吊装作业安全技术方案报审表

洛阳石化工程建设监理企业LouyangPetrochemicalEngineeringandConstructionSupervisionCompany（LPECSC）监理附表supervisionsheet丽东芳烃项目LIDONGAROMATICCOMPLEXPROJECT单项(单元)工程：施工质量规则附表目录(一)项目编号：WorkItem(Unit):PR-00-CIJ-QU-0002ProjectNo.:ConstructionQualityRulesAnnexedTableIndex(I)表号表格名称备注TableNo.TableTitleRemarks-A01a工程动工报审表ReviewRequestonCommencementofWork-A01b工程复工报审表ReviewRequestforResumeofWork-A02施工组织总设计报审表ReviewRequestonOverallConstructionOrganizationDesign-A02a工程技术管理文件报审表ReviewRequestonEngineeringTechnicalManagementDocument-A03分包单位资格报审表ReviewRequestonQualificationofSubcontractors-A03a( )资质报审表ReviewRequestonQualification-A04质量控制点核报审表ReviewRequestonQualityControlPointInspection-A05工程款支付申请表ApplicationforProjectPayment-A06监理工程师通知回复单SupervisionEngineerNoticeResponse-A07工程临时延期申请表ApplicationforTemporarilyPostponementofProject-A08花销索赔申请表ApplicationForClaimonCost-A09资料/构配件/设备报审表Material/Component/EquipmentReviewRequest-A10工程交工报验单ConstructionTakeoverInspectionRequest-A11质量控制点查验通知QualityControlPointInspectionNotice-A12主要施工设备进场报审表-B01监理工程师通知单SupervisionEngineerNotice-B02工程暂停令WorkSuspensionOrder-B03工程款支付证书ProjectPaymentCertificate-B04工程临时延期审批表ApprovalforPostponementofProjectTemporarily-B05工程最后延期审批表ApprovalforFinalPostponementofProject-B06花销索赔审批表ApprovalForClaimonCost-B07会议纪要（一）MinutesofMeeting(I)-C01监理工作联系单SupervisionCorrespondence-C02工程改正单VariationOrder-C03工程承包单位及承包内容ConstructionContractorInfo.AndScopeofContract洛阳石化工程建设监理企业LouyangPetrochemicalEngineeringandConstructionSupervisionCompany（LPECSC）丽东芳烃项目LIDONGAROMATICCOMPLEXPROJECTA—01a单项(单元)工程：WorkItem(Unit)

单位工程动工报审表ReviewRequeston

项目编号：ProjectNo.:CommencementofWorkUnit编号：No.致（监理单位）To(SupervisionCompany)：我方担当的工程，已完成了动工前的各项准备工作，计划于年月日动工，请审批。Wecontractedworkofandcompleteditemsofpreparationworkpriortocommencement.Weplannedtocommencetheworkat(Day)(Month)(Year),pleasereviewandapprove.附：Attachment:□图纸会审、设计交底Designcountercheckandclarificationrecords□施工组织设计（方案）审批文件（含主要管理人员及特别工种资格证明）Constructionmanagementdesign(proposal)reviewandapprovaldocument(includingmainmanagementpersonnelandspecialtradequalificationcertificate)3.□施工机具与检测试验设备检查Constructionmachineryandinspection&testingequipmentinspected.□工序质量控制点报审Workprocedurequalitycontrolpointreviewrequest.□施工测量放线Constructionsurveyingandsettingoutworkcompleted□主要人员、资料、设备进场Majorpersonnel,materialandequipmentmobilized7.□施工现场道路、水、电、通讯等已达到动工条件Accessroad,water,powerandcommunicationsetcforconstructionarereadyonsiteforcommencingthework.□承包单位（盖章）：项目经理（签字）：日期：ConstructionContractor(Chop)Projectmanager(Signature)Date审查建议Reviewremarks：专业监理工程师（签字）：日期：Disciplinesupervisionengineer(Signature)Date审批结论Reviewconclusion：赞成Approve不同样意Notapprove□□项目监理机构（章）：总监理工程师（签字）：日期：SupervisionCom.(ChopChiefsupervisionengineer(SignatureDate本表由承包单位填报，一式三份，经监理单位审批后，业主单位、监理单位、承包单位各存一份。Thistableshallbefilledupandsubmittedbythecontractorinthreecopies,onceitbeingreviewedandapprovedbythesupervisioncompany,eachoftheOwner,SupervisionCompanyandContractorshallholdonecopy.洛阳石化工程建设监理企业LouyangPetrochemicalEngineeringandConstructionSupervisionCompany（LPECSC）丽东芳烃项目LIDONGAROMATICCOMPLEXPROJECTA—01b单项(单元)工程：WorkItem(Unit):

