4. proces verbal de predare amplasament.doc

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ANEXA 4 CONTRACT NR. ___________________________________________________________ SANTIER ______________________ PUNCT DE LUCRU________________________ OBIECTIVUL ____________________________________________________________ PROCES VERBAL DE PREDARE AMPLASAMENT _____________________________________________ Nr. _______ / Data___________ Denumirea obiectivului (lucrarii) ___________________________________________________________________________ ______ Predarea a fost executata de ___________________________________________________________________________ ______ Pe baza planselor nr. _______________________________________________________________ din proiectul ______________________________________________________________________ Elementul de reper si verificare (borna, constructie invecinata, etc...) ___________________________________________________________________________ ___________________________________________________________________________ ____________ avand coordonatele: Borna 1 Borna 2 Borna 3 X___________________ X_________________ X_______________ Y___________________ Y_________________ Y_______________ Z ___________________ Z_________________ Z_______________ Constructii / instalatii existente la suprafata amplasamentului sau subteran : ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ________________________ Participanti:

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Proces Verbal de Predare Amplasament

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UNITATEA __________________________________________________________________

ANEXA 4

CONTRACT NR. ___________________________________________________________

SANTIER ______________________ PUNCT DE LUCRU________________________

OBIECTIVUL ____________________________________________________________

PROCES VERBAL DE PREDARE AMPLASAMENT

_____________________________________________

Nr. _______ / Data___________

Denumirea obiectivului (lucrarii)

_________________________________________________________________________________

Predarea a fost executata de

_________________________________________________________________________________

Pe baza planselor nr. _______________________________________________________________

din proiectul ______________________________________________________________________Elementul de reper si verificare (borna, constructie invecinata, etc...) __________________________________________________________________________________________________________________________________________________________________

avand coordonatele:Borna 1

Borna 2

Borna 3

X___________________ X_________________ X_______________

Y___________________

Y_________________ Y_______________

Z ___________________ Z_________________ Z_______________

Constructii / instalatii existente la suprafata amplasamentului sau subteran:

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Participanti: Nume:

Prenume:

Semnatura

Beneficiar Primarie

__________

_________________________Beneficiar ACET

__________

_________________________Inginer

__________

_________________________

Proiectant __________

_________________________Executant

__________

_________________________SC Romtelecom SA

__________

_________________________E ON Gaz fil. Suceava __________

_________________________ SC Termica SA __________

_________________________E ON Moldova fil. Suceava __________

_________________________