UNITATEA:

PUNCT DE LUCRU:
OBIECTUL:

PROCES-VERBAL DE PREDARE-PRIMIRE
A AMPLASAMENTULUI SI A BORNELOR DE REPER
Nr.: _______, data: ___________________

1. Delimitarea terenului cf. plan nr. ___________________________ avand 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 Borna 3 Borna 4
Coordonator X ___________ _____________ _____________ _____________
(axa) Y ___________ _____________ _____________ _____________
Z ___________ _____________ _____________ _____________
2. Constructii-instalatii existente pe amplasament sau in subsol:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
3. Alte mentiuni: ___________________________________________________________
________________________________________________________________________
________________________________________________________________________
4. PREDAT:

BENEFICIAR: Numele Prenumele Functia Semnatura

___________ _____________ _____________ _____________
DRDP CRAIOVA ___________ _____________ _____________ _____________

PROIECTANT: Numele Prenumele Functia Semnatura

___________ _____________ _____________ _____________
DRDP CRAIOVA

PRIMIT:
CONSTRUCTOR: Numele Prenumele Functia Semnatura
___________ _____________ _____________ _____________