UNITATEA _____________________________________

SANTIER ________________________ PUNCT DE LUCRU ________________________

OBIECTUL ________________________________________________________________

PROCES VERBAL DE PREDARE - PRIMIRE A AMPLASAMENTULUI SI

A BORNELOR DE REPERE
Nr. ____________ Data _________________

1. Denumirea

terenului

conf.

plan

nr.

___________________________________________

avind

coordonatele (axele) :
_________________________________________________________________________________________
_________________________________________________________________________________________
Plansa nr. _____________________ Proiect nr. _____________________
cu reperele de identificare a terenului si trasare a lucrarilor (bornele, constructiile, etc.) :
_________________________________________________________________________________________
_________________________________________________________________________________________
Indicativul bornei de referinta ____________________________ Cota _________________
Cota absoluta _________________________
borna 1
borna 2
X
_______________
___________
Coordonata
Y
_______________
___________
(Axa)
Z
_______________
___________
2. Constructii-instalatii existente pe amplasament sau in subsol :

borna 3
___________
___________
___________

borna 4
___________
___________
___________

_________________________________________________________________________________________
_________________________________________________________________________________________
3. Alte mentiuni :
CONSTRUCTORUL se obliga :
a. sa transporte cantitatea de_________mc

BENEFICIARUL se obliga :
a) sa plateasca constructorului costul incarcarii si

moloz existenta pe amplasament

b. sa demoleze volumul de fundatii existent pe

transporturilor comandate
b) sa plateasca constructorului valoarea lucrarilor

amplasament pentru a fi transportate _______ mc.

comandate

4.
PREDAT :
BENEFICIAR
PROIECTANT
PRIMIT :
CONSTRUCTOR

Numele

Prenumele

Functia

Semnatura

________________
________________

________________
________________

________________
________________

________________
________________

________________

________________

________________

________________