ULHASNAGAR MUNICIPAL CORPORATION CITIZEN FACILITATION CENTRE SUBJECT: PERMISSION FOR REPAIR / RENOVATION OF BUILDING / PROPERTY Token Number (For Office Use) Date:- / / (If Citizen Identification Number is given, do not fill below Details) Applicant's Details: Last Name/ Surname Name Father/Husband's Name Details of Society (If Application from Society): Name Of Society: Designation Address: Head Information House/Building/Soc. Name: Flat/Block/Barrack No.: Wing/Floor: Road/Street/Lane: Area/Locality/Town/City: Taluka: Pin code: Ward Committee No.: 1 [ ] 2 [ ] 3 [ ] 4 [ ] Electrol Panel No.: Telephone No. (if any): Contact Person: Email Address (if any): Information of Property: Head Information Type of Property (Please Tick [?] as applicable) [ ] Land [ ] Building Property Number (Computerized) Necessary Particulars about above service: Head Particulars 1 Address of the building / property (To be repair / renovate) Pin 2 Year of Construction Citizen Identification Number 3 Type of Property (Tick which ever [ ? ] applicable) [ ] Authorised [ ] Unauthorised 4 Type of Authorised / Unauthorised property (Tick which ever [ ? ] applicable) [ ] Chawl [ ] Bungalow [ ] Apartment 5 Construction permission / commencement certificate number Date: 6 Construction completion / Usage certificate number Date: 7 Usage Type - (Tick which ever [ ? ] applicable) [ ] Resident [ ] Non Resident [ ] Mixed 8 Details of repair / renovation Necessary Enclosures related to above application are enclosed as under. (If enclosed tick [ ? ] or not enclosed tick [?] ) Enclosures Yes/No 1 Certified copy of the construction completion certificate / usage permission along with approved map OR Copy of Certificate issued by CTS/ADM office regarding E/U No. [ ] 2 7/12 Extract / City Survey Extract [ ] 3 NOC of owner / society [ ] 4 Map prepared by Architect or License Engineer for renovation/repair [ ] Declaration I/We..................................................................................................state on solemn affirmation that the above information is true and correct with the best of my knowledge. If the information given is found wrong then I/We shall be held legally liable for its consequences. Date:- Applicant's Signature ( ) The document may please be delivered to:- 1. Self/Nominated Person [ ] a) C.F.C. [ ] b) Camp No. [ ] Name of Nominated Person (________________________________________________) 2. By Post a) U.P.C. [ ] b) Register A.D. [ ] 3. Courier [ ] (Not to be filled if address is same as above) Correspondence Address:- Last Name/ Surname Name Father/Husband Name House/Building/Soc. Name: Flat/Block/Barrack No.: Wing/Floor: Road/Street/Lane: Area/Locality/Town/City: Taluka: Pin code: Email Address (if any):