工程复工报审表ReviewRequestforResumeofWork

项目编号：ProjectNo.:编号：No.致（监理单位）To(SupervisionCompany：我方担当的工程，由总监理工程师签发的第号工程暂停令指出的原因已清除，经检查已具备了复工条件，请予以审查并赞成复工。ThereasonresultinginWorkSuspensionOrderNo.issuedbythechiefsupervisionengineerfortheworkcontractedbyushasbeeneliminated,it’sproventhattheconditionsforresumptionofworkhasbeenmadeready.Pleasereviewandapprove.附：具备复工条件的详细说明Attachment:Detailstatementofreasonsforresumingthework。.承包单位（盖章）：项目经理（签字）：日期：Contractor(Chop)Projectmanager(Signature)Date审批建议Review/approvalremarks：审批结论：Review/approvalconclusion□具备复工条件，赞成复工。Conditionsforresumingworkarereadyandagreetoresumework.□。Conditionsforresumingworkarenotreadyandnotagreeto不具备复工条件，暂不同样意复工resumeworknow.项目监理机构（章）：总监理工程师（签字）：日期：Projectsupervisioncompany(Chop)Chiefsupervisionengineer(Signature)Date本表由承包单位填报，一式三份，经监理单位审批后，业主单位、监理单位、承包单位各存一份。Thistableshallbefilledupandsubmittedbythecontractorinthreecopies,onceitbeingreviewedbythesupervisioncompany,eachoftheOwner’sRepresentative,SupervisionCompanyandContractorshallholdonecopy.洛阳石化工程建设监理企业LouyangPetrochemicalEngineeringandConstructionSupervisionCompany（LPECSC）丽东芳烃项目LIDONGAROMATICCOMPLEXPROJECTA—02单项(单元)工程：公用工程施工组织设计/施工方案报审表项目编号：LDA03/7S04/812041WorkItem(Unit):UTILITYReviewRequestonOverallConstructionProjectNo.:OrganizationDesign/Construction编号:No.Project致(监理单位)To(SupervisionCompany)：洛阳石化工程建设监理企业我方已依照施工合同的相关规定完成了丽东芳烃项目UT区FLARE区安装工程吊装作业安全技术方案的编制，并经我单位上级技术负责人审查赞成，请予以审查。We’vecompletedoverallconstructionorganizationdesign/ConstructionProjectforworksofasperrelatedrequirementsasspecifiedintheConstructionContract,whichhasbeenreviewedandapprovedbycompetenttechnicalleaderinourcompany,weherebysubmititforyourreview.附Attachment：UT区FLARE区安装工程吊装作业安全技术方案承包单位(章)：湖南大和设备安装有限企业项目经理（签字）：日期：Contractor(Chop)Projectmanager(Signature):Date:总监理工程师审查建议：ReviewremarksofChiefSupervisionEngineer:审查结论Reviewconclusion：□赞成Approve□更正后再报Toberesubmittedafterrevision□重新编制Tobecompiledagain项目监理机构（章）：

总监理工程师（签字）：

日期：Projectsupervisioncompany(Chop):

Chiefsupervisionengineer(Signature):

Date:业主项目经理审批建议

Reviewremarksof

theOwner’sprojectmanager

：审查结论Reviewconclusion：□赞成Approve□更正后再报Toberesubmittedafterrevision□重新编制Tobecompiledagain业主管理机构（章）：项目经理（代表）：日期：Owner’smanagementlevel(chop):Projectmanager(Representative):Date:注：施工组织总设计/方案审批建议中，特指的重要施工方案须经业主审批。Note:Majorconstructionmethodespeciallyspecifiedinreviewandapprovalremarksonoverallconstructionorganizationdesign/ConstructionProjectshallbealsoreviewedandapprovedbytheOwner.本表由承包单位填报，一式三份，经监理单位审查，业主代表赞成后，业主单位、监理单位、承包单位各存一份。Thistableshallbefilledupandsubmittedbythecontractorinthreecopies,onceitbeingreviewedbythesupervisioncompanyandapprovedbytheOwner’srepresentative,eachoftheOwner’sRepresentative,SupervisionCompanyandContractorshallholdonecopy.洛阳石化工程建设监理企业LouyangPetrochemicalEngineeringandConstructionSupervisionCompany（LPECSC）丽东芳烃项目LIDONGAROMATICCOMPLEXPROJECTA—02a单项(单元)工程：公用工程WorkItem(Unit):Utility

工程技术管理文件报审表ReviewRequestonEngineeringTechnicalManagementDocument

项目编号：LDA03/7S04/812041ProjectNo.:编号：No.致（监理单位）To(SupervisionCompany)：洛阳石化工程建设监理企业现报上关于丽东芳烃项目UT区、FLARE区安装工程施工组织设计工程技术管理文件，请予以判定。Thetechnicalmanagementdocumentofworksofisherebysubmittedforreviewandapproval.序号种类编制人册数页数No.CategoryPreparedby:Volume(s):Page(s)单位工程施工组织设计ConstructionOrganizationDesignofSingleUnitofWork施工方案ConstructionMethod34编制单位（章）：技术负责人（签字）：申报人（签字）：Preparedby(chop):Technicalleader(Signature):Submittedby(Signature):承包单位建议Contractor’sremark：有Yes/无No附页Annexedpages□□技术负责人(签字)：承包单位（章）：日期：Contractor(chop):Technicalleader(Signature):Date:监理机构审查建议ReviewandapprovalremarksoftheSupervisionCompany：判定结论Reviewconclusion：□赞成Approve更正后再报Toberesubmittedafterrevision□重新编制Tobecompiledagain□专业监理工程师（签字）：日期：Disciplinesupervisionengineer(Signature):Date:项目监理机构（章）：总监理工程师（签字）：日期：ProjectSupervisionCom.(Chop):Chiefsupervisionengineer(Signature):Date:业主项目经理审批建议ReviewremarksoftheOwner’sprojectmanager：业主管理机构（章）：项目经理（代表）：日期：Owner’smanagementlevel(chop):Projectmanager(Representative):Date:本表由承包单位填报，一式三份，经监理单位审查，业主代表赞成后，业主单位、监理单位、承包单位各存一份。Thistableshallbefilledupandsubmittedbythecontractorinthreecopies,onceitbeingreviewedbythesupervisioncompanyandapprovedbytheOwner’srepresentative,eachoftheOwner’sRepresentative,SupervisionCompanyandContractorshallholdonecopy.洛阳石化工程建设监理企业LouyangPetrochemicalEngineeringandConstructionSupervisionCompany（LPECSC）丽东芳烃项目LIDONGAROMATICCOMPLEXPROJECTA—03单项(单元)工程：WorkItem(Unit):

