采油六厂工程建设项目工程报审报验监理表格.doc

濮阳中油工程管理有限公司 监理资料采 油 六 厂 工 程 建 设 项 目 工程报审报验监 理 表 格（石油化工建设工程项目监理规范SH/T 3903-2004）濮阳中油工程管理有限公司工 程 管 理 六 站107 ST/T 3903-2004SH/T 3903-A.1工程开工/复工报审表Works Commencement/Resumption Approval Request工程名称 Works Title：编号 Item No：致 濮阳中油工程管理有限公司（监理单位）To （CS/CMC） 我单位承担的 采油六厂马厂联合站防洪排涝 工程，已完成了以下各项工作，具备了开工/复工条件，特此申请施工，请核查并签发开工/复工指令。We have fulfilled the following activities for the work contracted by us, the works commencement/works resumption conditions are available, therefore the construction is applied hereby, please review and issue works commencement/works resumption orders.附Attached：1 开工报告 commencement Report；2 证明文件 Supporting documents。 项目经理 Project Manager承包单位（章） 日 期Contractor(Chop) Date审查意见 Review Comments： 总监理工程师 Chief Supervision Engineer项目监理机构：工程管理六站 日 期CS/CMC DateSH/T 3903-A.2施工组织设计（方案）报审表Construction Organization Design Approval Request工程名称 Works Title：编号 Item No：致 濮阳中油工程管理有限公司（监理单位）To （CS/CMC） 我方已根据施工承包合同的有关规定完成了采油六厂马厂联合站防洪排涝工程施工组织设计（方案）的编制，并经我单位技术负责人审查批准，请予以审查。According to the regulations of the construction contract, we have completed the preparation of the construction organization design ,and it has been reviewed and approved by the technical responsible people of our company, please review it.附Attached施工组织设计/施工方案。Construction Organization Design/Construction Plan项目经理 Project Manager承包单位（章） 日 期Contractor(Chop) Date专业监理工程师审查意见 专业监理工程师 Discipline Supervision Engineer 日 期 Date总监理工程师审核意见 Review comments from chief supervision engineer：总监理工程师 Chief Supervision Engineer项目监理机构：工程管理六站 日 期CS/CMC DateSH/T 3903-A.3分包单位资格报审表Subcontractor Qualification Approval Request工程名称 Works Title：编号 Item No：致 濮阳中油工程管理有限公司（监理单位）To （CS/CMC） 经考察，我方认为拟选定的 菏泽方明集团有限公司 （分包单位）具有承担下列工程的施工资质和施工能力，可以保证本工程项目按合同的规定进行施工。分包后，我方仍承担承包合同的全部责任。请予以审查和批准。After investigation, we think the proposed (subcontractor) has the qualification and capability for contracting the fallowing works, and can assure that this woks will be constructed as per the contract regulations. After subcontracting this works, we still hold the whole responsibilities of the lump sum contractor. Please review and approve it.附Attached1 分包单位资质材料 Subcontractor Qualification Documents；2 分包单位业绩材料 Subcontractor Performance Documents。分包工程名称（部位）Subcontracted works(location)工程数量Works Quantity拟分包工程合同额Contract Price of proposed subcontracted works分包工程占全部工程Percentage of subcontracted works 合 计 Totals项目经理 Project Manager承包单位（章） 日 期Contractor(Chop) Date专业监理工程师审查意见 专业监理工程师 Discipline Supervision Engineer 日 期 Date总监理工程师审核意见 Review comments from chief supervision engineer：总监理工程师 Chief Supervision Engineer项目监理机构：工程管理六站 日 期CS/CMC DateSH/T 3903-A.4隐蔽记录 报验申请表 Inspection Request工程名称 Works Title：采油六厂马厂联合站防洪排涝工程编号 Item No：致 濮阳中油工程管理有限公司（监理单位）To （CS/CMC） 我已完成了采油六厂马厂联合站防洪排涝工程之电缆的隐蔽工作，经自检合格，先报上该工程报验申请表，请予以审查。We have completed the works, after self inspection, the works is on spec, now we submit the inspection request for this works, please inspect and accept.