DECLARATION

I ...................., son of ................ residing at ............ do hereby declare that I possess the
qualification and experience specified in the Table 2, Rule 11 of the Tamilnadu Public Buildings
(Licensing) Rules 1966, for issuing the certificate of structural soundness of the buildings
covered by the certificate.
Station:
Date: Signature of the Certifying Engineer
1. Name and Address ............................
2. Engineering Qualification ......................
3. Number of years of experience and nature thereof ........
FORM - A
(Form of application under Sub -Section (2) of Section (4) Madras Public Buildings (Licensing)
Act 1965 (Madras Act 13 of 1965) referred to in Rule 3 of the Tamilnadu Public Buildings
(Licensing) Rules 1966)
From
To
Sir,
I intend / to use the building / to continue to use the existing building not at present used as
public building / which is situated in the site or plot of land, Town or Revenue Survery No ..........
Street or Road ............... In the ward or division ............ village, taluk ..............., district .............
And specified in the statement enclosed as a public for a period of ............ years and
months ............. from the year ..........
The year of construction and present approximate costs of construction and the purpose for
which its to be used or is being used as public building are also furnished in the statement
accompany this application.
I enclose a Chelan for Rs............
I also enclose a Certificate of Structural Soundness in the prescribed form furnished by the
Engineer ...................... Registration No. K. Dis ..............
Date: Signature of the owner of the building
Enclosure: 1. Statement
1. Chelan for Rs........... Towards the application fee.
STATEMENT ACCOMPANYING FORM -A
BUILDING

1. Location (Street Number, Ward Number, Name of the place, i.e. Corporation,
Municipality / Panchayat union / Township/ cantonment):
2. Year of construction:
3. Approximate cost of construction as per current rates:
4. Purpose for which the building is being used or proposed to be used
5. Purpose for which the building has hitherto been used:
6. Details of construction of he building (particulars the foundation soils, specification of
the various parts under):
Foundation:
Superstructure:
Flooring:
Joinery:
Roof:
Finishing:
7. Period for which license is required
8. No of persons to be accommodated
Date Signature of the Engineer

Signature of the owner of the building.

Note: Enclose similar details for other building also if necessary.
***

FROM - B
(Form of certificate of structural under Sub-Section (4) of Madras Public Buildings (Licensing)
Act 1965 (Madras Act 13 of 1965) referred to in Rule 4 of Tamilnadu Public Building
(Licensing) Rules 1966)
I certify that I have inspected the building mentioned in the statement and furnish below its
salient technical features.
BUILDING
1. Foundation
I.

Depth below ground level :

II.

Nature of soil met with at foundation level:

III.

Pressure at foundation

IV.

Probable safe bearing capacity of state met with at foundation:

2. Super structure
I.
II.

Maximum stress in the most critical section column

Nature of masonry and concrete and its safe permissible stress

The structural soundness of the building has been verified by me with reference to ISI loading
standards 875 (latest version) and other relevant Indian standards code of practice and I declare
that the building is structurally sound to be used as a public building for the purpose noted in the
statement. A license may be granted for the period from 2001 to 2004 inclusive.
Date: Signature of the Engineer
Note: Enclose similar details for other building also if necessary.
***
STATEMENT ACCOMPANYING THE CERTIFICATE OF STRUCTURAL
SOUNDNESS
1. Location of the building Door Number, Street and Number of the place:
2. Age of the Building
3. Number of the Storey:
4. Short description of structures Steel or RCC framed or load bearing masonry:
5. purpose for which the building will be structurally sound:
6. The period for which the building will be structurally sound:
7. Number of persons to be accommodated:
8. Remarks

Date Signature of the Engineer

****
APPLICATION FOR THE STRUCTURAL STABILITY OF THE BUILDING
1. Name of the Institution
2. Location

3. By whom managed
4. Details of building in the campus
BUILDING
1. Condition of the Building:
2. Year of Construction:
3. Authority who have approved the construction from structural point of view: \
4. Type of building:
5. No. of Storeys:
6. Foundation and Basement
a. Adequacy and structural soundness:
b. Present condition:
c. Superstructure:
d. Type of masonry walls used in super structure
e. Structural Soundness:
f. Present condition:
7. Any partition walls intermediate floor which do not have proper support:
8. Veranda pillars:
a. Structural soundness:
b. Present condition:
c. Details of floors be furnished:
9. Floor joints etc
a. Structural soundness:
b. Present condition
10. Floor
a. Structural soundness:
b. Present condition:
11. Roof

i.

Details of roof:

ii.

Roof beams, joints, Rafters:

a. Structural soundness
b. Present condition:

iii.

Roof slab
a. Structural soundness:
b. Present condition:

5. Miscellaneous Items:
6. Fire protection:
7. is there are adequate provision in regard to entrances and exits for the emergency
8. General remarks
Date: Signature of the Engineer
***
FROM - C
(FORM OF OPINION UNDER SUB-SECTION (10) OF SECTION (5) OF MADRAS PUBLIC
BUILDINGS (LICENSING) ACT 1865 (MADRAS ACT 13 OF 1965) REFERRED TO IN
RULE 5 OF THE TAMILNADU PUBLIC BUILDINGS (LICENSING) RULES 1965)
I have inspected the building specified in the statement above and I have satisfied myself that the
building is structurally sound to be used as public buildings for the purpose specified in the
statement. The structural soundness of the buildings has been verified taking into account the
loading as per the latest Indian Standard 875. I am there fire of the opinion that a license may be
granted for a period of three years.
Date
Statement accompanying the opinion regarding structural soundness
Location of
building Door no
street and

Age of
building

purpose for which purpose for which the

the building can building will be
be
structurally sound

Date: Signature of the Engineer

No of persons to
accommodate