APPLICATION NUMBER BPS/......... APPLICATION FOR PENALISATION OF UNAUTHORISEDLY CONSTRUCTED BUILDING / BUILDING CONSTRUCTED IN DEVIATION OF THE SANCTIONED PLAN ----------------------------------------------------------MUNICIPAL CORPORATION / MUNICIPALITY ----------------------------------------------------------URBAN DEVELOPMENT AUTHORITY 1 Name of the Applicant 2 Postal Address 3 Building Location i T.S. No. ii Door No. iii Plot No. iv Layout / Sub Divn. No. v Street vi Locality vii City/Town/ Village 4 Furnish the following i Copy of latest Property Tax receipt YES NO ii Copy of Registered document duly attested by Gazetted Officer YES NO iii One Photograph showing the Elevation and roof slab YES NO 5 Details of Site & Building i Plot Area (in Sq.m) ii Building Permit No. & Date if any iii Sanctioned Plan copy enclosed iv No. of Floors Sanctioned and height of building iv No. of Floors and height of building from the road level as on site v Total Built Up Area Sanctioned (in Sq m) vi Total Built Up Area as on site (in Sq m) vii Additional built up area built a. Area in deviation to sanctioned plan within permitted floors b. Area constructed without any permission or over and above the permitted floors 6 Road Access Details i Existing Road Width of abutting road 7 Usage of the approved plan (if any) building as per As per Sanctioned Plan As on ground a. Individual Residential Building b. Commercial Building c. Non-Residential Building d. Apartment complex 8 Total Penalisation charges payable (as per Self Computation Table duly filled in) 9 Demand Draft / Pay Order i Amount: ii D.D.No. iii Date iv Name of the Bank & Branch 10 Any court case is pending regarding ownership of the site YES / NO 11 If yes details may be enclosed separately 12 Certificate to be submitted by the Applicant: ..I hereby certify that the Building Plans, Site Plan and the particulars furnished above are true and correct. ..I declare that the property for which I am applying for penalisation is not a public property and I further declare that there are no disputes/ legal cases pending in court of law regarding ownership of the site/ building. ..I also declare that my application is not in contravention of land use as per the Master Plan. ..In the event of the particulars furnished in the application are found to be not true , my application may summarily be rejected duly forfeiting the entire penal charges paid and I am liable for enforcement action by the Competent Authority as per the law. Date Name Place Signature 14 Certificate to be signed by the Licensed Technical Personnel: . I hereby certify that the Building Plans and Site Plan are prepared by me duly taking the measurements on ground. The technical data with regard to the permitted built up area, as per sanctioned plan and actual built up area existing at site, extent of built up area in deviation to sanctioned plan and total built up area without any building permission is true and correct. . . Signature Name License No. and Stamp Category Architect Surveyor Engineer Others (specify) Address with Contact Numbers 15 Certificate to be signed by the Structural Engineer: (Certificate to be submitted in case of the buildings of height above 15 m or above ) ..I hereby certify that the building is structurally safe and the construction is in accordance with the specified designs and that I will be held responsible if the same are not in order at a later stage. Signature Name Licence No. Address with Contact Numbers 16.1. Fill up the table applicable TABLE-1 Self Computation Table showing Penalisation Charges for Individual Residential Buildings / Commercial Buildings / other Non-Residential Buildings for the cases where Building Permission was obtained but deviated from the sanctioned plan Sl. No Category / Sub-category Built Up Area as per sanctioned plan (in sft) Built Up Area as on site (in sft) Difference of area in (in sft) % of violation Rate per sft as per Annexure-I of the Rules Total penal amount to be paid (1) (2) (3) (4) (5) = (4)-(3) (6) = (5) / (3)x100 (7) (8) = (5)x(7) A. INDIVIDUAL RESIDENTIAL BUILDINGS: 1 Upto G+2 floors or 10m height 2 Above G+2 floors and upto G+4 floors or above 10m and upto 15m height B. COMMERCIAL BUILDINGS: 1 Up to G+1 floor 2 Above G+1 floor and up to G+4 floors and upto 15m Height 3 Above 15 m in height C. Other Non-Residential Buildings (Institutional / Educational / Industrial, etc.): 1 upto 15m height 2 above 15 m in height Signature: Name : 16.2. Fill up the table applicable TABLE-2 Self-Computation Table showing Penalisation Charges for Individual Residential Buildings / Commercial Buildings /Other Non-Residential Buildings for the cases where No Building Permission was obtained Sl. No. Category / Sub-category Built Up Area as on ground (in sft) Rate per S. ft as per Annexure-I of the Rules (in Rs.) Total Penal Amount to be paid (in Rs.) 1 2 3 4 5 = 3x4 A INDIVIDUAL RESIDENTIAL BUILDINGS: 1 Up to G+2 floors or 10m height 2 Above G+2 floors and up to G+4 floors and above 10m and up to 15m COMMERCIAL BUILDINGS 1 Up to G+1 floor 2 Above G+1 floor and up to G+ 4 floors and up to 15m Height 3 Above 15 m in height OTHER NON-RESIDENTIAL BUILDINGS (Institutional / Educational / Industrial, etc.) 1 Up to 15m height 2 Above 15 m in height Signature Name 16.3 Fill up the table applicable TABLE-3 Self computing Table showing Penal Charges for Multiple Dwelling Units / Flats / Apartment Complexes Sl.N o. Categor y Permitted by Sanctioning Authority but deviated Building Constructed Without permission /Unauthorised Floor Sub-category Penalisati on Charges to be paid Built Up Area of Apartment (in Sq. ft.) Penalisatio n Charges per sft Penalisation Charges to be paid 1 2 3(a) 3(b) 4(a) 4(b) 4(c) = 4(a)x4(b) 1 Height less Apartment area up to 1000 sft than 18 mtrs Apartment area more than 1000 sft 2 Height 18 mtrs & above Signature: Name: 17. INDEMNITY BOND & UNDERTAKING (On Non-Judicial Stamp paper of Rs. 100 & Notarised) (To be submitted along with Application Form) This Indemnity Bond and Undertaking executed on this __________ day of ____200-by Smt./Sri S/o/W/o____________________________________________________Age________ Occupation____________________________________ R/o_____________________ Herein after called the FIRST PARTY which term shall include their legal heirs, successors, assignees, agents, representatives and tenants. IN FAVOUR OF The Commissioner of ------------------------------------------------------------------------------/ Vice-Chairman ______________________________Urban Development Authority herein after called the SECOND PARTY, which term shall include all officials and staff of the___________________________Municipal Corporation/Municipality/Urban Development Authority. Whereas the FIRST PARTY has applied for the penalisation of the unauthorized construction in Premises No.---------------------------of ---------------------, --------------/Sy. No.-------------------of ___________, _____________ Mandal, ____________ District in the site / plot covering an extent of __________________________ sq m. Whereas the SECOND PARTY has agreed to consider penalisation of the unauthorized construction in the said site/ plot in terms of 'the Andhra Pradesh Regulation and Penalisation of Unauthorisedly Constructed Buildings and Buildings constructed in deviation of the Sanctioned Plan Rules, 2007' and made it a condition that there shall not be any defect/litigations/Land Acquisition over the said site/land and the same shall be free from all claims of Govt./Banks/and attachments of Courts, and the FIRST PARTY has to indemnify the SECOND PARTY to this effect. Whereas the FIRST PARTY having agreed to the aforesaid condition hereby indemnifies the SECOND PARTY with the above assurance and hereby solemnly declare that the above said site/land is the property of the FIRST PARTY which is possessed by him/her since the date of purchase and the same is free from all defects, litigations, claims and attachments from any courts, etc. and in case of any disputes/litigations arises at any time in future the FIRST PARTY will be responsible for the settlement of the same and the SECOND PARTY will not be a party to nay such disputes/litigations. Hence this Indemnity Bond. FIRST PARTY ____________________________________ WITNESSES: 1. ______________________ Name and address_____________________________ 1. ______________________ Name and address____________________________ Sworn and signed before me on this ------------day of ----------200 in presence of above witnesses. PUBLIC NOTARY 18. List of documents to be enclosed along with the application: Submitted 1 Sanctioned Plan copy YES NO 2 Copy of Ownership document / Title Deed attested by Gazetted Officer YES NO 3 3 sets of Plans (one original on Tracing Paper / Cloth + 2 ammonia prints) as stated below drawn by Licensed Technical Person and signed by applicant YES NO and LTP a. Site Plan YES NO b. Location Plan YES NO c.Detailed Plan YES NO d. Section YES NO e. Elevation YES NO 4 Self computation table for the penalization charges YES NO 5 Demand Draft / Pay Order drawn in favour of the Competent Authority towards the penalization charges YES NO 6 Copy of latest Property Tax Receipt YES NO 7 One Photograph showing the Elevation YES NO 8 One Photograph showing the Roof Slab YES NO 9 Indemnity Bond YES NO 10 Affidavit as required under Urban Land Ceiling Act in case the total extent of the land held by the applicant does not exceed ceiling limit. YES NO 11 Urban Land Ceiling Clearance Certificate in case the extent of plot / site exceeds the ceiling limit YES NO 12 NOC from Fire Services Department (where ever applicable) YES NO 13 NOC from Airport Authority of India (where ever applicable) YES NO 14 15 Total No. of Documents 19. CHECK LIST & ACKNOWLEDGEMENT (To be submitted in duplicate -one to be retained in file and another to be given to applicant as acknowledgement) APPLICATION FOR PENALISATION OF UNAUTHORISEDLY CONSTRUCTED BUILDING /BUILDING CONSTRUCTED IN DEVIATION OF THE SANCTIONED PLAN -------------------------------------------------------------MUNICIPAL CORPORATION / MUNICIPALITY ----------------------------------------------------------------------URBAN DEVELOPMENT AUTHORITY 1 Name of the Applicant 2 Building Location i T.S. No. ii Door No. iii Plot No. iv Layout / Sub Divn. No. v Street vi Locality vii City/Town/Village List of documents to be enclosed along with the application: Submitted 1 Copy of Sanctioned Plan YES NO 2 Copy of Ownership document / Title Deed attested by Gazetted Officer YES NO 3 3 sets of Plans (one original on Tracing Paper / Cloth + 2 ammonia prints) as stated below drawn by Licensed Technical Person and signed by applicant and LTP YES NO a Site Plan YES NO b Location Plan YES NO c Detailed Plan YES NO d Section YES NO e Elevation YES NO 4 Self computation table for the penalization charges YES NO 5 Demand Draft / Pay Order drawn in favour of the Competent Authority towards the penalization charges YES NO 6 Copy of latest Property Tax Receipt attested by Gazetted Officer YES NO 7 One Photograph showing the Elevation YES NO 8 One Photograph showing the Roof Slab YES NO 9 Indemnity Bond YES NO 10 Affidavit as required under Urban Land Ceiling Act in case the total extent of the land held by the applicant does not exceed ceiling limit. YES NO 11 Urban Land Ceiling Clearance Certificate in case the extent of plot / site exceeds the ceiling limit YES NO 12 NOC from Fire Services Department (where ever applicable) YES NO 13 NOC from Airport Authority of India (where ever applicable) YES NO Total No. of Documents 20. ACKNOWLEDGEMENT Received the application and documents as stated above. OFFICE SEAL Application Number for future reference BPS/........... SIGNATURE OF THE RECEIVER DESIGNATION
