VIZAT

Responsabil tehnic cu executia

PROCES VERBAL DE RECEPTIE CALITATIVA
NR.:__________________
Incheiat la data de ____________la lucrarea de constructii:________________
_____________________________________________________________________
situate la adresa : _______________________________________________________
cu ocazia receptiei calitative a *___________________________________
_______________________________________________________
1. Factorii implicati in realizarea lucrarii de constructii:
 Investitor: ___________________________________________
 Proiectant:______________________________________________________
 Executant: ______________________________________________________
2. La baza verificarilor au stat urmatoarele documente:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
__________________________________________________________________
3. Din verificarile efectuate au rezultat urmatoarele:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
4. Au fost stabilite urmatoarele masuri (concluzii):
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
5. Mentiuni speciale :
_____________________________________________________________________
_____________________________________________________________________
Nota:*)
Se completeaza pentru lucrarile ce devin ascunse: cotele si dimensiunile fundatiilor, natura
terenului de fundare, aspectul betonului dupa decofrare, pozitionarea golurilor tehnologice si de
instalatii, precum si pentru receptia calitativa a lucrarilor pe faze de executie.

din partea
investitorului

din partea
executantului

………………….

…………………..

din partea
proiectantului

Nume si prenume:
Semnatura :

…………………….

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