Work Completion Certificate - House Service Connection

K.U.W.S.& D.B. DIVISION, Kalaburgi.
Name of project:		Providing Combined Water Supply Scheme distribution to Shahapur City under Amurit 2.0
HSC No.			Work Completion Certificate - House Service Connection						Date:
Name Of The Agency
M/s Shivakumar Patil Engineers and Contractors Pvt Ltd. Raichur (Lead Partner) In JV with ABP - SSSEC
1. Zone			1.1. GPS Co-ordinates
2. Node details			Upstream node		Downstream node			Distance			R/L
4. Type of connection			1. Domestic			2. Non-Domestic			3. Commercial
5. Details of materials used for connection
Sl. No.	Item Description			Qty		Sl. No.	Item Description			Qty

1	Size of EF saddle				MM.	6	Brass Ball Valve 15mm				No's
2	20mm EF Coupler				No's	7	Brass Bib Cock-15mm				No's
3	20mm MDPE Pipe				No's	8	GI 90° elbow				No's
4	PE-90° Compression elbow push fit and female threaded (metal)-20mm				M.	9	G.I. Collar				No's
5	GI Pipe-15mm					10	Water meter				No's
a.	24 Inch				No's	11	Meter protection box				No's
b.	12 Inch				No's	12	Concreting
c.	6 Inch				No's	13	Clamp				No's
d.	3 Inch				No's	14	Nails				No's
e.					No's
f.					No's
	TOTAL:				No's
6. Supervised by
	Name			Designation				Signature
6.1
6.2
7. Details of Customer:
Aadhar No:						7.1. RR No:
8. Details of the meter Installed
8.1 Water Meter Serial number:							8.2 Date of Installation:
8.3 Initial meter reading at the time of installation:
I HEREBY CONFIRM THAT THE ABOVE WORK IS COMPLETED AND I HAVE NOT PAID ANY AMOUNT TOWARDS THE EXECUTION OF THIS WORK AND HEREAFTER I AM RESPONSIBLE FOR THE EXTERNAL DAMAGES CAUSED FOR THE WORK.
9. Acceptance of the consumer
Consumer			Relationship to Owner			Date & Signature

House Front Photo						Water Meter Photo
Click to upload House Front Photo						Click to upload Water Meter Photo



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