附Attached：项目经理 Project Manager承包单位（章） 日 期Contractor(Chop) Date审查意见 Review Comments： 总/专业监理工程师 Chief /discipline supervision engineer项目监理机构：工程管理六站 日 期CS/CMC DateSH/T 3903-A.5工程款支付申请表Works payment Request工程名称 Works Title：编号 Item No：致 濮阳中油工程管理有限公司（监理单位）To （CS/CMC） 我方已完成了采油六厂马厂联合站防洪排涝工程 工作，按施工承包合同的规定，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 工程付款申请表，请予以审查并开具工程款支付证书。We have completed the Works,according to the contract regulations, the owner should make the payment of total of (amount in works),(say ) fort his works before . Now we submit the Works Payment Request, please review and issue the works payment certificate.附件 Attached：1 工程量清单 Quantity List；2 计算方法 Calculation Methods：项目经理 Project Manager承包单位（章） 日 期Contractor(Chop) DateSH/T 3903-A.9工程材料/构配件/设备报审表Works Materials/Components/Equipment Inspection Request工程名称 Works Title：采油六厂马厂联合站防洪排涝工程编号 Item No：致 濮阳中油工程管理有限公司（监理单位）To （CS/CMC） 我方于 年 月 日进场的工程材料/构配件/设备数量如下（见附件）。现将质量证明文件及自检结果报上，拟用于下述部位：采油六厂马厂联合站防洪排涝工程集水池的施工请予以审核。We have mobilized the following materials/components/equipment for the works on Its quantity is listed below(see the attachments)Now, we submit the quality documents and our self inspection results, The proposed locations for use as follows：Please review it. 附件 Attached：1 数量清单 Quantity List；2 质量证明文件 Quality Documents；3 自检结果 Self Inspection Results。项目经理 Project Manager承包单位（章） 日 期Contractor(Chop) Date审查意见 Review Comments： 经检查上述工程材料/构配件/设备，符合/不符合设计文件和规范的要求，准许/不准许进场，同意/不同意适用于拟定部位。 After the inspection, the abovematerials/components/equipment, meet do not meet the requirements of the design documents and specifications. site mobilization is allowed/site mobilization is not allowed. use for the proposed locations is allowed/not allowed.总/专业监理工程师 Chief /discipline supervision engineer项目监理机构：工程管理六站 日 期CS/CMC DateSH/T 3903-A.10工程竣工报验单Works Completion Inspection Request工程名称 Works Title：编号 Item No：致 濮阳中油工程管理有限公司（监理单位）To （CS/CMC） 我方已合同要求完成了 工程，经自检合格，请予以检查和验收。We have completed the works according to the requirements of the contract, after the self check, it is on spec, please inspect and accept.附 Attached：项目经理 Project Manager承包单位（章） 日 期Contractor(Chop) Date审查意见 Review Comments： 经初步验收，该工程： After the preliminary inspection and acceptance, this works：1 符合/不符合我国现行法律、法规要求；meet/not meet the requirements of the current state laws and regulations；2 符合/不符合我国现行工程建设标准； meet/not meet the requirements of the current national standards；3 符合/不符合设计文件要求； meet/not meet the requirements of the design documents；4 符合/不符合施工合同要求。 meet/not meet the requirements of the construction contract. 综上所述，该工程初步验收合格/不合格，可以/不可以组织正式验收。 Based on the above points, the preliminary inspection and acceptance of this works is on spec/off spec, formal inspection and acceptance can be/ can not be organized.