分包单位资格报审表ReviewRequestonQualificationofSubcontractors

项目编号：ProjectNo.:编号：No.致（监理单位）To(SupervisionCompany)：经察看，我方认为拟选择的（分包单位）拥有担当以下工程的施薪水质和施工能力，能够保证本工程项目按合同的规定进行施工。分包后，我方依旧担当总承包单位的全部责任。请予以审查和赞成。Afterinvestigation,webelievetheselectedSubcontractor,hasconstructionqualificationandconstructioncapabilityrequiredforfollowingworkandcanensuretocompleteconstructionoftheprojectaspercontractrequirements.Uponsubcontractingthework,wewillstillbearallresponsibilityasaGeneralContractor.Pleasereviewandapprove.附件Attachment：1、分包单位资质资料QualificationinformationoftheSubcontractor；2、分包单位业绩资料AchievementinformationoftheSubcontractor。分包工程名称（部位）拟分包工程合同额分包工程占全部工程工程数量Subcontractedamount/TotalSubcontractedworkProposedsubcontractWorkamountworkamountdescription(Location)value共计(Total)承包单位（章）：项目经理（签字）：日期：Contractor(Chop):Projectmanager(Signature):Date:专业监理工程师审查建议Reviewremarksofdisciplinesupervisionengineer：专业监理工程师（签字）：日期：Disciplinesupervisionengineer(signature):Date:总监理工程师审查建议Reviewremarksofthechiefsupervisionengineer：项目监理机构（章）：总监理工程师（签字）：日期：ProjectSupervisionCompany(chop)Chiefsupervisionengineer(Signature)Date本表由承包单位填报，一式三份，经监理单位审批后，业主单位、监理单位、承包单位各存一份。Thistableshallbefilledupandsubmittedbythecontractorinthreecopies,onceitbeingreviewedbythesupervisioncompany,eachoftheOwner’sRepresentative,SupervisionCompanyandContractorshallholdonecopy.洛阳石化工程建设监理企业LouyangPetrochemicalEngineeringandConstructionSupervisionCompany（LPECSC）丽东芳烃项目LIDONGAROMATICCOMPLEXPROJECTA—03a单项(单元)工程：公用工程WorkItem(Unit)；Utility

