Anexa nr.

Primria______________________________
municipiului, oraului, comunei, satului

CERTIFICAT DE URBANISM PENTRU PROIECTARE

nr.________din____________201___
Ca urmare a cererii depuse de ____________________________________,
cu domiciliul/sediul _________________________________________________
_____________________ telefon de contact______________________________,
nregistrat cu nr. _______ din _____________________ 201__
n baza prevederilor Legii privind autorizarea executrii lucrrilor de
construcie, se
CERTIFIC:
Elaborarea documentaiei de proiect pentru:
__________________________________________________________________
__________________________________________________________________
situat n raionul__________________municipiul/oraul_____________________
sectorul_____________________ comuna/satul ___________________________
strada __________________ nr. _______ bloc __________ ap. _______________
1. Regimul juridic:___________________________________________________
__________________________________________________________________
__________________________________________________________________
2. Regimul economic:________________________________________________
__________________________________________________________________
__________________________________________________________________
3. Regimul tehnic:___________________________________________________
__________________________________________________________________
__________________________________________________________________
4. Regimul arhitectural-urbanistic: ______________________________________
__________________________________________________________________
__________________________________________________________________

Prezentul certificat nu permite executarea lucrrilor de construcie.

Documentaia de proiect, n baza creia se va solicita eliberarea autorizaiei
de construire, va fi nsoit de urmtoarele avize i studii:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
PRIMAR

/ __________ /

L..

SECRETAR
ARHITECT-EF

/ ________/
/ ________/

Achitat plata de ___________ lei. Chitana nr.________din_________201___.

Transmis solicitantului la data de _____________201___direct/prin pot.
VALABILITATEA SE PRELUNGETE CU _________ LUNI
PRIMAR

/ __________ /

L..

SECRETAR

ARHITECT-EF

/ ________/
/ ________/

______________________201___
data
Not. n conformitate cu art. 26 din Legea privind autorizarea executrii lucrrilor de construcie,
responsabilitatea pentru emiterea certificatului de urbanism pentru proiectare revine solidar semnatarilor
acestuia.