UBND tnh thi nguyn

cng ho x hi ch ngha vit nam

Cng ty cp xy dng & pht trin nh song

c lp - T do - Hnh phc

in

Thi Nguyn, ngy thng

nm 20
Bin bn S: ....

Nghim thu ni b cng vic xy dng

Cng trnh: Nng cp tuyn ng Ph Hng v Lu Nhn Ch
-TP.Thi Nguyn.
Hng mc: Cng bn qua ng
a im xy dng: Phng Trung Thnh - TP.Thi Nguyn.
Ch u t: Cng ty c phn Bia v Nc gii kht Thi Nguyn.
n v t vn gim st: Cng ty TNHH Mt thnh vin Vnh Pht.
n v xy lp : Cng ty c phn XD&PT nh Song in
1. i tng nghim thu: Lp dng vn khun tm bn c sn
(35 tm).
- Cng cc C19 KM0+416.29 ( Tuyn Lu Nhn Ch).
- Cng cc C26 KM0+389.11 ( Tuyn Ph Hng).
- Cng cc P9 KM0+32.11 (Tuyn Ph Hng).
- Cng cc C23 KM0+423.74 (Tuyn Ph Hng).
- Cng cc C34 KM0+648.89 (Tuyn Ph Hng).
- Cng cc C40 KM0+789.00 (Tuyn Ph Hng).
- Cng cc P6 KM0+557.02 (Tuyn Ph Hng).
2. Thnh phn trc tip tham gia nghim thu:
Nh thu thi cng xy dng cng trnh: Cng ty c phn XD&PT
nh Song in.
ng: Nguyn Hu Thun
Chc v: Trng phng k
thut.
ng: Trng Gip
Chc v: K thut thi cng trc
tip
3. Thi gian nghim thu :
Bt u: , ngy /./20, kt thc: .., ngy //20.
Ti cng trnh: Nng cp tuyn ng Ph Hng v Lu Nhn ChTP.Thi Nguyn
4. V ti liu lm cn c nghim thu:
- H s thit k bn v thi cng do Cng ty c phn t vn Giao
Thng II Thi Nguyn lp c ph duyt ngy 25/12/2010;

- Cn c vo tiu chun, quy phm thi cng v nghim thu xy

dng hin hnh TCVN ..;
- Nht k thi cng cng trnh, cc chng ch kim tra th
nghim v cc vn bn khc c lin quan n i tng nghim thu;
5. nh gi cng vic xy dng thc hin:
a) V cht lng cng vic xy dng:
- Kch thc hnh hc: ng theo HSTK c ph duyt
- Cht lng: t yu cu.
b)
Cc

kin
khc
:
...............
..
..
6. Kt lun : ng nghim thu ni b cng vic trn cho php
n v thi cng gi
phiu YCNT n Ch u t v T vn gim st.

Trng phng k thut

KT thi cng trc tip

UBND tnh thi nguyn

cng ho x hi ch ngha vit nam

Cng ty cp xy dng & pht trin nh song

c lp - T do - Hnh phc

in

Thi Nguyn, ngy thng

nm 20
Phiu yu cu Nghim thu cng vic xy dng
S:
Knh gi: - Ch u t
- n v t vn gim st
Cng trnh: Nng cp tuyn ng Ph Hng v Lu Nhn Ch
-TP.Thi Nguyn.
a im xy dng: Phng Trung Thnh - Tp. Thi Nguyn.
Ch u t: Cng ty c phn Bia v Nc gii kht Thi Nguyn.
n v t vn gim st: Cng ty TNHH Mt thnh vin Vnh Pht.
n v xy lp : Cng ty c phn XD&PT nh Song in
Cn c vo h s thit k k thut do cng ty c phn t vn GTII
c ph duyt ngy 25/12/2010;
Cn c vo bin bn nghim thu ni b cng vic xy dng hon
thnh s: ngy /./20;
Nh thu xy dng yu cu Ch u t, t vn gim st, tin hnh
nghim thu hng mc, cng vic xy dng nh sau:
1. Hng mc : Cng bn qua ng
2. i tng cng vic nghim thu: Lp dng vn khun tm bn
c sn (35 tm).
- Cng cc C19 KM0+416.29 ( Tuyn Lu Nhn Ch).
- Cng cc C26 KM0+389.11 ( Tuyn Ph Hng).
- Cng cc P9 KM0+32.11 (Tuyn Ph Hng).
- Cng cc C23 KM0+423.74 (Tuyn Ph Hng).
- Cng cc C34 KM0+648.89 (Tuyn Ph Hng).