(湖南大和企业)资质报审表ReviewRequestonQualification

项目编号：7S04ProjectNo.编号:No.致（监理单位）To(SupervisionCompany)：洛阳石化工程建设监理企业事由Subject:：现将我企业资质证书等资料报予贵企业，请审查。内容Content:：1、资质证书一份。2、营业执照一份。3、企业法人营业执照一份。4、组织机构代码证一份。5、压力管道安装同意证资料一份。提出单位（章）：湖南大和设备安装有限企业代表人（签字）：日期：Issuedby(Chop)Representative(Signature)Date专业监理工程师审查建议Reviewremarksofdisciplinesupervisionengineer：专业监理工程师（签字）：日期：Disciplinesupervisionengineer(signature):Date:总监理工程师审查建议Reviewremarksofthechiefsupervisionengineer：项目监理机构（章）：总监理工程师（签字）：日期：ProjectSupervisionCompany(chop)Chiefsupervisionengineer(Signature)Date本表由承包单位填报，一式三份，经监理单位审批后，业主单位、监理单位、承包单位各存一份。Thistableshallbefilledupandsubmittedbythecontractorinthreecopies,onceitbeingreviewedbythesupervisioncompany,eachoftheOwner’sRepresentative,SupervisionCompanyContractorandshallholdonecopy.洛阳石化工程建设监理企业LouyangPetrochemicalEngineeringandConstructionSupervisionCompany（LPECSC）丽东芳烃项目LIDONGAROMATICCOMPLEXPROJECTA—04单项(单元)工程：项目编号：LDA03/7S04/812041公用工程（查验批）分项工程质量报验申请表(InspectionBatch)WorkItemProjectNo.:WorkItem(Unit)编号：QualityInspectionApplicationUTILITYNo.致（监理单位）To(SupervisionCompany)：洛阳石化工程建设监理企业我方已完成了公用工程消防水管道安装（查验批）分项工程，经我方查验吻合设计、规范要求，请予以查收。We’vecompletedsingleitemofwork(inspectionbatch)of,whichhasbeeninspectedbyusandproventobeinaccordancewithdesignandcoderequirements,pleaseinspectandacceptit.附Attachment：名称Description页数Page编号No.1、□设备、资料、构配件质量证明文件页PageEquipment,MaterialandComponentsQualityCertificateDocument2、□隐蔽工程检查记录表ConcealedWorkInspectionRecord页Page3、□予检工程检查记录表Pre-inspectedWorkInspectionRecord页Page4、□施工记录ConstructionRecord页Page5、□施工试验记录ConstructionTestRecord,页Page6、□工序质量控制点查验认可文件页PageWorkProcedureQualityControlPointInspectionandApprovalDocument7、□分项工程质量查验评定记录页PageIndividualItemofWorkQualityInspectionandEvaluationRecord专业质量工程师(检查员）（签字）：日期DisciplineQualityEngineer(Inspector)(SignatureDate承包单位（章）：湖南大和设备安装企业(DC)技术负责人（签字）：日期：ConstructionContractor(Chop)Technicalleader(Signature)Date审查建议：ReviewRemarks:审查结论Reviewconclusion：□合格Qualified□不合格Unqualified项目监理机构（章）：专业监理工程师（签字）日期SupervisionCom.(Chop)Disciplinesupervisionengineer(signature)Date本表由承包单位填报，一式三份，经监理单位审批后，业主单位、监理单位、承包单位各存一份。Thistableshallbefilledupandsubmittedbythecontractorinthreecopies,onceitbeingreviewedandapprovedbythesupervisioncompany,theOwner,SupervisionCompanyandContractorshallholdonecopy.洛阳石化工程建设监理企业LouyangPetrochemicalEngineeringandConstructionSupervisionCompany（LPECSC）丽东芳烃项目LIDONGAROMATICSCOMPLEXPROJECTA—05单项(单元)工程：工程款支付申请表项目编号：ProjectNo.:WorkItem(Unit):ApplicationforProjectPayment编号：No.:致To：（监理单位SupervisionCompany）我方已完成了工作，按施工合同的规定，建设单位应在年月日前支付该项工程款共（大写）（小写）现报上工程款申请表请予以审查并开具工程款支付证书。We’vefinishedworkof.AccordingtotherulesoftheConstructionContract,ownershouldpaythisprojectpaymenttotal(amountinwords)(amountinordinaryfigures)before.Nowwesubmitapplicationforprojectpayment.Pleasecheckupandwriteoutprojectpaymentcertificate.附件Attchment：工程量清单;QuantityBill计算方法.countmethod承包单位（章）：

项目经理（签字）：

日期：Contractor(Seal)

ProjectManager(Sign)

Date本表由承包单位填报，一式三份，经监理单位审批后，业主单位、监理单位、承包单位各存一份。Thistableshallbefilledupandsubmittedbytheconstructioncontractorinthreecopies.Onceitbeingreviewedandapprovedbythesupervisioncompany,eachoftheOwner,supervisioncompanyandconstructioncontractorshallholdonecopy.洛阳石化工程建设监理企业LouyangPetrochemicalEngineeringandConstructionSupervisionCompany（LPECSC）丽东芳烃项目LIDONGAROMATICCOMPLEXPROJECTA—06单项(单元)工程：WorkItem(Unit):

监理工程师通知回复单SupervisionEngineerNoticeResponse

项目编号：ProjectNo.:编号：No.:致（监理单位）To(SupervisionCompany)：我方接到编号为的监理工程师通知后，已按要求完成了工作，现报上，请予复查。UponreceivingnoticeNo.engineer,we’vecompletedworkofsubmititforyourinspection.

whichisissuedbythesupervisionasrequired.We,hereby,详细内容：Detailcontent:承包单位（章）：项目经理（签字）：日期：ConstructionContractor(Chop)ProjectManager(Signature)Date:复查建议Inspectionremarks：项目监理机构（章）总/专业监理工程师（签字）：日期：Projectsupervisioncompany(Chop)Chief/disciplinesupervisionengineer(Signature)Date本表由承包单位填报，一式三份，经监理单位审批后，业主单位、监理单位、承包单位各存一份。Thistableshallbefilledupandsubmittedbythecontractorinthreecopies,onceitbeingreviewedbythesupervisioncompany,eachoftheOwner’sRepresentative,SupervisionCompanyandContractorshallholdonecopy.洛阳石化工程建设监理企业LouyangPetrochemicalEngineeringandConstructionSupervisionCompany（LPECSC）丽东芳烃项目LIDONGAROMATICSCOMPLEXPROJECTA—07单项(单元)工程：WorkItem(Unit):

工程临时延期申请表ApplicationforTemporarilyPostponementofProject

项目编号：ProjectNo.:编号：No.:致To：（监理单位SupervisionCompany）依照施工合同条款条的规定，由于原因，我方申请工程延期，请予以赞成。Accordingtotherulesofitemofconstructioncontract,oursideapplyprojecttobepostponed,becauseof。Pleasegrantourapplication.附件Attchment：1.工程延期的依照及工期计算Basisofprojecttobepostponedandcounttothetimelimitforaproject合同竣工日期contractcompletetime：申请延长竣工日期Applycompletetimetobeextend：2.证明资料certificatematerial承包单位（章）：项目经理（签字）：日期：Ccontractor(Seal)ProjectManager(Sign)Date本表由承包单位填报，一式三份，经监理单位审批后，业主单位、监理单位、承包单位各存一份。Thistableshallbefilledupandsubmittedbytheconstructioncontractorinthreecopies.Onceitbeingreviewedandapprovedbythesupervisioncompany,eachoftheOwner,supervisioncompanyandconstructioncontractorshallholdonecopy.洛阳石化工程建设监理企业LouyangPetrochemicalEngineeringandConstructionSupervisionCompany（LPECSC）丽东芳烃项目LIDONGAROMATICSCOMPLEXPROJECTA—08单项(单元)工程：WorkItem(Unit):

