UNITATEA _____________________________________________________________________________________

SANTIER __________________________ 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
Coordonata X ____________ ____________ ____________ ____________
(axa) Y ____________ ____________ ____________ ____________
Z ____________ ____________ ____________ ____________
2. Constructii-instalatii existente pe amplasament sau in subsol:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
3. Alte mentiuni:
CONSTRUCTORUL se oblige: BENEFICIARUL se oblige:
a) sa transporte cantiatea de _______mc a) sa plateasca constructorului costul
moluz existenta pe amplasament incarcarii si transporturilor comandate

b) sa demoleze volumul de fundatii existent b) sa plateasca constructorului valoarea

pe amplasament pentru a fi transportate lucrarilor comandate
____mc.
4. PREDAT:
Numele Prenumele Functia Semnatura
BENEFICIAR: ______________ ______________ ______________ ______________
PROIECTANT: ______________ ______________ ______________ ______________

PRIMIT:
Numele Prenumele Functia Semnatura
CONSTRUCTOR: ______________ ______________ ______________ ______________