Appendix N — Format of Completion Certificate (Water Supply Works) Completion Certificate (Water Supply Works)

Certified that I/we have completed the plumbing work of water connection No ______________
for the premises as detailed below. This may be inspected and connection given.
Ward No. ___________________ Road No._________________ House No. _________________
Existing water connection No. (if any) ________________________________________________
________________________________________________________________________________
Owned by _______________________________________________________________________
Owner's address : _________________________________________________________________
________________________________________________________________________________
Applicant's name : ________________________________________________________________
son of __________________________________________________________________________
Address : _______________________________________________________________________
Situated __________________________________________________________________ Size of
main _____________________on _________________Street _____________________________
Where main is ______________________________ Size of service pipe ____________________
Size of ferrule ________________No. of taps ________No. of closets _______________________
Capacity of Underground Reservoir (where required) ____________________________________
No. of other fittings and appliances __________________________________________________
Road cutting and repairing fee ______________________________________________________
Paid Tk. ______________ (Receipt No. ________________dated ___________ (receipt enclosed)
Dated _____________________                  Signature of the licensed plumber_______________
                                             Name and address of the licensed plumber _______
                                             _________________________________________
________________________________________________________________________
The Authority's Report/ Certificate :
Certified that the communication and distribution pipes and all water fittings have been laid,
applied and executed in accordance with Chapter 5 of Part 8 of the Bangladesh National Building
Code, and satisfactory arrangements have been made for draining off waste water.
The water supply connection will be made on ___________________________________

Date ________________                   Water Supply Authority______________________
                                        __________________________________________
                                        __________________________________________