BXD - 10 2012 TT BXD - 20122012

B XY DNG
___________
CNG HO X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
__________________________________
S : 10/2012/TT-BXD
H Ni, ngy 20 thng 12 nm 2012

THNG T
Hng dn chi tit mt s ni dung ca
Ngh nh s 64/2012/N-CP ngy 04/9/2012
ca Chnh ph v cp giy php xy dng
Cn c Ngh nh s 17/2008/N-CP ngy 04/02/2008 ca Chnh ph

quy nh chc nng, nhim v, quyn hn v c cu t chc ca B Xy dng;
Cn c Ngh nh s 64/2012/N-CP ngy 04/9/2012 ca Chnh ph v
cp giy php xy dng;
Xt ngh ca V trng V qun l hot ng xy dng,
B trng B Xy dng ban hnh Thng t hng dn chi tit mt s ni
dung ca Ngh nh s 64/2012/N-CP ngy 04/9/2012 ca Chnh ph v cp
giy php xy dng (di y vit tt l Ngh nh 64/CP) nh sau:
iu 1. Ni dung giy php xy dng
Ni dung giy php xy dng quy nh ti iu 4 ca Ngh nh 64/CP
i vi tng loi cng trnh c thc hin theo cc mu ca Thng t ny nh
sau:
1. Giy php xy dng cp cho cc loi cng trnh, theo mu ti Ph lc
s 1, gm:
a) Cng trnh khng theo tuyn theo mu s 1,
b) Cng trnh theo tuyn theo mu s 2,
c) Cng trnh theo giai on theo mu s 3,
d) Cp cho cc cng trnh ca d n theo mu s 4.
2. Giy php xy dng cp cho nh ring l, theo mu ti Ph lc s 2,
gm:
a) Nh ti th theo mu s 1,
b) Nh ti nng thn theo mu s 2.
3. Giy php xy dng cp cho sa cha, ci to cng trnh, nh ring
l, theo mu ti Ph lc s 3.
4. Giy php cp cho di di cng trnh theo mu ti Ph lc s 4.
5. Giy php xy dng tm cp cho cng trnh, nh ring l theo mu ti

Ph lc s 5.
iu 2. iu kin c cp giy php xy dng
1. V iu kin quy nh ti khon 2 iu 5 c thc hin nh sau:
Ty thuc vo quy m, tnh cht, a im xy dng cng trnh, nh
ring l, c quan cp giy php xy dng xem xt nu cng trnh lin quan n
cc iu kin no quy nh ti iu 5, iu 6 Ngh nh 64/CP th gi h s
ly kin ca cc c quan qun l nh nc c thm quyn v cc lnh vc ;
nu cng trnh, nh ring l khng lin quan n cc iu kin no quy nh
ti cc iu ny th khng phi ly kin.
2. V iu kin quy nh ti im b khon 1 iu 6 c thc hin nh
sau:
i vi cc khu vc, tuyn ph trong th c bn n nh chc nng
s dng cc l t th khng phi lp n quy hoch th, nhng phi lp
n thit k th ring trnh cp c thm quyn ph duyt lm c s cp giy
php xy dng.
y ban nhn dn cp tnh cn c vo tnh cht, chc nng v yu cu
qun l kin trc, cnh quan th quy nh c th cc khu vc, tuyn ph trong
th phi lp n thit k th, c bit i vi cc tuyn ph c l gii t
12 m tr ln v giao nhim v cho cc c quan chc nng t chc lp, thm
nh, ph duyt n thit k th theo quy nh hin hnh.
Nhng khu vc, tuyn ph khc khng thuc danh mc yu cu phi lp
n thit k th th U ban nhn dn cp tnh ban hnh Quy ch qun l quy
hoch, kin trc lm cn c cp giy php xy dng.
3. V iu kin i vi nh ring l nng thn quy nh ti im b
khon 3 iu 6 c thc hin nh sau:
Trng hp khu vc xy dng cha c quy hoch im dn c nng thn
(quy hoch xy dng x nng thn mi) c duyt th y ban nhn dn cp
huyn c trch nhim quy nh cc khu vc khi xy dng phi c giy php xy
dng lm cn c cp giy php xy dng.
Nh ring l ti nng thn nm ngoi cc khu vc quy nh ti khon
ny th khng phi xin cp giy php xy dng.
iu 3. H s ngh cp giy php xy dng i vi trng hp xy
dng mi
1. i vi cng trnh khng theo tuyn:
a) n ngh cp giy php xy dng theo mu ti Ph lc s 6 (mu 1)
Thng t ny;
b) Bn sao c cng chng hoc chng thc mt trong nhng giy t v
quyn s dng t theo quy nh ca php lut v t ai;
2
c) Hai b bn v thit k, mi b gm:

- Bn v mt bng v tr cng trnh trn l t t l 1/100 - 1/500, km
theo s v tr cng trnh;
- Bn v cc mt bng, cc mt ng v mt ct ch yu ca cng trnh, t
l 1/50 - 1/200;
- Bn v mt bng mng t l 1/100 - 1/200 v mt ct mng t l 1/50,
km theo s u ni vi h thng h tng k thut v giao thng; cp nc;
thot nc ma, nc bn; x l nc thi; cp in; thng tin lin lc; cc h
thng h tng k thut khc lin quan n d n, t l 1/50 - 1/200.
2. i vi cng trnh theo tuyn trong th:
a) n ngh cp giy php xy dng, theo mu ti Ph lc s 6 (mu 2)
Thng t ny;
- S v tr, hng tuyn cng trnh;
- Bn v mt bng tng th hoc bn v bnh cng trnh t l 1/500 1/5000;
- Bn v cc mt ct ngang ch yu ca tuyn cng trnh t l 1/50 1/200;
- Ring i vi cng trnh ngm phi b sung thm:
+ Bn v cc mt ct ngang, cc mt ct dc th hin chiu su cng trnh
t l 1/50 - 1/200;
+ S u ni vi h thng h tng k thut ngoi cng trnh.
3. i vi cng trnh tn gio:
H s ngh cp giy php xy dng gm cc ti liu nh quy nh ti
khon 1 iu ny v vn bn chp thun v s cn thit xy dng v quy m
cng trnh ca c quan qun l nh nc c thm quyn v tn gio theo phn
cp.
4. i vi cng trnh tn ngng:
H s ngh cp giy php xy dng nh quy nh ti khon 1 iu ny.
5. Cng trnh tng i, tranh honh trng:
a) n ngh cp giy php xy dng, theo mu ti Ph lc s 7 Thng
t ny;
3
c) Bn sao c chng thc giy php hoc vn bn chp thun ca c quan

qun l nh nc v vn ho, di tch lch s theo phn cp.
d) Hai b bn v thit k, mi b gm:
- S v tr cng trnh t l 1/100 - 1/500;
- Bn v mt bng cng trnh t l 1/100 - 1/500;
- Bn v mt ng, mt ct ch yu cng trnh t l 1/50 - 1/200.
6. i vi cng trnh qung co:
a) n ngh cp giy php xy dng, theo quy nh ti Ph lc s 8;
Trng hp thu t hoc cng trnh thc hin qung co, th phi c
bn sao c cng chng hoc chng thc hp ng thu t hoc hp ng
thu cng trnh;
c) Bn sao c cng chng hoc chng thc giy php hoc vn bn
chp thun ca c quan qun l nh nc v lnh vc qung co.
- i vi trng hp cng trnh xy dng mi:
+ S v tr cng trnh t l 1/50 - 1/500;
+ Bn v mt bng cng trnh trn l t t l 1/50 - 1/500;
+ Bn v mt ct mng v mt ct cng trnh t l 1/50;
+ Bn v cc mt ng chnh cng trnh t l 1/50 - 1/200;
- i vi trng hp bin qung co c gn vo cng trnh c xy
dng hp php:
+ Bn v kt cu ca b phn cng trnh ti v tr gn bin qung co, t l
1/50;
+ Bn v mt ct ti cc v tr lin kt gia bin qung co vi cng trnh,
t l 1/50;
+ Bn v cc mt ng cng trnh c gn bin qung co, t l 1/50 1/100.
7. i vi cng trnh ca cc c quan ngoi giao v t chc quc t:
H s ngh cp giy php xy dng i vi cng trnh ca cc c quan
ngoi giao, t chc quc t v c quan nc ngoi khc u t ti Vit Nam
c thc hin theo quy nh ti khon 1 iu ny v cc iu khon quy nh
ca Hip nh hoc tho thun c k kt vi Chnh ph Vit Nam.
iu 4. H s ngh cp giy php xy dng theo giai on
1. i vi cng trnh khng theo tuyn:
4

