DZONGKHAG ADMINISTRATION, SAMTSE

A prosperous community living in harmony with diverse culture and safe environment”

SDA Reg. No: ………………………. FORM – 1

CONSTRUCTION APPLICATION FORM- RURAL AREA

1. APPLICANTS DETAIL:

1. Applicants Name:-………………………………………..………………….
2. D.O.B. ……………………………………………………………………….. Affix
Passport
3. CID No:-……………………….……………………………………………. Size
Photo

4. Contact No:-……………………………………………………………….....

5. Thram No:-……………………………………Plot No:-…………………….

6. Village ……………………………… Gewog ……………………………....
7. Dungkhag: ……………………………………………………………………
8. Building Use. …………………………………………………………………

2. DOCUMENTS TO BE SUBMITTED:

 Drawings: 1 Set of Architectural, Structural, Electrical, Water & sanitation drawing

duly signed by the designer and owner.
 For RCC structure above G+1 and above, Analysis file to be submitted (either staad / Etabs
file)
 Certificate of Designers with Contact Number.
 Copy of latest Lag Thram/LUC and Annual Land Tax Receipt.
 Environment Clearance required if it is a proposal other than Residential and Residential
cum Commercial use.
 Road Right of Way clearance from DoR, MoWHS for the proposed construction along the
Highway.
 Power clearance from the Bhutan Power Corporation.
 A Ground floor plan showing complete building profile dimensions, set back lines, plot
boundary, the access road/footpath, location of drains, location and dimensions of existing
buildings, trees and car parking spaces, layout dimensions from building corners to plot
corners shall be submitted in the Architectural drawing set.

3. DECLARATION TO BE SIGNED BY THE APPLICANT:

The information supplied in this application form is correct to the best of my

knowledge. I shall be held responsible for any discrepancies to which I am prepared
to face any disciplinary or legal consequences. AFFIX
LEGAL
I shall hereby agree to construct my building as per the approval accorded by the STAMP

Dzongkhag Administration and I will not deviate out of the final layout
checked by the Municipality. If I deviate from the approved plan, I shall be liable
for the penalties as per the any relevant regulations.

Dzongkhag Administration, Post Box No. 301, Dasho Dzongdag: 05-365308, Dasho Dzongrab: 05-365304
 DZONGKHAG ADMINISTRATION, SAMTSE
A prosperous community living in harmony with diverse culture and safe environment”

1. CLEARANCE FROM GEWOG ADMINISTRATION

Chiwog Tshogpa Gup

Gewog Administration Gewog Administration

*Authenticate and verify: Gewog shall verify the documents submitted and confirm the residency of
the applicant.
Gewog also shall obtain the authorization from all the legal plot owners if the construction is to be
carried out in a land owned by family or in joint ownership.

2. CLEARANCE FROM Dz. LAND RECORD SECTOR

Surveyor/Land Inspector
Plot Demarcated for construction purpose Land Record Officer
Land Record & Survey Section Land Record & Survey Section
*Authenticate and verify: Land Record/Surveyor shall verify that it is a constructible land
(Kamzhing) and also demarcate the plot showing the legal plot boundary.

3. CLEARANCE FROM Dz. HUMAN SETTLEMENT SECTOR

Building Inspector Verifying Officer at site

*Authenticate and verify: Building Inspector and the officer at site shall verify the building layout,
the levels and orientation and also all the applicable setbacks as per BBR-2018.