- Cng cc C40 KM0+789.00 (Tuyn Ph Hng).

- Cng cc P6 KM0+557.02 (Tuyn Ph Hng).
3. Thi gian nghim thu :
Vo hi: gi pht, ngy thng nm 201.
ngh Ch u t, t vn gim st n ng gi cng vc c hon thnh ng k hoch.
Nh thu xy lp

UBND tnh thi nguyn

cng ho x hi ch ngha vit nam

Cng ty cp xy dng & pht trin nh song

c lp - T do - Hnh phc

in

Thi Nguyn, ngy thng

nm 20
Bin bn S: ....
Nghim thu cng vic xy dng
Cng trnh: Nng cp tuyn ng Ph Hng v Lu Nhn Ch TP.Thi Nguyn
Hng mc: Cng bn qua ng
a im xy dng: Phng Trung Thnh - TP.Thi Nguyn.
Ch u t: Cng ty c phn Bia v Nc gii kht Thi Nguyn.
n v t vn gim st: Cng ty TNHH Mt thnh vin Vnh Pht.
n v xy lp : Cng ty c phn XD&PT nh Song in.
1. i tng nghim thu : Lp dng vn khun tm bn c sn
(35 tm).
- Cng cc C19 KM0+416.29 ( Tuyn Lu Nhn Ch).
- Cng cc C26 KM0+389.11 ( Tuyn Ph Hng).
- Cng cc P9 KM0+32.11 (Tuyn Ph Hng).
- Cng cc C23 KM0+423.74 (Tuyn Ph Hng).
- Cng cc C34 KM0+648.89 (Tuyn Ph Hng).
- Cng cc C40 KM0+789.00 (Tuyn Ph Hng).
- Cng cc P6 KM0+557.02 (Tuyn Ph Hng).
2. Thnh phn trc tip nghim thu:
a) n v t vn gim st: Cng ty TNHH Mt thnh vin Vnh Pht.

ng: Nguyn Quc Hi

Chc v: T trng t vn gim
st.
ng: Nguyn Vn Thng
Chc v: Gim st thi cng
xy dng
b) Nh thu thi cng xy dng cng trnh: Cng ty c phn
XD&PT nh Song in.
ng: ..
Chc v: ..
ng: Trng Gip
Chc v: K thut thi cng trc
tip.
3. Thi gian nghim thu:
Bt u vo hi: gi pht, ngy thng nm 20.
Kt thc vo hi: gi pht, ngy thng nm 20.
Ti: Cng trnh nng cp tuyn ng Ph Hng v Lu Nhn Ch
Tp. Thi Nguyn
4. Ni dung nghim thu :
- Kim tra v cht lng chng loi thp
- Khong cch gia cc thanh thp
- Cht lng mi hn cc thanh
5. V ti liu lm cn c nghim thu:
- Bin bn nghim thu ni b.
- Phiu yu cu nghim thu ca nh thu thi cng xy dng;
H s thit k do cng ty c phn t vn giao thng II Thi
Nguyn lp c ph duyt ngy 25/12/2010;
- Tiu chun, quy phm xy dng hin hnh c p dng:
TCVN ..
- Cc kt qu kim tra th nghim, quan trc ca i tng
nghim thu;
- Nht k thi cng, nht k gim st ca ch u t v cc vn
bn khc c lin quan n i tng nghim thu;
6. nh gi cng vic xy dng thc hin:
a) V cht lng cng vic xy dng:
- Kch thc hnh hc: ng theo HSTK c ph duyt
- Cht lng: t yu cu.
b)
Cc

kin
khc:
..
..
..
7. Kt lun :
- ng nghim thu phn vic nu trn cho php n c thi cng
chuyn bc thi cng tip theo.

T vn gim st

KT thi cng trc tip