APPENDIX- A1

[See rules 5(1)(b), 75(1), 87(1) and 93(1)]

APPLICATION FOR PERMIT/REGULARISATION
Kuttiadi Grama Panchayat , Kozhikode

File No: SC 2/2487/2024 Electoral Ward : 12 Registration No : 2362470

1. Name in capital letters MUHAMMAD
2. Address:
2(i). Permanent address of the owner 12/, MANIYALAKANDY, KARAYATT THAMASIKKUM MANIYALAKANDY,
VATAYAM, VADAYAM, VATAYAM, 673518
2(ii). To which communications are to 12,MANIYALAKANDY,KARAYATT THAMASIKKUM
be sent MANIYALAKANDY,VATAYAM,VADAYAM,VATAYAM,Kozhikode,India
,Vatayam-673518
3. Nature of New Construction
development/Construction
4 Details of Plot
Sl (i)Survey No (ii)Resurvey (iii)Extent In (iv)Nature Of (v)Deed No. (vi)Deed (vii) Sub (viii)
. No Ares Ownership Date Registrar's Sub
N Office Division
o
1 63 94/50 9.54 Gift Deed 1351 04/12/2023 Kuttiadi 94
2 63 94/51 6.65 Gift Deed 1351 04/12/2023 Kuttiadi 94
ix. Ward No. 12
x. Authorised number of the nearest 12/254
building
xi. Nearest Electric Post/Telecom KKL/MN/83
Post number
xii. Taluk Vadakara
xiii. Revenue Village Kuttiadi
xiv. District Kozhikode
5. Whether the land, if any, No
contiguous to this plot of the
owner shown in the site plan (Rule
6(4)(a)(i)): Yes /No
6 Usage of surrounding plots in general
6(i). North Dry land
6(ii). East Dry land
6(iii). South Residential plot with Corp/Muni/Panc road access
6(iv). West Dry land
7. Whether Government or Quasi No
Government
8. Details of the Construction
Mercantile/Commercia
Special Residential

Multiplex Complex
Medical/Hospital

Office/Business

Industrial G1

Industrial G2
Construction

Educational
Residential

Hazardous
AreaType

Assembly

Storage

Total
Floor

1st Ground Floor Building Area 159. 159.

Constructi 3 3
on
1st 1st Floor Building Area 111. 111.
Constructi 25 25
on
1st Ground Floor Floor Area 154. 154.
Constructi 78 78
on
1st 1st Floor Floor Area 90.6 90.6
Constructi 2 2
on

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 8(i). Other Construction Details

Whether Government or Quasi

Permit Fee Area in Sqm

Other Rule Description

Other Rule Comments

Coverage Area in Sqm

Special Condition
Existing Building

Number of Well
FSI Area in Sqm

Existing Area
Construction

Parking Unit
Acess Width

Wall Length

Permit Fee
Govt:
Slno

1 New Construction × 2.70 0 245.4 159.3 270.5 × 0 0 0 1893.8

0000 5 5
0476
8372
8(ii). Height of Construction in Meters:
From ground level From Street level From Street level
Construction From ground level without with stair without stair room, with stair room,
stair room,machine room,etc. room,machine machine room, etc machine room, etc
room,etc.
1st
Construction 3.70000004768372 6.80000019073486 3.70000004768372 6.80000019073486

8(iii). Total Built-up Area 270.549987792969

8(iv). Total Covered Area 159.3
8(v). Total parking area provided inside 0
the building(s)
8(vi). Total Area for F.S.I. 245.4
9. Basic KPBR Verification w.r.t. proposed plot
Sl.No. Rule Description Provided
No.
1. Access width to the plot 0
2. Coverage in % 9.84
3. Floor Space Index 0.15
10. Basic KPBR Verification w.r.t. proposed building(s)

Building Type: Group - A1. Residential building up to 7 mheight for Construction 1.