(Chief Engineer, Dz. Engineering & Human Settlement Sector)

Dzongkhag Administration, Post Box No. 301, Dasho Dzongdag: 05-365308, Dasho Dzongrab: 05-365304
 DZONGKHAG ADMINISTRATION, SAMTSE
A prosperous community living in harmony with diverse culture and safe environment”

SDA Reg. No: ………………………. FORM – 2a

CONSTRUCTION AGREEMENT

This agreement made on month ............................ date............... year ............................ is

executed between Samtse Dzongkhag Administration (hereinafter called SDA) of the one part and the
Ownerof the Plot/ Official representative of ................... ……………………………………………….
(hereinaftercalled as owner) of theotherpart.
The following terms and conditions shall apply for proposed new construction / Vertical
Extension / Horizontal Extension / or any alteration of ..................................... storeyed
Commercial/Residential/Institutional/Industrial building on plot no. ……………, at
…………………………. Village, ....................................... Gewog, Samtse.
1. It is mandatory for the owner of the building to keep the original approved drawing at the
site at all times. This will help the Building Inspector to check deviations. Any unapproved
deviations from the approved set of drawings shall result in penalties as per BBR-2018.

2. The building owner shall ensure that before commencing any work (levelling/clearing the
site) on the proposed site, he/she shall obtain a work clearance from the Authorities
concerned. In the event services such as Water supply line, Sewer line, TV cable lines,
Telephone lines, Electricity lines and roads are damaged, the actions will be taken as per
the Water & Sanitation Rules, Bhutan Building Rules, and Code of Practice for
Plumbing and other relevant Rules.

3. The building owner shall take necessary precautions against accidents, damages or
inconvenience to the public and workers or adjacent property either directly or indirectly
during the execution of the work. Further, the owner shall ensure that the construction
materials are properly stacked and covered within the plot.

4. The building owner shall ensure that the building under construction has proper
scaffolding, platforms, net and signboards cautioning the pedestrian and vehicular traffic.

5. All constructions, including roof projections and gutters, shall be within the registered
area. The setback to be maintained as per approved building plan.

6. The Approved drawings shall be strictly used for construction and not for obtaining
any other approvals/clearances. The construction shall start within two years from the
issuance of final approval.

7. During finalization of building layout, the owner shall obtain a Building Inspection
report Form I from Municipal before commencing any construction. Once it is checked
and approved by SDA, if found deviated later, then owner shall be held responsible.

Dzongkhag Administration, Post Box No. 301, Dasho Dzongdag: 05-365308, Dasho Dzongrab: 05-365304
 DZONGKHAG ADMINISTRATION, SAMTSE
A prosperous community living in harmony with diverse culture and safe environment”

8. Should the owner wish to make any alteration to the approved drawings, they must seek
prior approval from SDA.

9. The building owner shall be responsible for disposal of construction materials including
debris to a dumping site as advised by Gewog/SDA.

10. The building owner shall restore/reinstate the public or private properties
interfered/damaged during the construction to the satisfaction of the Implementing
Authority/affected property owner. In the event, the interference is affecting both the parties
the restoration shall be carried out jointly as determined by the SDA.

11. When the construction work is completed, the owner has to submit the supervising
Engineer's (Thikadhar/mason) Completion Certificate to SDA.

12. Occupation of any building without obtaining occupancy certificate shall result in
penalty and disconnection of services.

13. The building owner shall ensure that the building under construction is completed within three
years from the date of commencement. In the event that the construction is stopped (for
whatsoever the reason) for a period exceeding one year the owner shall erect a pitch roof
over the finished floor.

14. The approved Building Drawings shall be valid for two years (2 years) from the date
of approval. (i.e. …………………..to ........................................... )

………………………….. ……………………………………

Chief Dz. Engineer, DE&HSS, SDA Owner/Authorized proponent

Witness(Sign&Address)

Dev. Regulatory Officer,

DE&HSS, SDA

ENDORSED BY

DZONGDAG

Dzongkhag Administration, Post Box No. 301, Dasho Dzongdag: 05-365308, Dasho Dzongrab: 05-365304
 DZONGKHAG ADMINISTRATION, SAMTSE
A prosperous community living in harmony with diverse culture and safe environment”

SDA Reg. No: ………………………. FORM – 4a

UNDERTAKING LETTER - From Head mason/thikadar.

