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.