t ny;
c) Bn sao Giy chng nhn ng k doanh nghip hoc giy chng nhn
u t;
- Giai on 1:
+ Bn v mt bng cng trnh trn l t t l 1/100 - 1/500, km theo s
v tr cng trnh;
+ Bn v mt bng mng t l 1/100 - 1/200 v mt ct mng t l 1/50,
km theo s u ni vi h thng thot nc ma, x l nc thi, cp nc,
cp in, thng tin lin lc t l 1/100 - 1/200.
- Giai on 2:
+ Bn v cc mt bng, cc mt ng v mt ct ch yu ca cng trnh,
t l 1/50 - 1/200;
2. i vi cng trnh theo tuyn trong th:
t ny;
quyn s dng t theo quy nh ca php lut v t ai hoc vn bn cho php
v tho thun v hng tuyn ca cp c thm quyn;
c) Bn sao Giy chng nhn ng k doanh nghip hoc giy chng nhn
u t;
- S v tr tuyn cng trnh t l 1/100 - 1/1000;
- Bn v mt bng tng th ca cng trnh t l 1/100 - 1/500;
- Cc bn v theo tng giai on:
+ Bn v cc mt ct ngang ch yu ca tuyn cng trnh theo giai on,
t l 1/50 - 1/200;
+ i vi cng trnh ngm yu cu phi c bn v cc mt ct ngang, cc
mt ct dc th hin chiu su cng trnh theo tng giai on, t l 1/50 - 1/200;
+ S u ni vi h thng h tng k thut khu vc theo tng giai
on, t l 1/100- 1/500.
iu 5. H s ngh cp giy php xy dng cho d n
1. n ngh cp giy php xy dng, theo mu ti Ph lc s 12 Thng
t ny;
5
2. Bn sao c cng chng hoc chng thc mt trong nhng giy t v

3. Bn sao Giy chng nhn ng k doanh nghip hoc giy chng nhn
u t;
4. Hai b bn v thit k, mi b gm:
a) Bn v tng mt bng ca d n hoc tng mt bng tng giai on ca
d n, t l 1/100 - 1/500;
b) Bn v mt bng tng cng trnh trn l t t l 1/100 - 1/500, km
theo s v tr cng trnh;
c) Bn v cc mt ng v mt ct ch yu ca tng cng trnh, t l 1/50
- 1/200;
d) Bn v mt bng mng tng cng trnh t l 1/100 - 1/200 v mt ct
mng tng cng trnh t l 1/50, km theo s u ni vi h thng thot nc
ma, x l nc thi, cp nc, cp in, thng tin lin lc t l 1/50 - 1/200.
iu 6. H s ngh cp giy php xy dng i vi nh ring l
1. i vi nh ring l ti th:
a) n ngh cp giy php xy dng, theo mu ti Ph lc s 13 ca
Thng t ny;
- Bn v mt bng cng trnh trn l t t l 1/50 - 1/500, km theo s
v tr cng trnh;
- Bn v mt bng cc tng, cc mt ng v mt ct ch yu ca cng
trnh, t l 1/50 - 1/200;
- Bn v mt bng mng t l 1/50 - 1/200 v mt ct mng t l 1/50,
km theo s u ni h thng thot nc ma, x l nc thi, cp nc, cp
in, thng tin t l 1/50 - 1/200.
2. i vi nh ring l ti nng thn:
a) n ngh cp giy php xy dng, theo mu ti Ph lc s 14 ca
Thng t ny;
- S mt bng xy dng t l 1/50 - 1/500, theo mu ti Ph lc s 15
ca Thng t ny;
- Bn v cc mt ng chnh ca cng trnh, t l 1/50 - 1/200;
6
- Bn v s u ni h thng thot nc ma, nc thi, cp nc, cp

in, thng tin, t l 1/50 - 1/200.
3. i vi cng trnh xy chen c tng hm, ngoi cc ti liu quy nh ti
khon 1, khon 2 iu ny, h s cn phi b sung vn bn ph duyt bin php
thi cng mng v tng hm ca ch u t m bo an ton cho cng trnh v
cng trnh ln cn.
iu 7. H s ngh cp giy php xy dng i vi trng hp sa
cha, ci to
1. n ngh cp giy php sa cha, ci to cng trnh, nh , theo
mu ti Ph lc s 16 Thng t ny;
2. Bn sao c cng chng hoc chng thc mt trong nhng giy t v
quyn s dng t theo quy nh ca php lut v t ai hoc giy t v quyn
qun l, s dng cng trnh;
3. Cc bn v hin trng ca b phn, hng mc cng trnh c ci to
c t l tng ng vi t l cc bn v ca h s ngh cp php sa cha, ci
to v nh chp (10x15 cm) hin trng cng trnh v cng trnh ln cn trc khi
sa cha, ci to;
4. i vi cc cng trnh di tch lch s, vn ho v danh lam, thng cnh
c xp hng, cng trnh h tng k thut th phi c vn bn chp thun
ca c quan qun l nh nc c thm quyn theo phn cp.
iu 8. H s ngh cp giy php di di cng trnh
1. n ngh cp giy php di di cng trnh theo mu ti Ph lc s 20
Thng t ny;
2. Bn v hon cng cng trnh (nu c) hoc bn v thit k thc trng
cng trnh c di di, t l 1/50 -1/200;
3. Bn v tng m t bng, ni cng trnh s c di di ti, t l 1/50 1/500;
4. Bn v m t bng mng t l 1/100 - 1/200, m t ct mng t l 1/50 ti
a im cng trnh s di di ti;
5. Cc ti liu khc theo quy nh ti khon 2, khon 6, khon 7 iu 13
ca Ngh nh 64/CP.
iu 9. Giy php xy dng tm
1. Cn c quy nh ti khon 2 iu 26 ca Ngh nh 64/CP v trn c s
k hoch thc hin quy hoch, v tr xy dng cng trnh, y ban nhn dn cp
tnh ban hnh quy nh c th quy m cng trnh, chiu cao ti a, thi gian
c php tn ti ca cng trnh lm cn c cp giy php xy dng tm bo
m an ton, v sinh mi trng, phng chng chy, kin trc, cnh quan, p
ng cc iu kin v h tng k thut.
2. H s ngh cp giy php xy dng tm nh quy nh i vi tng

loi cng trnh, nh ring l quy nh ti khon 1 iu 3, iu 6, iu 7
Thng t ny. Ring tiu ca n c i thnh n ngh cp giy php
xy dng tm.
3. Trng hp cng trnh theo giy php xy dng tm ht thi hn tn
ti, nhng Nh nc vn cha thc hin quy hoch, nu ch u t c nhu cu
th ngh vi c quan cp php xem xt cho php ko di thi hn tn ti.
iu 10. Cc ti liu khc ca h s ngh cp giy php xy dng
Ngoi cc ti liu quy nh i vi mi loi cng trnh, nh ring l nu
ti cc iu 3, 4, 5, 6, 7, 8, 9, tu thuc a im xy dng cng trnh, quy m
cng trnh, tnh cht cng trnh, i chiu vi cc quy nh ca quy chun, tiu
chun xy dng; quy chun, tiu chun chuyn ngnh v cc quy nh ca php
lut lin quan, h s ngh cp php xy dng cn phi b sung cc ti liu
sau:
1. Bn v h thng phng chy chng chy (PCCC) t l 1/50 - 1/200,
c ng du thm duyt i vi cng trnh thuc danh mc yu cu phi thm
duyt phng n phng chy chng chy theo quy nh ca php lut v PCCC.
2. Bo co kt qu thm nh v vn bn ph duyt thit k k thut hoc
thit k bn v thi cng ca ch u t theo quy nh; Bo co thm tra thit k
do c quan qun l nh nc v xy dng hoc t chc t vn c iu kin
nng lc theo quy nh thc hin, km theo cc bn v kt cu chu lc chnh c
k tn, ng du ca t chc, c nhn thit k. i vi nh ring l khng bt
buc phi c bo co thm nh, ph duyt thit k; nhng nu quy m t 3 tng
tr ln hoc c tng din tch sn xy dng t 250 m 2 tr ln th phi do t chc
t vn hoc c nhn c iu kin nng lc theo quy nh thit k. C quan
cp php xy dng ch kim tra tnh hp l ca cc bn v kt cu chu lc. T
chc, c nhn thit k v thm tra thit k (nu c) phi chu trch nhim v kt
qu thit k do mnh thc hin.
i vi nh ring l di 3 tng hoc c tng din sn xy dng nh
hn 250 m2, h gia nh c th t t chc thit k v phi chu trch nhim v an
ton ca cng trnh v cc cng trnh ln cn.
3. Quyt nh ph duyt d n km theo vn bn chp thun u t ca c
quan nh nc c thm quyn, vn bn tham gia kin v thit k c s (nu
c) ca c quan qun l nh nc v cng trnh xy dng chuyn ngnh theo
quy nh.
4. Vn bn ph duyt bin php thi cng ca ch u t m bo an ton
cho cng trnh v cng trnh ln cn, i vi cng trnh xy chen c tng hm.
5. Bn k khai nng lc, kinh nghim ca t chc thit k, c nhn l ch
nhi m, ch tr thit k theo Ph lc s 9 Thng t ny, km theo bn sao c
chng thc chng ch hnh ngh ca ch nhim, ch tr thit k.
iu 11. Quy trnh xt cp giy php xy dng
8
1. Cn c cc quy nh ca Ngh nh 64/CP v hng dn ca Thng t

