………………. No. of Registered Engineer ……………………….. Address

………………. ………………. ………………. ……………….

Factory, Stable for which it is intended to be used.

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………………. ………………. ………………. ……………….

(b) Details of coverage on respective floors are given below :—

Existing Proposed Total

1. Basement Floor.

2. Ground Floor.

3. Messanine Floor.

4. First Floor.

5. Second Floor.

6. Third Floor.

(c) Approximate number of inhabitants proposed to be accommodated.

(d) The number of latrines, urinals, kitchens, baths to be provided.

(e) The source of water to be used in the construction.

(f) Distance from public sewer.

(g) The material to be used in constructions Walls/Columns/ Foundations/Roof Floors.

Signature of Registered Engineer

………………………..

Name of Registered Engineer

………………………..

(in block letters)

Registration No. of Registered Engineer

………………………..

Address of Registered Engineer

………………………..

Dated……………….

x

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