No Mandatory permissible type as per building rules Requir Provide Remarks of

ed d Verifier
1 (28)Access to the building (in metre) <=0.00 2.70
2 (23)Minimum distance from the abutting road/access to other building(s) (in <=1.50 21.80
metre)
3 (29)No. of Four-wheeler parking <=0.00 0.00
4 (29)No. of Two-wheeler parking <=0.00 0.00
5 (29)No. of Parking for Differently abled <=0.00 0.00
6 (29)No. of Parking for Visitors <=0.00 0.00
7 (29)Loading/unloading space (in sqm) <=0.00 0.00
8 (26)Set Backs (in m) 0.00 YES
9 (26)Front <=3.00 21.80
10 (26)Side 1 <=1.00 7.10
11 (26)Side 2 <=1.00 4.15
12 (26)Rear <=1.50 14.15
13 (37)Exit Width (in m) <=0.00 0.00
14 (35(1))No. of Stair case(s) <=0.00 0.00
15 (35(2))No. of Fire Escape Stair case(s) <=0.00 0.00
16 (76(2)3)Rainwater storage capacity (in litre) 25.00 NA
17 (62)SURRENDERED FOR ROADS 0.00 NA
18 (72)SPECIAL PROVISIONS 0.00 NA
19 (77)Solar Assisted Water Heater/Lighting System 0.00 NA

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 11. Provisions of Town Planning Schemes, if any, applicable to the construction
11(i).Zoning
Sl.No. Name of the TP Stage(Sanctioned/Pub Zone Permissibility of
Scheme lished) proposed construction
as per the scheme
11(ii).Road Widening
Sl.No. Name of the Stage(Sancti Existing Proposed Building Line Set Back Set back
TP Scheme oned/Publish Width of Width of (in m) Required provided (in
ed) road (in m) road (in m) from m)
Existing road
boundary (in
m)
12. Permissibility with respect to NA
Kerala Conservation of Paddy Land
and Wet and Act 2008 / KLU order
1967
12(i). Type of land as per BTR
12(ii). Type of land as per Data Bank
13. If the application is for
regularisation
13(i). Whether construction completed
or not
13(ii). If not completed, the stage of
construction
14. Details of permit/approved plan
already obtained.
Permit No.
Permit Date , ,
15. Details of Fee paid Application fee Layout scrutiny fee
15(i) Amount 0 0
15(ii) No. and date of receipt ,
16. Details of documents, plans, certificate, etc. enclosed
1. Ownership 2. Land Tax Receipt 3. Site Plan 4. Location Plan 5. Building/Development Plan
17. Details of NOC obtained
Sl.No. Required Whether enclosed or not Details of the NOC / Clearances

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 18. DECLARATION
I MUHAMMAD hereby declare that the measurements, specifications and other details mentioned above are
correct, complete and true to the best of my knowledge and belief and that I shall abide by the approved
plan and the provisions in the Act and Rules in undertaking the construction.
Place :Kozhikode
Date :02/05/2024
Signature of the Applicant with Name
19. CERTIFICATE
1. Certified that the site plan is prepared after verification of ownership document and site and the
measurements shown are found to be correct.
2. Certified that the building plan is prepared in accordance with the provisions in the Kerala Panchayat
Building Rules 2019, Kerala Panchayat Raj Act, 1994 and the provisions contained in the sanctioned Town
Planning Schemes, if any.

Signature
Name :URBAN AFFAIRS
Reg.No. :E-2050/08/20180/KKD/162/2021/SA
Address KOYILOTHUMPOYIL(HO) AROOR (PO)KAKKATTIL(VIA)KOZHIKODE 673507
(Registered Architect/Engineer/ Town Planner/Supervisor)
Place:Kozhikode
Date :02/05/2024
20. UNDERTAKING
I LISINA MP hereby undertake that the building construction and/or land development will be carried on/
being carried on/ was carried on as per the approved plan and permit in accordance with the rules in
force.

Signature
Name :LISINA MP
Reg.No. :E-2050/08/20180/KKD/162/2021/SA
Address KOYILOTHUMPOYIL(HO) AROOR (PO)KAKKATTIL(VIA)KOZHIKODE 673507
(Registered Architect/Engineer/ Town Planner/Supervisor)
Place:Kozhikode
Date :02/05/2024
21. VERIFICATION
Certified that the extract of the Building Permit Application prepared electronically on 17/05/2024 at
NADUPPOYIL[12] was verified by me in details and to the best of my knowledge and belief the entries made
there in are correct.
22. Permit Fee Rs. 27055

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