ny, y ban nhn dn cp tnh ban hnh chi tit quy trnh cp giy php xy
dng cho ph hp vi c im, tnh hnh ca a phng. C quan cp giy
php xy dng c trch nhim nim yt cng khai quy trnh cp giy php xy
dng ti ni tip nhn h s cho t chc, c nhn c bit.
2. Khi cp giy php cho ch u t, c quan cp giy php xy dng
ng du vo cc bn v thit k kin trc, bao gm: mt bng, cc mt ng,
mt ct ch yu ca cng trnh; mt bng mng cng trnh. Cc bn v thit k
kin trc c c quan cp giy php xy dng ng du l b phn khng tch
ri giy php xy dng c cp.
iu 12. iu chinh giy php xy dng
Vic iu chnh giy php xy dng quy nh ti iu 10 Ngh nh
64/CP thc hin nh sau:
1. i vi cng trnh:
a) n ngh iu chnh giy php xy dng, theo mu ti Ph lc s 17
Thng t ny;
b) Bn chnh giy php xy dng c cp;
c) Cc bn v thit k mt bng, mt ng, mt ct b phn, hng mc
cng trnh ngh iu chnh, t l 1/50 -1/200;
d) Bo co kt qu thm nh v vn bn ph duyt thit k iu chnh
ca ch u t, trong c ni dung m bo an ton chu lc; an ton phng
chng chy; bo m mi trng. Bo co kt qu thm tra thit k (nu c) do
t chc t vn c iu kin nng lc theo quy nh thc hin.
) i vi cng trnh khi cng xy dng, phi c c quan c thm
quyn v qun l xy dng xc nhn bng vn bn vic ch u t xy dng
ng theo giy php xy dng ti thi im xin iu chnh giy php xy dng.
2. i vi nh ring l:
a) Nh ring l ti th:
- n ngh iu chnh giy php xy dng, theo mu ti Ph lc s 18
Thng t ny;
- Bn chnh giy php xy dng c cp;
- Cc bn v thit k mt bng, mt ng, mt ct b phn, hng mc
cng trnh ngh iu chnh, t l 1/50 -1/200;
b) i vi nh ring l ti nng thn:
- n ngh iu chnh giy php xy dng, theo mu ti Ph lc s 19
Thng t ny;
- Bn chnh giy php xy dng c cp;
- S mt bng xy dng iu chnh theo mu ti Ph lc s 15 Thng

t ny;
3. Ni dung giy php xy dng iu chnh c ghi trc tip vo giy
php xy dng cp hoc ghi thnh Ph lc ring v l b phn khng tch ri
vi giy php xy dng c cp.
4. Trng hp xy dng sai vi giy php xy dng c cp th phi b
x l vi phm theo quy nh hin hnh, trc khi ngh iu chnh giy php
xy dng.
iu 13. Thm quyn cp giy php xy dng
Thm quyn cp, iu chnh, gia hn, cp li v thu hi giy php xy
dng quy nh ti iu 14 Ngh nh 64/CP thc hin nh sau:
1. y ban nhn dn cp tnh u quyn cho S Xy dng cp giy php
xy dng i vi cc cng trnh xy dng cp c bit, cp I, cp II; cng trnh
tn gio, cng trnh di tch lch s - vn ho, cng trnh tng i, tranh honh
trng c xp hng thuc a gii hnh chnh do mnh qun l; nhng cng
trnh trn cc tuyn, trc ng ph chnh trong th theo quy nh ca UBND
cp tnh; cng trnh thuc d n c vn u t trc tip nc ngoi; cng trnh
thuc d n v cc cng trnh khc do y ban nhn dn cp tnh y quyn.
2. y ban nhn dn cp huyn cp giy php xy dng cc cng trnh cn
li v nh ring l th, bao gm c nh ring l trong khu vc c
Nh nc cng nhn bo tn thuc a gii hnh chnh do mnh qun l, tr cc
i tng quy nh ti khon 1 iu ny.
3. y ban nhn dn x cp giy php xy dng nh ring l ti nhng
im dn c nng thn c quy hoch xy dng c duyt v ti nhng khu
vc theo quy nh ca UBND cp huyn khi xy dng phi c giy php xy
dng thuc a gii hnh chnh do mnh qun l.
4. Ty thuc vo c cu t chc, nng lc qun l, UBND cp tnh c th
y quyn cho Ban qun l cc khu cng nghip, Ban qun l cc khu th mi
cp giy php xy dng cho cc cng trnh thuc khu cng nghip v khu th
mi, tr cc cng trnh nu ti khon 1 iu ny.
5. Cng trnh do c quan no cp giy php xy dng th c quan iu
chnh, gia hn, cp li v thu hi giy php xy dng do mnh cp.
6. y ban nhn dn cp tnh quyt nh thu hi giy php xy dng do
cp di cp khng ng quy nh.
iu 14. X ly chuyn tip
1. Nhng cng trnh, theo quy nh trc khi Ngh nh 64/CP c hi u
lc thu c i tng khng phi c giy php xy dng, nhng theo quy nh
ca Ngh nh 64/CP thu c i tng phi c giy php, nu khi cng xy
dng trc khi Ngh nh 64/CP c hiu lc th khng phi ngh cp giy
10
php xy dng; nhng nu cha khi cng xy dng th phi n p h s ngh

cp giy php xy dng theo quy nh ca Ngh nh 64/CP v hng dn ti
Thng t ny c xem xt cp giy php xy dng, trc khi khi cng xy
dng.
2. Vic iu chnh giy php xy dng i vi cc cng trnh c xy
dng trc ngy Ngh nh 64/CP c hiu lc c thc hin theo quy nh ca
Ngh nh 64/CP v hng dn ti Thng t ny.
3. i vi cc khu vc, tuyn ph trong th c bn n nh chc
nng s dng cc l t, nu cha c quy hoch chi tit hoc thit k th c
duyt th c th cn c cc quy nh trc thi im Ngh nh 64/CP c hiu
lc xem xt cp giy php xy dng. K t ngy 01/7/2013, vic cp giy
php xy dng phi cn c vo cc iu kin quy nh ti Ngh nh 64/CP v
hng dn ca Thng t ny.
4. Nhng cng trnh thu c i tng theo quy nh ca iu 121 Lu t
Xy dng c thc hi n theo Quyt nh s 39/2005/Q-TTg ngy
28/02/2005 ca Th tng Chnh ph v vi c hng dn thc hi n iu 121
Lu t Xy dng.
iu 15. iu khon thi hnh
1. Hiu lc thi hnh: Thng t ny c hiu lc thi hnh t ngy 06 thng
02 nm 2013.
2. Cc B, c quan ngang B, y ban nhn dn cc cp, cc t chc, c
nhn c lin quan chu trch nhim thi hnh Thng t ny. Trong qu trnh thc
hin nu c vng mc, ngh phn nh v B Xy dng xem xt gii quyt
v xut iu chnh cho ph hp.
Ni nhn:
- Ban B th Trung ng ng;
- Th tng Chnh ph;
- VP Trung ng v cc Ban ca ng;
- VP Quc hi;
- VP Ch tch nc;
- Vn phng Chnh ph;
- Cc B, c quan ngang B, c quan thuc Chnh ph;
- UBND tnh, TP trc thuc TW;
- To n nhn dn ti cao;
- Vin Kim st nhn dn ti cao;
- Kim ton Nh nc;
- C quan Trung ng ca cc on th;
- Cng bo;
- Website: B XD, Chnh ph;
- Cc Kim tra vn bn QPPL (B T php);
- Cc S Xy dng;
- Cc Cc, V, Thanh tra B Xy dng;
- Lu: VT, V QLHXD.
11
B TRNG
Trnh nh Dng
12
Ph lc s 1 (mu 1)
(Trang 1)
(Ban hnh km theo Thng t s 10/2012/TT-BXD
ngy 20 thng 12 nm 2012 ca B Xy dng)
UBND tinh,
TP trc thuc TW
C quan cp GPXD...
CNG HA X HI CH NGHA VIT NAM

_______
..........., ngy ........ thng .......... nm..........
_____________________________________
S: /GPXD-UBND (SXD)
GIY PHP XY DNG
(S dng cho cng trnh khng theo tuyn)
_________
1. Cp cho: ........................................................ ...........................