I hereby undertake and assure that the building construction /development/ erection/ re-
erection or material alteration in/of building on plot No… ............................, registered under
thram no.:..............,belonging to Mr /Mrs
/Ms…………………………………………………
in ……………………………………… shall be supervised by me. It shall be carried out as
per the approved set of drawings vide
No……………………………………………………................, dated.....................
The work shall be done to my best satisfaction, the workmanship and all the materials (type
& grade) be used strictly in accordance with general and detailed specifications.
All conditions stipulated in the construction agreement dated …………………………….
shall be fulfilled.

…………………………………..........
Name & Signature of Site Engineer/ Contractor
Address of Site Engineer/ Contractor

...............................................

...............................................

………………………………………….
Signature & Name of the Owner
Signature, Name & Designation of the Authorized Official
With Official seal (in case of Govt. /Semi-Govt. Project).
Date: …………………

Dzongkhag Administration, Post Box No. 301, Dasho Dzongdag: 05-365308, Dasho Dzongrab: 05-365304
 DZONGKHAG ADMINISTRATION, SAMTSE
A prosperous community living in harmony with diverse culture and safe environment”

SDA Reg. No: ………………………. FORM – 4b

UNDERTAKING LETTER - From Electrician.

I hereby undertake and assure that the electrical works in building construction
/development/ erection/ re-erection or material alteration in/of building on plot
No…………………...., registered under thram no.:..............,belonging to Mr /Mrs
/Ms…………………………………………………
in ……………………………………… shall be supervised by me. It shall be carried out as
per the approved set of drawings vide
No……………………………………………………................, dated.....................
The work shall be done to my best satisfaction, the workmanship and all the materials (type
& grade) be used strictly in accordance with general and detailed specifications.
All conditions stipulated in the construction agreement dated …………………………….
shall be fulfilled.

…………………………………..........
Name & Signature of Electrician
Address of Electrician

...............................................

...............................................

………………………………………….
Signature & Name of the Owner
Signature, Name & Designation of the Authorized Official
With Official seal (in case of Govt. /Semi-Govt. Project).
Date: …………………

Dzongkhag Administration, Post Box No. 301, Dasho Dzongdag: 05-365308, Dasho Dzongrab: 05-365304
 DZONGKHAG ADMINISTRATION, SAMTSE
A prosperous community living in harmony with diverse culture and safe environment”

SDA Reg. No: ………………………. Date:

LETTER OF UNDERTAKING FOR BASEMENT APPROVAL

I, undersigned undertake that my building basement is required for the following:

o To meet storage requirements for the building and shops.

o To meet the parking requirement in the building.
Upon approval of the basement, I agree to the following terms and condition laid down by
Samtse Dzongkhag.
1. I will use the basement as storage only as reflected/rectified in the approved drawings.
2. The basement shall be constructed totally under the ground level and plinth level shall
be maintained as per the approved drawings with the comments incorporated.
3. Once the basement has been approved and constructed, I will not propose or convert
the basement into habitable/ commercial space.
4. I pledge to resolve all issues related to drainage and sewage with my own personal
expense.
5. I undertake to repair, reconstruct and compensate for any damages inflicted upon the
adjoining properties and take full responsibility for any other issues related due to the
excavation of the building basement.
6. I agree to remove/demolish any construction in the basement and bear the penalties as
per Dzongkhag notification if any of the above clauses are violated.
7. I accept the aforementioned terms and agree to all conditions laid down by
Dzongkhag with regards to the construction of the basement.

*Not adhering to the aforementioned terms and conditions and the DCR (and the circulars for
basement from the Ministry of works and human settlement) shall be liable for fines/penalties
and cancellation of the approval.

Name:

CID No.: Affix Legal

stamp here
Plot No.: (Sign)

Thram No:

Mobile No.:

Witness

Name & CID No.: Affix Legal

stamp here
Mobile No.: (Sign)

Dzongkhag Administration, Post Box No. 301, Dasho Dzongdag: 05-365308, Dasho Dzongrab: 05-365304