花销索赔申请表ApplicationForClaimonCost

项目编号：ProjectNo.:编号：No.:致To：（监理单位SupervisionCompany）依照施工合同条款条的规定，由于的原因，我方要求索赔金额（大写），请予赞成。Accordingtotherulesofitemofconstructioncontract,oursidedemandcompensationofmoney(amountinwords),becauseof.Pleasegrantourapplication.索赔的详细原因及经过:detailedclaimreasonandcondition索赔金额的计算：claimmoneycount附：证明资料attch:certificatematerial承包单位（章）：项目经理（签字）：日期：Contractor(Seal)ProjectManager(Sign)Date本表由承包单位填报，一式三份，经监理单位审批后，业主单位、监理单位、承包单位各存一份。Thistableshallbefilledupandsubmittedbytheconstructioncontractorinthreecopies.Onceitbeingreviewedandapprovedbythesupervisioncompany,eachoftheOwner,supervisioncompanyandconstructioncontractorshallholdonecopy.洛阳石化工程建设监理企业LouyangPetrochemicalEngineeringandConstructionSupervisionCompany（LPECSC）丽东芳烃项目LIDONGAROMATICCOMPLEXPROJECTA—09单项(单元)工程：WorkItem(Unit):

资料/构配件/设备报审表Material/Component/EquipmentReviewRequest

项目编号：ProjectNo.编号：No.致（监理单位）To(SupervisionCompany)：现报上工程进场资料/构配件/设备查验记录，该批物质经我方查验吻合设计、规范及合同要求，请予以赞成使用。Therecordofmaterial,componentandequipmentinspectionformobilizationofworkofissubmittedasbelow.Thisbatchofmaterialhasbeeninspectedbyusandproventomeetrequirementsofdesign,specificationandcontract,pleaseapproveapplicationofthesematerialsinthisproject.序号物质名称主要规格单位数量选择审报表编号使用部位No.MaterialdescriptionMainspec.UnitQuantityReviewRequestTableNo.Applicationlocation附：Attachment1、□出厂合格证Ex-workscertificateofcompliance页Page编号No2、□厂家质量查验报告Qualityinspectionreportofthevendor页Page编号No.3、□厂家质量保证书Qualityguaranteeofthevendor页Page编号No.4、□监检、监造文件Documentofmanufacturingsupervisionbyresidinginfactory页Page编号No.5、□商检证Commodityinspectioncertificate页Page编号No.6、□进场检查记录Mobilizationinspectionrecord页Page编号No.7、□进场复试报告Mobilizationretestreport页Page编号No.8、□备案情况Putonrecord页Page编号No.承包单位（章）：技术负责人（签字）：日期：Constructioncontractor(Chop)Technicalleader(Signature)Date:审查建议Reviewremarks：□赞成使用Approvetobeapplied□补报资料Supplementaryinformationtobesubmitted□重新查验Inspectiontoberedone□散场demobilization项目监理机构（章）：总/专业监理工程师（签字）：日期：Projectsupervisioncompany(Chop)Chief/Disciplinesupervisionengineer(Signature)Date本表由承包单位填报，一式三份，经监理单位审批后，业主单位、监理单位、承包单位各存一份。Thistableshallbefilledupandsubmittedbytheconstructioncontractorinthreecopies.Onceitbeingreviewedandapprovedbythesupervisioncompany,eachoftheOwner,supervisioncompanyandconstructioncontractorshallholdonecopy.洛阳石化工程建设监理企业LouyangPetrochemicalEngineeringandConstructionSupervisionCompany（LPECSC）丽东芳烃项目LIDONGAROMATICCOMPLEXPROJECTA—10单项(单元)工程：工项目编号：WorkItem(Unit):程交工报验单ProjectNo.:ConstructionTakeoverInspection编号：RequestNo.:致（监理单位）To(SupervisionCompany)：我方已按合同要求完成了工程，经自检合格，请予以检查和查收。We’vecompletedworkofaspercontractrequirement,whichhasbeenproventobeacceptableuponself-inspection,pleaseinspectandacceptit.附：交工申请、工程实物量清单、交工技术文件。Attachment:Takeoverapplication,BillsofQuantities,TakeoverTechnicalDeliverables.承包单位（章）：项目经理（签字）：日期ConstructionContractor(Chop)ProjectManager(Signature)Date:审查建议Reviewremarks:经初步查收，该工程Uponinitialinspection,thisworkis1、□吻合□不吻合我国现行法律、法规要求；In/notinconformancewithcurrentlawandrulerequirementsofthenation.2、□吻合□不吻合我国现行工程建设标准；In/notinconformancewithcurrentconstructionstandardsofthenation.3、□吻合□不吻合设计文件要求4、□吻合□不吻合施工合同要求