- a ch:
S nh: .......ng ....... Phng (x): .......... Tnh, thnh ph: ..........
2. c php xy dng cng trnh: (tn cng trnh)..........................
- Theo thit k c k hiu: .........................................
- Do: (tn t chc t vn) ..................lp
- n v thm nh, thm tra (nu c): ..........................................
- Gm cc ni dung sau:
+ V tr xy dng (ghi r l t, a ch): ...................................................
+ Ct nn xy dng cng trnh: ...............................................................
+ Mt xy dng:.............., h s s dng t: ..............................................
+ Ch gii ng : ............,ch gii xy dng: .............................................
+ Mu sc cng trnh: ..........................
+ Chiu su cng trnh (tnh t ct 0,00 n y tng hm i vi cng trnh c
tng hm): ..........
i vi cng trnh dn dng, cng trnh cng nghip th b sung cc ni dung
sau:
+ Din tch xy dng (tng mt): ....................m2
+ Tng din tch sn (bao gm c tng hm v tng lng): ...................m2
+ Chiu cao tng 1:....................m
+ Chiu cao cng trnh: ................m;
+ S tng (trong ghi r s tng hm v tng lng):.........................
i vi khu vc c thit k th c duyt th b sung nhng ni dung theo
quy nh ca Quy ch qun l quy hoch, kin trc th.
3. Giy t v t ai:...................................................
4. Giy php ny c hiu lc khi cng xy dng trong thi hn 12 thng k t
ngy cp; qu thi hn trn th phi ngh gia hn giy php xy dng.
Ni nhn:
- Nh trn
- Lu
Th trng c quan cp giy php xy dng

(K tn, ng du)
13
(Trang 2)
CH U T PHI THC HIN CC NI DUNG SAU Y:
1. Phi hon ton chu trch nhim trc php lut nu xm phm cc quyn
hp php ca cc ch s hu lin k.
2. Phi thc hin ng cc quy nh ca php lut v t ai, v u t xy
dng v Giy php xy dng ny.
3. Phi thng bo cho c quan cp php xy dng n kim tra khi nh v cng
trnh, xy mng v cng trnh ngm (nh hm v sinh t hoi, x l nc thi...).
4. Xut trnh Giy php xy dng cho chnh quyn s ti trc khi khi cng
xy dng v treo bin bo ti a im xy dng theo quy nh.
5. Khi iu chnh thit k lm thay i n i dung giy php xy dng th phi
ngh iu chnh giy php xy dng v ch quyt nh ca c quan cp giy php xy
dng.
IU CHNH GIY PHP
1. Ni dung iu chnh:
2. Thi gian c hiu lc ca giy php:
........, ngy ........ thng .......... nm..........
(K tn, ng du)
14
Ph lc s 1 (mu 1)
(trang 1)
_________
UBND tinh,
TP trc thuc TW
C quan cp GPXD...

_______
..........., ngy ........ thng .......... nm..........
S:
_____________________________________
/GPXD-UBND (SXD)
GIY PHP XY DNG
(S dng cho cng trnh ngm khng theo tuyn )
_________
1. Cp cho: ........................................................ .........................................

- a ch: ........................................................ ............................................
2. c php xy dng cng trnh theo nhng ni dung sau: ...................
- Tn cng trnh: .......................................... ..............................................
- V tr xy dng: ....................................................................................
+ im u cng trnh: ........................................................................
+ im cui cng trnh: ......................................................................
- Quy m cng trnh: .................................................................................
- Tng chiu di cng trnh: ...................................................................m.
- Chiu rng cng trnh:
t: .................. m, n: ...........................m.
- Chiu su cng trnh:
t: .................. m, n: ...........................m.
- Khong cch nh nht n nh dn: ........................................................

3. Giy t v t ai:...................................................
4. Giy php ny c hiu lc khi cng xy dng trong thi hn 12 thng
k t ngy cp; qu thi hn trn th phi ngh gia hn giy php xy dng.
Ni nhn:
- Nh trn;
- Lu:
(K tn, ng du)
15
(Trang 2)
1. Phi hon ton chu trch nhim trc php lut nu mt an ton, h
hng cy xanh, cc cng trnh ngm, ni lin k hoc xm phm cc quyn hp
php ca cc ch s hu lin k.
3. Sau khi xy dng xong cng trnh phi hon tr mt bng nguyn trng,
bo m cht lng v cao bo m an ton giao thng.
4. Phi thng bo cho c quan cp php xy dng, n v c lin quan n
kim tra khi nh v cng trnh, xy mng v x l giao ct vi cng trnh khc.
5. Xut trnh Giy php xy dng cho chnh quyn s ti trc khi khi
cng xy dng v treo bin bo ti a im xy dng theo quy nh.
6. Khi cn thay i thit k hoc vng cc cng trnh ngm khc th phi
thng bo cho cc bn lin quan, bo co v ch quyt nh ca c quan cp
giy php xy dng.
7. Nu c s dng h, ng hoc khng gian cng cng th phi tha
thun vi c quan qun l c lin quan v v tr, thi gian s dng v cc
phng n bo m v an ton, v sinh mi trng, giao thng thng sut trong
qu trnh thi cng./.
16
Ph lc s 1 (mu 2)
(Trang 1)
UBND tinh,
TP trc thuc TW
C quan cp GPXD...

_______
..........., ngy ........ thng .......... nm..........
_____________________________________
S: /GPXD-UBND (SXD)
GIY PHP XY DNG
(S dng cho cng trnh theo tuyn)
_________
1. Cp cho: ........................................................ ...........................

- a ch:
- Theo thit k c k hiu: .........................................
- Do: (tn t chc t vn) ..................lp
+ V tr xy dng (ghi r v tr, a ch): ...................................................
+ Hng tuyn cng trnh: ......................................................................
+ Khong cch t ct 0,00 v khong cch n cc cng trnh c th:..........
+ Chiu su cng trnh (i vi cng trnh ngm theo tuyn): ........................
3. Giy t v t ai:...................................................
Ni nhn:
- Nh trn
- Lu

(K tn, ng du)
17
(Trang 2)
dng.
IU CHNH GIY PHP
1. Ni dung iu chnh:
........, ngy ........ thng .......... nm..........
(K tn, ng du)
18
Ph lc s 1 (mu 3)
(Trang 1)
UBND tinh,
TP trc thuc TW
_____________________________________
C quan cp GPXD...
_______
..........., ngy ........ thng .......... nm..........
S: /GPXD-UBND (SXD)
GIY PHP XY DNG
(S dng cp theo giai on ca cng trnh khng theo tuyn)
________
1. Cp cho: ........................................................ ...........................

- a ch:
2. c php xy dng hng mc cng trnh: (tn hng mc cng trnh)......
- Theo thit k c k hiu: .........................................
- Do: (tn t chc t vn) ..................lp
* Giai on 1:
+ Mt xy dng:.............., h s s dng t: ..............................................
+ Ch gii ng : ............,ch gii xy dng: .............................................
+ Din tch xy dng: ..... m2
* Giai on 2:
+ Tng din tch sn xy dng: .........m2
+ Chiu cao tng 1: ....m
+ Chiu cao cng trnh:...........m
+ S tng(ghi r s tng hm, tng lng):....... tng
+ Mu sc cng trnh: ..........................
quy nh ca Quy ch qun l quy hoch, kin trc th.
3. Giy t v t ai:...................................................
Ni nhn:
- Nh trn
- Lu

(K tn, ng du)
19
(Trang 2)
dng.
IU CHNH GIY PHP
1. Ni dung iu chnh:
........, ngy ........ thng .......... nm..........
(K tn, ng du)
20
Ph lc s 1 (mu 3)
(Trang 1)
UBND tinh,
TP trc thuc TW
_____________________________________
C quan cp GPXD...
_______
..........., ngy ........ thng .......... nm..........
S: /GPXD-UBND (SXD)
GIY PHP XY DNG
(S dng cp theo giai on ca cng trnh theo tuyn)
________
1. Cp cho: ........................................................ ...........................

