…………………………………………………………
Recovered in Challan No...................................... Dated
…………………………………………Refunded in refund Voucher
No.................................................... Dated ………………..Entered in sewage connection
Register Aege ……………….Item No..............................
RECORDED
Municipal Engineer Municipal Commissioner
--------------------------------------------Municipality
Under Ground Drainage Estimate Form for Providing New House Service Connection /.
Alternation Repairs Name of Applicant: No:
Door No. or T.S. No. Street
Nos.
Rate
Per Amount Rs. Ps.
PART A
1. Form main Sewer to Syphone Pointin the Street ( Rft)
PART B
From syphone point to water closet and drain in lot point inside the house (Materials supplied
by the party)
S W G Pipes 4" or 6" size
S W G ‘Y’ or T junction pipes 4 or 6
Stone ware gully pipes 4 or 8
Indian water closet with ‘P’ traps
Foot rests
Absestos cement pipe 4" sie for providing as vent
A C Wire Gowl
C I Manhole covers 13"X18" or 4"X24"
SWG Bonds 4’ OR 8"
C 1 ‘I’ or ‘Y’ Pipes 4 or 6
C 1 ‘I’ or ‘Y’ Pipes 4" or 6"
PART C
Labour Charges (Done by plumber)
Earth work excavation including refilling
Laying and joining SWG Pipes 4" or 6" size as specifications
Fixing A C Vont pipes
Fixing the water closet as per specification
Dismantling the flooring cone
Boring holes in the walls
Fixing the gully trap 4" or 8" size
Construction of manhole chambers of
13 x 18 or 24 x 34 size as instructed by
the authority
Fixing CI Pipes 4" or 6" size
TOTAL
ESTIMATE NO
PART – D
Total cost of Estimate --------------------------- } Rs
1 Centage and Supervision charges at 15% }
of the total cost of the estimate subjected to }
Minimum of Rs.15/- (ie) 15/- of Parts A+B+C
Labour charges Inclusive of Materials for the
Work of street house service connection from main sewer to syphone
Point Rs.
Amounts to be remitted to the Municipality by the party
--------------------------------------
Signature of the Applicant. Checked and found correct
Signature of the Plumber Drainage Work Supervision
--------------------------------------------------------------------------------------
SKETCH
--------------------------------------------------------------------------------------
Inspected, The estimate may be approved and a sum of Rs. -----------(in words)---------------------
------------------- may be permitted to be remitted to the party in Municipal Treasury as per this
Estimate.
Drainage Work Supervisor
SANCTIONED
Municipal Engineer Municipal Commissioner.
---------------------------------------------Municipality
FORM – C
From Dated
To
The Municipal Commissioner,
-------------------------Municipality,
Sir,
I wish to give notice that I intend to effect (1) a new drainage house service or (2) extensions,
alternation and repairs to the existing connection in House No.--------- in --------------------------
Street Ward and in accordance with the Bye-laws framed under section 306 (7) (b) of the Tamil
Nadu District Municipalities Act 1920 as amended I forward here with an estimate and plans
induplicate of the work to be done I have engage Thiru ---------------------------------------------------
a licensed plumber works for carrying out the said work.,
I request that permission may be accorded for executing the said work.
Signature of the owner or occupier
Address ----------------------------------------------------------------------------------
Signature of the licensed plumber
Address ------------------------------------------------------------------------------------
Estimate No: -----------------------------
COMPLETION CERTIFICATE
Work commenced on
Work completed on:…
Deviation if any…
Amount to be recovered if any on actuals ….
Amount to be refunded if any on actuals ….
Certified that the work has been completed as per estimates and plans approved (with
definitions as stated above) and hence Balance of Rs. ---------------(in words -------------------------
-----------------------------may be recovered from the party/reunded to the party as per completion
report.
Overseer/Junior Engineer. Municipal Engineer.---------------------------------------------------------------
-----------------------Amount of Rs. -----------------(in words------------------------------------------------------
----------------- Recovered in Chalan No.---------------------------Dated Refunded in refund Voucher
No.----------------------- Dated---------------------- Entered in sewage connection Register Page Item
No.---------------------------------------------
RECORDED
Municipal Engineer Municipal Commissioner.