In/notinconformancewithrequirementsofthedesigndocument.In/notinconformancewithrequirementsofconstructioncontract.综上所述，该工程予查收结论Aboveall,throughinspection,thisprojectshallbeconcludedas：□合格Qualified□不合格Unqualified；可否组织正式交工查收Isitpropertoorganizefinaltakeoverinspectionandacceptance：□可Yes□否No。项目监理机构（章）总监理工程师（签字）：日期SupervisionCompany(chop)Chiefsupervisionengineer(signature)Date本表由承包单位填报，一式三份，经监理单位审批后，业主单位、监理单位、承包单位各存一份。Thistableshallbefilledupandsubmittedbythecontractorinthreecopies,onceitbeingreviewedandapprovedbythesupervisioncompany,eachoftheOwner,SupervisionCompanyandContractorshallholdonecopy.洛阳石化工程建设监理企业LouyangPetrochemicalEngineeringandConstructionSupervisionCompany（LPECSC）丽东芳烃项目LIDONGAROMATICCOMPLEXPROJECTA—11单项(单元)工程：公用工程WorkItem(Unit):UTILITY

工序质量控制点查验通知WorkProcedureQualityControlPointInspectionNotice

项目编号：ProjectNo.:LDA03/7S04/812041编号：No.:8107致（监理单位）To(SupervisionCompany)：洛阳石化工程建设监理企业依照施工质量控制程序的规定，我方已完成以下工序质量控制点的施工，并经自检合格，特报请核查确认。（请通知业主专业工程师参加A级质量控制点核查）Asperregulationsofconstructionqualitycontrolprocedure,we’vecompletedconstructionoffollowingworkprocedurequalitycontrolpoints,whichhavebeenproventobeacceptableafterself-inspection.Pleasebenotedtoinspectandapprove.(PleaseinformdisciplineengineeroftheOwnertoattendinspectionofClassAqualitycontrolpoints)附Attachment：自检资料Self-inspectioninformation。单位工程Workunit：青岛丽东芳烃UTU消防管道安装工程质量控制点名称/（级别）Description/Class管道试压、A级ofqualitycontrolpoint详细部位Specificlocation131-FW-干线查验内容Contentofinspection试验压力、保压时间、过程检查、管道复位、填写记录查验标准（依照）Inspectionstandard(Basis)GB50235-97要求列席查验时间年月日Requiredarrivetimeforattendinginspection承包单位（章）：湖南大和设备安装企业(DC)(签字）：日期：Constructioncontractor(Chop)Technicalleader(Signature)Date专业监理工程师签收Singedforconfirmationbythedisciplinesupervisionengineer：定于年月日按要求到现场查验。It’sconfirmedtoarriveonsiteonDayMonthYearasrequiredforattendinginspection.监理机构（章）：专业监理工程师（签字）：日期：SupervisionCompany(Chop)Disciplinesupervisionengineer(Signature)Date本表由承包单位填报，一式3~4份，经监理单位审批后，业主单位、监理单位、承包单位各存一份。其中A级质量控制点应供应业主一份。Thistableshallbefilledupandsubmittedbythecontractorinthreetofourcopies,onceitbeingreviewedandapprovedbythesupervisioncompany,eachoftheOwner,SupervisionCompanyandContractorshallholdonecopy.Amongwhich,onecopyofdocumentregardingtoClassAqualitycontrolpointshallbesubmittedtotheOwner.洛阳石化工程建设监理企业LouyangPetrochemicalEngineeringandConstructionSupervisionCompany（LPECSC）丽东芳烃项目LIDONGAROMATICCOMPLEXPROJECTA—11单项(单元)工程：公用工程WorkItem(Unit):UTILITY

工序质量控制点查验通知WorkProcedureQualityControlPointInspectionNotice

项目编号：ProjectNo.:LDA03/7S04/812041编号：No.:8107致（监理单位）To(SupervisionCompany)：洛阳石化工程建设监理企业依照施工质量控制程序的规定，我方已完成以下工序质量控制点的施工，并经自检合格，特报请核查确认。（请通知业主专业工程师参加A级质量控制点核查）Asperregulationsofconstructionqualitycontrolprocedure,we’vecompletedconstructionoffollowingworkprocedurequalitycontrolpoints,whichhavebeenproventobeacceptableafterself-inspection.Pleasebenotedtoinspectandapprove.(PleaseinformdisciplineengineeroftheOwnertoattendinspectionofClassAqualitycontrolpoints)附Attachment：自检资料Self-inspectioninformation。单位工程Workunit：青岛丽东芳烃UTU消防管道安装工程质量控制点名称/（级别）Description/Class管道试压、A级ofqualitycontrolpoint详细部位Specificlocation131-FW-干线查验内容Contentofinspection试验压力、保压时间、过程检查、管道复位、填写记录查验标准（依照）Inspectionstandard(Basis)GB50235-97要求列席查验时间年月日Requiredarrivetimeforattendinginspection承包单位（章）：湖南大和设备安装企业(DC)(签字）：日期：Constructioncontractor(Chop)Technicalleader(Signature)Date专业监理工程师签收Singedforconfirmationbythedisciplinesupervisionengineer：定于年月日按要求到现场查验。It’sconfirmedtoarriveonsiteonDayMonthYearasrequiredforattendinginspection.监理机构（章）：专业监理工程师（签字）：日期：SupervisionCompany(Chop)Disciplinesupervisionengineer(Signature)Date本表由承包单位填报，一式3~4份，经监理单位审批后，业主单位、监理单位、承包单位各存一份。其中A级质量控制点应供应业主一份。Thistableshallbefilledupandsubmittedbythecontractorinthreetofourcopies,onceitbeingreviewedandapprovedbythesupervisioncompany,eachoftheOwner,SupervisionCompanyandContractorshallholdonecopy.Amongwhich,onecopyofdocumentregardingtoClassAqualitycontrolpointshallbesubmittedtotheOwner.洛阳石化工程建设监理企业LouyangPetrochemicalEngineeringandConstructionSupervisionCompany（LPECSC）丽东芳烃项目LIDONGAROMATICSCOMPLEXPROJECTA—12单项(单元)工程：WorkItem(Unit):