- a ch:
2. c php xy dng hng mc cng trnh: (tn hng mc cng trnh)......
- Theo thit k c k hiu: .........................................
- Do: (tn t chc t vn) ..................lp
* Giai on 1:
+ Hng tuyn cng trnh: ......................................................................
+ Chiu su cng trnh (i vi cng trnh ngm theo tuyn):
* Giai on 2:
+ Hng tuyn cng trnh: ......................................................................
+ Chiu su cng trnh (i vi cng trnh ngm theo tuyn):
3. Giy t v t ai:...................................................
Ni nhn:
- Nh trn
- Lu

(K tn, ng du)
21
(Trang 2)
dng.
IU CHNH GIY PHP
1. Ni dung iu chnh:
........, ngy ........ thng .......... nm..........
(K tn, ng du)
22
Ph lc s 1 (mu 4)
(trang 1)
UBND tinh,
TP trc thuc TW
_____________________________________
C quan cp GPXD...
_______
..........., ngy ........ thng .......... nm..........
S: /GPXD-UBND (SXD)
GIY PHP XY DNG
(S dng cp cho cc cng trnh thuc d n)
1. Cp cho: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .
- a ch : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
S nh: . . . .ng . . . . . .Phng (x): . . . . . .Tnh, thnh ph: . .
2. c php xy dng cc cng trnh thuc d n: . . . . . . . . . . . . . . .
- Tng s cng trnh: (n) cng trnh
- Cng trnh s (1-n): .............................
+ Theo thit k c k hiu: ........................
+ Do: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . lp . . . . . . . . . . . . .
+ Gm cc ni dung sau y: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. Din tch xy dng:.. . . . . . . . . . . . . . . m2.
. Tng din tch sn: . . . . . . . . . . . . . . . . . . . . . . m2.
. Chiu cao tng 1:.............................................. m
. Chiu cao cng trnh: . . . . . . . . . . . m . . . . . . . . . s tng . . . . . . . .
. Trn l t: . . . . . . . . . . . . . . . . . . . . . . . . Din tch . . . . . . . . .m 2
. Ct nn xy dng cng trnh: . . . . . . . . . . . .
. Ch gii xy dng. . . . . . . . . . . . . . . . . . .
. Mt xy dng, h s s dng t .......................................
. Mu sc cng trnh: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. Cc ni dung khc: .....................................
Ti: . . . . . . . . . . . . . . . . . . . . . . . . . ng .. .. . . . . . . . . . . . . .
Phng (x) . . . . . . . . . . . . . . . . . . . . . . . . Qun (huyn). . . . . . . . . . . .
Tnh, thnh ph. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Giy t v quyn s dng t: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4. Ghi nhn cc cng trnh khi cng:
- Cng trnh: ........................................
- Cng trnh: .........................................
5. Giy php c hiu lc khi cng xy dng trong thi hn 12 thng k t ngy cp;
qu thi hn trn th phi ngh gia hn giy php xy dng.
Ni nhn:
- Nh trn;
- Lu:......

(k, ghi r h tn, ng du)
23
(Trang 2)
Ch u t phi thc hin cc ni dung sau y:
4. Xut trnh Giy php xy dng cho chnh quyn s ti trc khi khi cng xy
dng v treo bin bo ti a im xy dng theo quy nh.
5. Khi iu chnh thit k lm thay i ni dung giy php xy dng th phi
ngh iu chnh giy php v ch quyt nh ca c quan cp giy php xy dng.
IU CHNH GIY PHP

1. Ni dung iu chnh:
........., ngy ...... thng ...... nm ........
(k, ghi r h tn, ng du)
24
Ph lc s 2 (mu 1)
(Trang 1)
UBND tinh,
TP trc thuc TW
_____________________________________
C quan cp GPXD...
_______
..........., ngy ........ thng .......... nm..........
S: /GPXD-UBND (SXD)
GIY PHP XY DNG
(S dng cho nh ring l th)
_________
1. Cp cho: ........................................................ ...........................

- a ch: ................................. ...........................................................
- Theo thit k c k hiu:..................................
- Do : .........................................lp
+ Mt xy dng: ............, h s s dng t: .................................
+ Ch gii ng , ch gii xy dng: .............................................
+ Mu sc cng trnh (nu c): ..........................
+ Din tch xy dng (tng mt): ....................m2
+ Tng din tch sn (bao gm c tng hm v tng lng)........................m2
+ Chiu cao tng 1:....................m
+ Chiu cao cng trnh: ................m; s tng ...........................
quy nh ca Quy ch qun l quy hoch, kin trc.
3. Giy t v quyn s dng t: ............................
Ni nhn:
- Nh trn
- Lu

(K tn, ng du)
25
(Trang 2)
IU CHNH GIY PHP
1. Ni dung iu chnh:
........, ngy ........ thng .......... nm..........
(K tn, ng du)
26
Ph lc s 2 (mu 2)
(trang 1)
UBND huyn ...
UBND x ....
________________________________________________
S:
/GPXD-UBND
..........., ngy ........ thng .......... nm..........
GIY PHP XY DNG

(S dng cho nh ring l nng thn)
________
1. Cp cho (ng/b): ......................................................................................

- a ch thng tr: .....................................................................................
2. c php xy dng nh : .......................................................................
- Ti: ................................................................................................................
- Din tch xy dng tng 1: .................................. m2.....................................
- Tng din tch sn xy dng: ...............................m2..................................
- Chiu cao cng trnh: .............................. m, s tng: ...............................
Ni nhn:
- Nh trn
- Lu
Ch tch UBND x ...

(K tn, ng du)
IU CHNH GIY PHP

1. Ni dung iu chnh:
....., ngy ........ thng .......... nm..........
(K tn, ng du)
27
(Trang 2)
3. Xut trnh Giy php xy dng cho c quan qun l nh nc c thm quyn
trc khi khi cng xy dng.
dng.
28
S:
Ph lc s 3
UBND tinh,
TP trc thuc TW
_____________________________________
C quan cp GPXD...
_______
..........., ngy ........ thng .......... nm..........
/GPSC (GPCT)-UBND (SXD)
GIY PHP SA CHA, CI TO CNG TRNH/NH
_______
1. Cp cho : ........................................................................................
- a ch: ...............................................................................
- Ngi i din: .............................................Chc v: .................................
- a ch lin h: ..............................................................................................
S nh: ................. ng ....................Phng (x) ......................................
Tnh, thnh ph: ......................... ...................................................................
S in thoi: .................................................................................................
2. Hi n trng cng trnh: ......................................................................
- L t s:..........................................Din tch ............m2.
- Ti: ........................................... . ................................................
- Phng (x) ..........................................Qun (huyn) .....................................
- Tnh, thnh ph: ..........................................................................................
- Loi cng trnh: .................................................Cp cng trnh: .......................
- Din tch xy dng tng 1: .........m2.
- Tng din tch sn:.. m2 (ghi r din tch sn cc tng hm, tng trn mt t, tng
k thut, tng lng, tum).
- Chiu cao cng trnh: .....m (trong ghi r chiu cao cc tng hm, tng trn mt t, tng
lng, tum).
- S tng: (ghi r s tng hm, tng trn mt t, tng k thut, tng lng, tum)
3. c php sa cha, ci to vi ni dung sau: ..........................................
- Din tch ci to: .........m2.
lng, tum).
4. Giy t v quyn s dng t v s hu cng trnh: ............................

5. Giy php ny c hiu lc khi cng xy dng trong thi hn 12 thng k t ngy
cp; qu thi hn trn th phi ngh gia hn giy php xy dng.
Ni nhn:
- Nh trn;
- Lu:

(K tn, ng du)
29
(Trang 2)
3. Xut trnh Giy php xy dng cho c quan qun l nh nc c thm quyn
trc khi khi cng xy dng.
dng.
30
Ph lc s 4
S:
UBND tinh,
TP trc thuc TW
C quan cp GPXD...

