Government of Tamil Nadu Electrical Inspectorate Department FORM 'A' APPLICATION FOR PERMISSION TO INSTALL (OR) TO MAKE ADDITIONS (OR) ALTERATIONS TO A LIFT (Rule 3 of the Tamil Nadu Lift Rules, 1997) To The Inspector of Lifts 1 Full Name and address of the applicant 2 Name and Address of the Agent, if any: 3.a. Address of the premises where the Lift is to be installed b. Approval reference of Urban Local Body Concerned for the Building Plan (Copy of approval letter and approved plan to be enclosed). 4 Whether a licence has been previously granted (Details to be given): 5 Type and Make of Lift Proposed to be erected(A sketch of the lift and erection plans as per Rule 3 shall be attached 6 The rated maximum speed of the Lift The Maker's or Designer's rated capacity in Weight (Kgs.) 7 The maximum number of passengers in Addition to the Lift operator which the Lift can carry. 8 The total weight of the lift carrying the Maximum load (Weight of car plus maximum Allowable load) 9 The weight of the counterweight(Kgs.): 10 The number, description, weights (Kgs.) and size (in Sq.mm) of the supporting cables 11 The depth of the pit from lowest part of the car when at the lowest floor (in mms.) 12 Details of the construction of the overhead Arrangement with weight (Kgs.) and sizes(mms.) of beams. 13 A Fee of Rs.500/- (Rupees five hundred only) for each lift paid into Government treasury. Date: Signature of the Applicant. Encl: 1.Challan. 2. Copy of approval obtained from the urban local body concern for the building plan. *Strike off whichever is inapplicable