主要施工设备进场报审表MainconstructionequipmententerthefieldReviewRequest

项目编号：ProjectNo.:编号：No.:工程名称合同编号致（监理单位）To(SupervisionCompany)：我单位担当的工程的以下主要施工用设备、机具及检测设备、工具已按合同规定进场，请查验，准予使用。Malreadyainconstructionequipment,machine,inspectequipmentandtoolthatshouldbeusebycontractorarrive,pleaseinspectandapprove.1.主要施工设备、机具Mainequipment,machine序设备名称规格型号数量制造厂技术性能进场日期拟用日期拟用哪处号equipmentspectypenumberManufactoryTechniquedateenterplantowherenamefunctionusedate2.主要检测设备、工具inspectequipmentandtool序设备名称规格型号数量制造厂校核日期有效期号equipmentnamespectypenumberManufactoryperiodofcheckperiodofvalidity附：详细清单页。Add:list施工项目经理部（章）：Projectmanager'sdepartment(chop)项目经理：日期：Projectmanager:date:监理单位审查建议：remark:赞成上述设备、机具进场。以下设备、机具能力或数量不能够满足施工需要，请赶忙按施工进度要求配足后进场：序号设备名称进场技术性能应配技术性能进场数量应配数量项目监理机构（章）：Supervision(chop):总监理工程师：日期：监理工程师/监理员：日期：Chiefsupervisor:datesupervisor:date洛阳石化工程建设监理企业LouyangPetrochemicalEngineeringandConstructionSupervisionCompany（LPECSC）丽东芳烃项目LIDONGAROMATICCOMPLEXPROJECTB—01单项(单元)工程：监理工程师通知单WorkItem(Unit)SupervisionEngineerNotice

项目编号：ProjectNo.编号：No.致To:事由Subject:内容Content：项目监理机构（章）：总/专业监理工程师（签字）日期：SupervisionCompany(Chop)Chief/DisciplineProjectSupervisionengineer(Signature)Date注：重要监理通知应由总监理工程师签署，监理单位、业主及相关单位各存一份。Note:Importantnoticefromthesupervisioncompanyshallbesignedbythechiefsupervisionengineer.Supervisioncompany,Ownerandrelatedcompanyshalleachkeeponecopy.洛阳石化工程建设监理企业LouyangPetrochemicalEngineeringandConstructionSupervisionCompany（LPECSC）丽东芳烃项目LIDONGAROMATICCOMPLEXPROJECTB—02单项(单元)工程工程暂停令WorkItem(Unit)WorkSuspensionOrder

项目编号：ProjectNo.:编号：No致To：（承包单位）(Constructioncontractor)由于的原因，现通知你必定于年代日时起，对本工程的部位（工序）推行暂停施工，并按下述要求做好各项工作：Duetothereasonof,weherebyinformyoutosuspendworkatlocation(ofworkprocedure)ofsinceHourDayMonthYearandimplementitemsofworkasperfollowingrequirements.项目监理机构（章）总监理工程师（签字）：日期：Projectsupervisioncompany(Chop)Chiefsupervisionengineer(Signature)Date注：本表由监理单位签发，签发前应征得业主项目经理赞成；业主、监理单位、承包单位各存一份。Note:ThistableshallbeissuedbythesupervisioncompanywhomustobtainconsentoftheOwner’sprojectmanagerpriortoissuance.EachoftheOwner,supervisioncompanyandconstructioncontractorshallkeeponecopy.洛阳石化工程建设监理企业LouyangPetrochemicalEngineeringandConstructionSupervisionCompany（LPECSC）丽东芳烃项目LIDONGAROMATICSCOMPLEXPROJECTB—03单项(单元)工程工程款支付证书项目编号：ProjectNo.WorkItem(Unit)ProjectPaymentCertificate编号：No.致to：依照施工合同的规定，经审查施工单位的付款申请和报表，并扣除相关款项，赞成本期支付共（大写）（小写）请按合同规定及时付款。Aftercheckuptheapplicationforpaymentandreportform,deductingrelatedasumofmoney,weagreetopaythisperiod,total(amountinwords)(amountinordinaryfigures)accordingtotherulesoftheConstructionContract.PleasepayontimeaccordingtotherulesofContract.其中thereinto：承包单位申报款为：contractordeclaredpayment本期应扣款为：paymenttobedeductedthisperiod应付款为：paymentthatshouldbepaid附件Attchment：承包单位的工程付款申请表及附件ApplicationforProjectPaymentandAttchment项目监理机构审查记录ProjectSupervisionCom.Examinationnote项目监理机构（章）：总监理工程师（签字）：日期：ProjectSupervisionCom.(Seal):ChiefSupervisionEngineer(Sign):Date:注：本表由监理单位签发，签发前应征得业主项目经理赞成；业主、监理单位、承包单位各存一份。Note:ThistableshallbeissuedbythesupervisioncompanywhomustobtainconsentoftheOwner’sprojectmanagerpriortoissuance.EachoftheOwner,supervisioncompanyandconstructioncontractorshallkeeponecopy.洛阳石化工程建设监理企业LouyangPetrochemicalEngineeringandConstructionSupervisionCompany（LPECSC）丽东芳烃项目LIDONGAROMATICSCOMPLEXPROJECTB—04单项(单元)工程WorkItem(Unit)