_______
..........., ngy ........ thng .......... nm..........
_____________________________________
/GPDDCT-UBND (SXD)
GIY PHP DI DI CNG TRNH
_______
1. Cp cho: .......................................................................................................
- a ch : ..........................................................................................................
S nh: ............. ng:..............................................................................
Phng (x): .............................................................................................
Tnh, thnh ph: ...........................................................................................
2. c php di di cng trnh:
- Tn cng trnh: ..
- T a im: (ghi r l t, a ch)
- Quy m cng trnh: (din tch mt bng, chiu cao cng trnh)
- Ti a im: : (ghi r l t, a ch)
- L t di di n: (din tch, ranh gii)
- Ct nn cng trnh di di n: ................................................................
- Ch gii ng , ch gii xy dng: ..........................................................
3. Thi gian di di: T n........
Ni nhn:
- Nh trn;
- Lu:
Th trng c quan cp giy php di di

(K tn, ng du)
31
(Trang 2)
hp php ca cc ch s hu lin k; m bo an ton, v sinh trong khu vc di di
cng trnh.
dng v Giy php di di ny.
3. Phi thng bo cho c quan cp php di di n kim tra khi nh v cng
4. Xut trnh Giy php di di cho chnh quyn s ti trc khi di di v treo
bin bo ti a im di di theo quy nh.
32
Ph lc s 5
(Trang 1)
UBND tinh,
TP trc thuc TW
C quan cp GPXD...

_______
..........., ngy ........ thng .......... nm..........
_____________________________________
S: /GPXD-UBND (SXD)
GIY PHP XY DNG TM
(S dng cho cng trnh, nh ring l)
_________
1. Ni dung tng ng vi ni dung ca giy php xy dng i vi cc

loi cng trnh v nh ring l;
2. Cng trnh c tn ti n: ..................
3. Ch u t phi t d b cng trnh theo giy php xy dng tm khi
Nh nc thc hin quy hoch theo thi hn ghi trong giy php c cp.
4. Giy php ny c hiu lc khi cng xy dng trong thi hn 12 thng
k t ngy cp; qu thi hn trn th phi ngh gia hn giy php xy dng.
Ni nhn:
- Nh trn
- Lu

(K tn, ng du)
33
(Trang 2)
IU CHNH GIY PHP
1. Ni dung iu chnh:
........, ngy ........ thng .......... nm..........
(K tn, ng du)
34
Ph lc s 6
(Mu 1)
_______________________________________
N NGHI CP GIY PHP XY DNG

Knh gi: ..............................................................
1. Tn ch u t: ........................................................................................
- Ngi i din: .............................................Chc v: .................................
- a ch lin h: ..............................................................................................
- S nh: ................. ng ....................Phng (x) ......................................
- Tnh, thnh ph: .............................................................................................
- S in thoi: .................................................................................................
2. a im xy dng: .......................................................................................
- L t s:..........................................Din tch ............m 2.
- Ti: ........................................... . ................................................
- Phng (x) ..........................................Qun (huyn) .....................................
- Tnh, thnh ph: ..........................................................................................
3. Ni dung ngh cp php: ..........................................................................
- Tng din tch sn:.. m2 (ghi r din tch sn cc tng hm, tng trn mt t,
tng k thut, tng lng, tum).
- Chiu cao cng trnh: .....m (trong ghi r chiu cao cc tng hm, tng trn mt
t, tng lng, tum).
4. n v hoc ngi ch nhim thit k: ....................................................
- Chng ch hnh ngh s: ...............do .. Cp ngy: .....................
- a ch: .................................................................................................
- in thoi: ..........................
- Giy php hnh ngh s (nu c): .............................cp ngy .....................
5. D kin thi gian hon thnh cng trnh: ...................... thng.
6. Cam kt: ti xin cam oan lm theo ng giy php c cp, nu sai ti xin hon
ton chu trch nhim v b x l theo quy nh ca php lut.
Gi km theo n ny cc ti liu:
12......... ngy ......... thng ......... nm .........

Ngi lm n
(K ghi r h tn)
35
Ph lc s 6
(Mu 2)
_______________________________________

Knh gi: ..............................................................
1. Tn ch u t: ........................................................................................
- Ngi i din: .............................................Chc v: .................................
- a ch lin h: ..............................................................................................
- S nh: ................. ng ....................Phng (x) ......................................
- Tnh, thnh ph: .............................................................................................
- S in thoi: .................................................................................................
2. a im xy dng: .......................................................................................
- Tuyn cng trnh:...........m.
- i qua cc a im: ........................................... . ................................................
- Phng (x) ..........................................Qun (huyn) .....................................
- Tnh, thnh ph: ..........................................................................................
3. Ni dung ngh cp php: ..........................................................................
- Tng chiu di cng trnh:..m (ghi r chiu di qua tng khu vc c thu,
qua tng a gii hnh chnh xa, phng, qu n, huyn,
tnh, thnh ph).
- Ct ca cng trnh: ........m (ghi r ct qua tng khu vc)
- Chiu cao tnh khng ca tuyn: .....m (ghi r chiu cao qua cc khu vc).
- su cng trnh: .............m (ghi r su qua tng khu vc)
- a ch: .................................................................................................
- in thoi: ..........................
12......... ngy ......... thng ......... nm .........

Ngi lm n
(K ghi r h tn)
36
Ph lc s 7
_______________________________________

(S dng cho cng trnh tng i, tranh honh trng)
Knh gi: ..............................................................
1. Tn ch u t: ........................................................................................
- Ngi i din: .............................................Chc v: .................................
- a ch lin h: ..............................................................................................
- S nh: ................. ng ....................Phng (x) ......................................
- Tnh, thnh ph: .............................................................................................
- S in thoi: .................................................................................................
2. a im xy dng: .......................................................................................
- L t s:..........................................Din tch ............m 2.
- Ti: ........................................... . ................................................
- Phng (x) ..........................................Qun (huyn) .....................................
- Tnh, thnh ph: ..........................................................................................
3. Ni dung ngh cp php: ..........................................................................
- Din tch xy dng: .........m2.
- Ct xy dng:...........m
- Chiu cao cng trnh: .....m
- a ch: .................................................................................................
- in thoi: ..........................
12......... ngy ......... thng ......... nm .........

Ngi lm n
(K ghi r h tn)
37
Ph lc s 8
_______________________________________

(S dng cho cng trnh qung co)
Knh gi: ..............................................................
1. Tn ch u t: ........................................................................................
- Ngi i din: .............................................Chc v: .................................
- a ch lin h: ..............................................................................................
S nh: ................. ng ....................Phng (x) ......................................
- Tnh, thnh ph: .............................................................................................
- S in thoi: .................................................................................................
2. a im xy dng: .......................................................................................
- L t s:..........................................Din tch ............m 2.
- Ti: ........................................... . ................................................
- Phng (x) ..........................................Qun (huyn) .....................................
- Tnh, thnh ph: ..........................................................................................
3. Ni dung ngh cp php: ..........................................................................
- Ct xy dng:...........m
- Chiu cao cng trnh: .....m
- Ni dung qung co:..........................
- a ch: .................................................................................................
- in thoi: ..........................
12......... ngy ......... thng ......... nm .........

Ngi lm n
(K ghi r h tn)
38
Ph lc s 9
BN K KHAI KINH NGHIM CA T CHC THIT K
1. T chc thit k:
1.1. Tn:
1.2. a ch:
1.3. S in thoi:
1.4. Ni dung ng k kinh doanh:
2. Kinh nghim thit k:
2.1. K 3 cng trnh thit k tng t nh cng trnh ngh cp php:
a)
b)
c)
2.2. T chc trc tip thit k:
a) S lng:
Trong :
- KTS:
- KS cc loi:
b) Ch nhim thit k:
- H v tn:
- S chng ch (km photocopy chng ch):
- Cng trnh ch nhim, ch tr (tn cng trnh, quy m, ch u t, a
ch):
c) Ch tr thit k cc b mn (k khai i vi tt c cc b mn):
- H v tn:
- S chng ch (km photocopy chng ch):
- Cng trnh ch nhim, ch tr (tn cng trnh, quy m, ch u t, a
ch):
...... .., Ngy ..... thng .... nm ....
i din n v thit k
39
Ph lc s 10
_______________________________________
N NGHI CP GIY PHP XY DNG THEO GIAI ON

Knh gi: ..............................................................
1. Tn ch u t: ........................................................................................
- Ngi i din: .............................................Chc v: .................................
- a ch lin h: ..............................................................................................
S nh: ................. ng ....................Phng (x) ......................................
Tnh, thnh ph: .............................................................................................
S in thoi: .................................................................................................
2. a im xy dng: .......................................................................................
- L t s:..........................................Din tch ............m 2.
- Ti: ........................................... . ................................................
- Phng (x) ..........................................Qun (huyn) .....................................
- Tnh, thnh ph: ..........................................................................................
3. Ni dung ngh cp php: ..........................................................................
+ Giai on 1:
- Ct xy dng:...........m
- Chiu su cng trnh:........m (tnh t ct xy dng)
+ Giai on 2:
- Tng din tch sn:.. m2 (ghi r din tch sn cc tng hm, tng trn mt t,
tng k thut, tng lng, tum).
t, tng lng, tum).
- S tng:......(ghi r s tng hm, tng trn mt t, tng k thut, tng lng, tum)
- a ch: .................................................................................................
- in thoi: ..........................
1......... ngy ......... thng ......... nm .........

2Ngi lm n
(K ghi r h tn)
40
Ph lc s 11

_______________________________________
N NGHI CP GIY PHP XY DNG THEO GIAI ON

Knh gi: ..............................................................
1. Tn ch u t: ........................................................................................
- Ngi i din: .............................................Chc v: .................................
- a ch lin h: ..............................................................................................
S nh: ................. ng ....................Phng (x) ......................................
Tnh, thnh ph: .............................................................................................
S in thoi: .................................................................................................
2. a im xy dng: .......................................................................................
- Tuyn cng trnh:...........m.
- i qua cc a im: ........................................... . ................................................
- Phng (x) ..........................................Qun (huyn) .....................................
- Tnh, thnh ph: ..........................................................................................
3. Ni dung ngh cp php: ..........................................................................
- Tng chiu di cng trnh:..m (ghi r chiu di qua tng khu vc c thu,
qua tng a gii hnh chnh xa, phng, qu n, huyn,
tnh, thnh ph).
- Ct ca cng trnh: ........m (qua cc khu vc theo tng giai on)
- Chiu cao tnh khng ca tuyn: .....m (ghi r chiu cao qua cc khu vc theo tng
giai on).
- su cng trnh: ...........m (ghi r su qua cc khu vc theo tng giai on)
- a ch: .................................................................................................
- in thoi: ..........................
12......... ngy ......... thng ......... nm .........

Ngi lm n
(K ghi r h tn)
41
Ph lc s 12
N NGHI CP GIY PHP XY DNG CHO D N
cho cng trnh thuc d n ..................
Knh gi: ... . (c quan cp GPXD). . . . . . . . . . . .. . . . . .
1. Tn ch u t: . . . . . . . . . . . . . . . . . .. . . .......
- Ngi i din . . . . . . . . . .. . . . . . . . . . Chc v: . . . . . . . . . . . . . ..
- a ch lin h: . . . . . . . . . .. . . . . . . .. . . . . . . . . . . . . . . . . ......
S nh: . . . . . . . .ng. . .. .. . . . . . . Phng (x). . .. . . . . . ..
Tnh, thnh ph: . . . . . .. . . . . .. . . . . . . . . . . . . . . . . . . .
S in thoi: . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. a im xy dng: . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . .
- L t s . . . . . . . . . . .... . . . . . . . .Din tch . . . . . .. . . ... . .m 2.
- Ti: . . . . . . . . . . . . . . . . .. . . . . . ng: . . .. . . . . . . . .. . . .. . .
- Phng (x) . . . . . . . . . . . . . . . . . Qun (huyn). .......... . . . . . . .
- Tnh, thnh ph. . . . . . . . . . . . . ....... . . . . . . . . . . . . .. . . . . . . . .
3. Ni dung ngh cp php: . . . .. ...... . . . . . . . . . . . . . . . . . . . . .
- Tn d n:........................................................
- c: ..............ph duyt, theo Quyt nh s: ............... ngy............
- Gm: (n) cng trnh
Trong :
+ Cng trnh s (1-n): (tn cng trnh)
- Loi cng trnh: ....................................Cp cng trnh: .......................
- Tng din tch sn:.. m 2 (ghi r din tch sn cc tng hm, tng trn
mt t, tng k thut, tng lng, tum).
- Chiu cao cng trnh: .....m (trong ghi r chiu cao cc tng hm, tng trn
mt t, tng lng, tum).
- Ni dung khc:................................................
4. T chc t vn thit k: .. . . . . . . . . . . . . . . . . . . . . . . . . .
+ Cng trnh s (1-n): ........................
- a ch . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . .
- in thoi . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
- S chng ch hnh ngh ca ch nhim thit k: ..........cp ngy:.........
5. D kin thi gian hon thnh d n: . ............... thng.
6. Cam kt: ti xin cam oan lm theo ng giy php c cp, nu sai ti xin
hon ton chu trch nhim v b x l theo quy nh ca php lut.
1...... .., Ngy ..... thng .... nm ....

2Ngi lm n
(K ghi r h tn)
42
Ph lc s 13
_________

_______________________________________
N NGHI CP GIY PHP XY DNG NH

Knh gi: ..............................................................
1. Tn ch h : ........................................................................................
- a ch lin h: ..............................................................................................
S nh: ................. ng ....................Phng (x) ......................................
Tnh, thnh ph: .............................................................................................
S in thoi: .................................................................................................
2. a im xy dng: .......................................................................................
- L t s:..........................................Din tch ............m 2.
- Ti: ........................................... . ................................................
- Phng (x) ..........................................Qun (huyn) .....................................
- Tnh, thnh ph: ..........................................................................................
3. Ni dung ngh cp php: ..........................................................................
- Cp cng trnh: .......................
- Tng din tch sn:.. m2 (trong ghi r din tch sn cc tng hm, tng
trn mt t, tng k thut, tng lng, tum).
t, tng lng, tum).
- S tng: (trong ghi r s tng hm, tng trn mt t, tng k thut, tng lng,
tum)
4. n v hoc ngi ch nhim thit k (nu c): .............................................
- a ch: .................................................................................................
- in thoi: ..........................
- Giy ng k doanh nghi p s (nu c): ..........................cp ngy ..................
5. D kin thi gian hon thnh cng trnh: ...................... thng
12......... ngy ......... thng ......... nm .........

Ngi lm n
(K ghi r h tn)
43
Ph lc s 14
_________

_______________________________________

(S dng cho nh nng thn)
Knh gi: UBND x ..........................................................
1. Tn ch h gia nh: ................................................. ............................
- S chng minh th: ..............................Ngy cp: ....................................
- a ch thng tr: ............................................................................
- S in thoi: ............................. ..................................................
2. a im xy dng: ....................................... .....................................
3. Ni dung ngh cp php xy dng: .......................................
- Din tch xy dng tng mt .......................m2 .....................................
- Tng din tch sn ....................... m2 .......................................................
- Chiu cao cng trnh ....................m; s tng ........................................
4. Cam kt:
Ti xin cam oan lm theo ng Giy php xy dng c cp, nu sai ti xin
12........,ngy........thng........nm........
Ngi lm n
(K ghi r h tn)
44
Ph lc s 15
Ranh gii ng theo quy hoch
n
g
t
h
e
o
Nh
q
u
y
Ranh gii ng hin ti
Ranh gii l t ca ch h
Ch nh: ........................................................
V tr xy dng: .............................................
Thn (p): ........... x: ......... huyn: ..............
Tn ngi v: ................................................
a ch: .........................................................
S MT BNG
45
h
o
c
h
Ph lc s 16
_______________________________________

Ci to/sa cha ..................
Knh gi: ..............................................................
1. Tn ch u t: ........................................................................................
- Ngi i din: .............................................Chc v: .................................
- a ch lin h: ..............................................................................................
S nh: ................. ng ....................Phng (x) ......................................
Tnh, thnh ph: .............................................................................................
S in thoi: .................................................................................................
2. Hi n trng cng trnh: ......................................................................
- L t s:..........................................Din tch ............m2.
- Ti: ........................................... . ................................................
- Phng (x) ..........................................Qun (huyn) .....................................
- Tnh, thnh ph: ..........................................................................................
lng, tum).
3. Ni dung ngh cp php: ..........................................................................
lng, tum).
- a ch: .................................................................................................
- in thoi: ..........................
6. Cam kt: ti xin cam oan lm theo ng giy php c cp, nu sai ti xin hon ton
chu trch nhim v b x l theo quy nh ca php lut.
Gi km theo n ny cc ti li u:
1......... ngy ......... thng ......... nm .........
2Ngi lm n
(K ghi r h tn)
46
Ph lc s 17
_______________________________________
N NGHI IU CHNH GIY PHP XY DNG