工程临时延期审批表ApprovalforPostponementofProjectTemporarily

项目编号：ProjectNo.编号：No.致to：依照施工合同条款条的规定，我方对你方提出的工程延期申请（第号）要求延长工期日历天的要求，经过审查评估：Accordingtotherulesofitemofconstructioncontract,oursidecheckupandevaluateonApplication(No.)forpostponementofprojecttemporarilytodemandextendingtimelimitforaprojectdaybyyoursidesubmited.临时赞成工期延长日历天。使竣工日期（包括已指令延长的工期）从原来的年月日延缓到年代日。请你方执行。Agreedwithtemporarilytimelimitforaprojecttobeextendday.Completedate(includethetimelimitthathadbeendictatedextending)willdelayfromto.Pleaseexecutethisinstruction.不同样意延长工期，请按约定竣工日期组织施工。Disagreedwithtimelimitforaprojecttobeextend.PleaseexecuteconstructionaccordingtoappointedCompleteDate.说明:explanation项目监理机构（章）：总监理工程师（签字）：日期：ProjectSupervisionCom.(Seal):ChiefSupervisionEngineer(Sign):Date:注：本表由监理单位签发，签发前应征得业主项目经理赞成；业主、监理单位、承包单位各存一份。Note:ThistableshallbeissuedbythesupervisioncompanywhomustobtainconsentoftheOwner’sprojectmanagerpriortoissuance.EachoftheOwner,supervisioncompanyandconstructioncontractorshallkeeponecopy.洛阳石化工程建设监理企业LouyangPetrochemicalEngineeringandConstructionSupervisionCompany（LPECSC）丽东芳烃项目LIDONGAROMATICSCOMPLEXPROJECTB—05单项(单元)工程WorkItem(Unit)

工程最后延期审批表ApprovalforFinalPostponementofProject

项目编号：ProjectNo.编号：No.致to：依照施工合同条款条的规定，我方对你方提出的工程延期申请（第号）要求延长工期日历天的要求，经过审查评估：Accordingtotherulesofitemofconstructioncontract,oursidecheckupandevaluateonApplication(No.)forpostponementofprojecttemporarilytodemandextendingtimelimitforaprojectdaybyyoursidesubmited.最后赞成工期延长日历天。使竣工日期（包括已指令延长的工期）从原来的年月日延缓到年代日。请你方执行。Agreedwithfinallytimelimitforaprojecttobeextendday.Completedate(includethetimelimitthathadbeendictatedextending)willdelayfromto.Pleaseexecutethisinstruction.不同样意延长工期，请按约定竣工日期组织施工。Disagreedwithtimelimitforaprojecttobeextend.PleaseexecuteconstructionaccordingtoappointedCompleteDate.说明:explanation项目监理机构（章）：总监理工程师（签字）：日期：ProjectSupervisionCom.(Seal):ChiefSupervisionEngineer(Sign):Date:注：本表由监理单位签发，签发前应征得业主项目经理赞成；业主、监理单位、承包单位各存一份。Note:ThistableshallbeissuedbythesupervisioncompanywhomustobtainconsentoftheOwner’sprojectmanagerpriortoissuance.EachoftheOwner,supervisioncompanyandconstructioncontractorshallkeeponecopy.洛阳石化工程建设监理企业LouyangPetrochemicalEngineeringandConstructionSupervisionCompany（LPECSC）丽东芳烃项目LIDONGAROMATICSCOMPLEXPROJECTB—06单项(单元)工程：WorkItem(Unit):致To：依照施工合同条款写）

花销索赔审批表项目编号：ProjectNo.:ApprovalForClaimonCost编号：No.:（承包单位Constructioncontractor）条的规定，你方提出的花销索赔申请（第号）索赔（大经我方审查评估：Accordingtotherulesofitemofconstructioncontract,oursidecheckupandevaluateonApplication(No.)ForClaimonCostclaiming(amountinwords)byyoursidesubmitted.不同样意此项索赔。Disagreedwiththisclaim.赞成此项索赔，金额为（大写）Agreedwiththisclaim.Themoney(amountinwords)赞成/不同样意索