(S dng cho cng trnh)
Knh gi: ..............................................................
1. Tn ch u t: ......................................................................................................
- Ngi i din: ..............................................Chc v: .......................................
- a ch lin h: ........................................................................................................
S nh: ................. ng ....................Phng (x) ..........................................
Tnh, thnh ph: ......................................................................................................
S in thoi: ...........................................................................................................
2. a im xy dng: .............................................................................................
- L t s:...............................................Din tch .......................................... m 2.
- Ti: ......................................................... ng: ................................................
- Phng (x) ..........................................Qun (huyn) .....................................
- Tnh, thnh ph: ..................................................................................................
3. Giy php xy dng c cp: (s, ngy, c quan cp)
Ni dung Giy php :
4. Ni dung ngh iu chnh so vi Giy php c cp:
5. n v hoc ngi thit k iu
chnh: ...........................................................................
- Chng ch hnh ngh s: .......................... Cp ngy: .....................
- a ch: ..................................................................................................................
- in thoi: ..........................
- a ch: .......................................................... in thoi: .....................................
6. D kin thi gian hon thnh cng trnh theo thit k iu chnh: ....... thng.
7. Cam kt: ti xin cam oan lm theo ng giy php iu chnh c cp, nu sai ti
xin hon ton chu trch nhim v b x l theo quy nh ca php lut.
12........ ngy ......... thng ......... nm .........

Ngi lm n
(K ghi r h tn)
47
Ph lc s 18
_________

_______________________________________

Knh gi: ..............................................................
1. Tn ch h : ........................................................................................
- a ch lin h: ..............................................................................................
S nh: ................. ng ....................Phng (x) ......................................
Tnh, thnh ph: .............................................................................................
S in thoi: .................................................................................................
2. a im xy dng: .......................................................................................
- L t s:..........................................Din tch ............m 2.
- Ti: ........................................... . ................................................
- Phng (x) ..........................................Qun (huyn) .....................................
- Tnh, thnh ph: ..........................................................................................
3. Giy php xy dng c cp (s, ngy, c quan cp): ...............................
Ni dung giy php:
4. Ni dung giy php ngh iu chnh:
5. n v hoc ngi ch nhim thit k iu chnh (nu c): ...................................

- a ch: .................................................................................................
- in thoi: ..........................
- Giy ng k doanh nghi p s (nu c): ..........................cp ngy ..................
6. D kin thi gian hon thnh cng trnh theo thit k iu chnh: ................ thng
12......... ngy ......... thng ......... nm .........

Ngi lm n
(K ghi r h tn)
48
Ph lc s 19
_________

_______________________________________

(S dng cho nh nng thn)
Knh gi: UBND x ..........................................................
1. Tn ch h gia nh: ................................................. ............................
- S chng minh th: ..............................Ngy cp: ....................................
- a ch thng tr: ............................................................................
- S in thoi: ............................. ..................................................
2. a im xy dng: ....................................... .....................................
3. Ni dung giy php xy dng c cp: .......................................
4. Ni dung ngh iu chnh:
5. Cam kt:
Ti xin cam oan lm theo ng Giy php xy dng c cp, nu sai ti xin
12........,ngy........thng........nm........
Ngi lm n
(K ghi r h tn)
49
Ph lc s 20
_______________________________________
N NGHI CP GIY PHP DI DI CNG TRNH

Knh gi: ..............................................................
1. Tn ch s hu cng trnh di di.......................................................................
- Ngi i din: ..............................................Chc v: .......................................
- a ch lin h: ........................................................................................................
- S nh: ................. ng ....................Phng (x) ..........................................
- Tnh, thnh ph: ......................................................................................................
- S in thoi: ...........................................................................................................
2. Cng trnh cn di di:
+ Loi cng trnh: .................................................Cp cng trnh: .......................
+ Din tch xy dng tng 1: .............................................................................m 2.
+ Tng din tch sn: ..........................................................................................m 2.
+ Chiu cao cng trnh: ......................................................................................m.
3. a im cng trnh cn di di ; ...................................................
- L t s:...............................................Din tch .......................................... m 2.
- Ti: ......................................................... ng: ................................................
- Phng (x) ..........................................Qun (huyn) .....................................
- Tnh, thnh ph: ..................................................................................................
4. a im cng trnh di di n: .
- L t s:...............................................Din tch .......................................... m 2.
- Ti: ......................................................... ng: ................................................
- Phng (x) ..........................................Qun (huyn) .....................................
- Tnh, thnh ph: ..................................................................................................
+ S tng: ..................................................................................................................
5. n v hoc ngi thit k bin php di di: .......................................................
- a ch: ..................................................................................................................
- in thoi: ..........................
- a ch: .......................................................... in thoi: .....................................
6. D kin thi gian hon thnh di di cng trnh: .........................
7. Cam kt: ti xin cam oan lm theo ng giy php di di, bin php di di c
duyt, m bo an ton, v sinh, nu xy ra s c g ti xin hon ton chu trch nhim
v b x l theo quy nh ca php lut.
12......... ngy ......... thng ......... nm .........

Ngi lm n
(K ghi r h tn)
50

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B XY DNG

CNG HO X HI CH NGHA VIT NAM

H Ni, ngy 20 thng 12 nm 2012

Cn c Ngh nh s 17/2008/N-CP ngy 04/02/2008 ca Chnh ph

5. Giy php xy dng tm cp cho cng trnh, nh ring l theo mu ti

c) Hai b bn v thit k, mi b gm:

c) Bn sao c chng thc giy php hoc vn bn chp thun ca c quan

a) n ngh cp giy php xy dng, theo mu ti Ph lc s 10 Thng

2. Bn sao c cng chng hoc chng thc mt trong nhng giy t v

- Bn v s u ni h thng thot nc ma, nc thi, cp nc, cp

2. H s ngh cp giy php xy dng tm nh quy nh i vi tng

1. Cn c cc quy nh ca Ngh nh 64/CP v hng dn ca Thng t

- S mt bng xy dng iu chnh theo mu ti Ph lc s 15 Thng

php xy dng; nhng nu cha khi cng xy dng th phi n p h s ngh

CNG HA X HI CH NGHA VIT NAM

..........., ngy ........ thng .......... nm..........

1. Cp cho: ........................................................ ...........................

Th trng c quan cp giy php xy dng

CNG HA X HI CH NGHA VIT NAM

..........., ngy ........ thng .......... nm..........

1. Cp cho: ........................................................ .........................................

- Chiu su cng trnh:

- Khong cch nh nht n nh dn: ........................................................

Th trng c quan cp giy php xy dng

CNG HA X HI CH NGHA VIT NAM

..........., ngy ........ thng .......... nm..........

1. Cp cho: ........................................................ ...........................

Th trng c quan cp giy php xy dng

1. Cp cho: ........................................................ ...........................

Th trng c quan cp giy php xy dng

1. Cp cho: ........................................................ ...........................

Th trng c quan cp giy php xy dng

Th trng c quan cp giy php xy dng

IU CHNH GIY PHP

1. Cp cho: ........................................................ ...........................

Th trng c quan cp giy php xy dng

..........., ngy ........ thng .......... nm..........

GIY PHP XY DNG

1. Cp cho (ng/b): ......................................................................................

Ch tch UBND x ...

IU CHNH GIY PHP

4. Giy t v quyn s dng t v s hu cng trnh: ............................

Th trng c quan cp giy php xy dng

CNG HA X HI CH NGHA VIT NAM

..........., ngy ........ thng .......... nm..........

Th trng c quan cp giy php di di

CNG HA X HI CH NGHA VIT NAM

..........., ngy ........ thng .......... nm..........

1. Ni dung tng ng vi ni dung ca giy php xy dng i vi cc

Th trng c quan cp giy php xy dng

N NGHI CP GIY PHP XY DNG

12......... ngy ......... thng ......... nm .........

N NGHI CP GIY PHP XY DNG

12......... ngy ......... thng ......... nm .........

N NGHI CP GIY PHP XY DNG

12......... ngy ......... thng ......... nm .........

N NGHI CP GIY PHP XY DNG

12......... ngy ......... thng ......... nm .........

N NGHI CP GIY PHP XY DNG THEO GIAI ON

1......... ngy ......... thng ......... nm .........

(Ban hnh km theo Thng t s 10/2012/TT-BXD

N NGHI CP GIY PHP XY DNG THEO GIAI ON

12......... ngy ......... thng ......... nm .........