总监理工程师 Chief Supervision Engineer项目监理机构：工程管理六站 日 期CS/CMC DateSH/T 3903-A.11施工进度计划报审表Construction Schedule Approval Request工程名称 Works Title：编号 Item No：致 濮阳中油工程管理有限公司（监理单位）To （CS/CMC） 我方已根据承包合同的有关规定编制完成了采油六厂马厂联合站防洪排涝工程施工进度计划We have completed the preparations of the following schedules from to according to the related regulations of the construction contract：1 工程施工总进度计划 Project Construction Overall Schedule2 工程施工月进度计划Project Construction 3 工程施工周进度计划Project Construction4 计划Project Construction并经我单位技术负责人审查批准，先报上，请予以审查。我们将严格按审查通过的进度计划组织施工。附Attached：图表、说明书共 1 页。Drawings and charts, instruction book, totally in pages.项目经理 Project Manager承包单位（章） 日 期Contractor(Chop) Date审查意见 Review Comments：同意此计划。Approved this schedule.不同意此计划，请按以下要求修改再报。Not approved this schedule, please modify it according to the following requirements, and resubmit it:专业监理工程师 Discipline Supervision Engineer 日 期 Date审查意见 Review Comments：总监理工程师 Chief supervision engineer项目监理机构：工程管理六站 日 期CS/CMC DateSH/T 3903-A.13主要施工设备进场报审表Major Construction Equipment Mobilization Approval Request工程名称 Works Title：采油六厂马厂联合站防洪排涝工程编号 Item No：致 濮阳中油工程管理有限公司（监理单位）To （CS/CMC） 我单位承担的 采油六厂马厂联合站防洪排涝工程，按合同规定的主要施工设备、机具及检测设备、工具拟进场，并经自荐合格，请查验。We contracted the works, we are going to mobilize the major construction equipment and tools as well as the inspection equipment and tools specified by the contract, after the self inspection, they are on spec, please inspect.附Attached：项目经理 Project Manager承包单位（章） 日 期Contractor(Chop) Date审查意见 Review comments经检查上述施工设备、机具及检测设备、工具，符合/不符合施工组织设计文件和相关要求，准许/不准许进场。According to inspection, the above equipment, tools and the inspection equipment and tools meet/do not meet the requirements of the construction organization design documents and other rules, site mobilization allowed/site mobilization not allowed.不准许进场原因如下：The reasons for not allowing site mobilization are listed below.总/专业监理工程师 Chief /discipline supervision engineer项目监理机构：工程管理六站 日 期CS/CMC DateSH/T 3903-C.2工程变更单Works Change Order工程名称 Works Title：编号 Item No：致 濮阳中油工程管理有限公司（监理单位）To （CS/CMC）由于 原因，兹提出 工程变更（内容见附件），请予以审批。Due the reasons ,We request hereby the Works Change Order (for its contents, see the attachments),please approve it.代 表 人Representative提出单位 日 期Requested by Date一致意见 consistent comments：建设单位代表（签字）Owner representative(Signature)日期Date设计单位代表（签字）Design unit representative(Signature)日期Date项目监理机构代表（签字）Project CS/CMC(Signature)日期Date承包单位代表（签字）CC representative(Signature)日期DateSH/T 3903-A.2施工组织设计（方案）报审表Construction Organization Design Approval Request工程名称 Works Title：采油六厂马厂联合站防洪排涝工程编号 Item No：致 濮阳中油工程管理有限公司（监理单位）To （CS/CMC） 我方已根据施工承包合同的有关规定完成了采油六厂马厂联合站防洪排涝工程灯架运输及吊装（方案）的编制，并经我单位技术负责人审查批准，请予以审查。According to the regulations of the construction contract, we have completed the preparation of the construction organization design ,and it has been reviewed and approved by the technical responsible people of our company, please review it.附Attached施工组织设计/施工方案。Construction Organization Design/Construction Plan项目经理 Project Manager承包单位（章） 日 期Contractor(Chop) Date专业监理工程师审查意见 专业监理工程师 Discipline Supervision Engineer 日 期 Date总监理工程师审核意见 Review comments from chief supervision engineer：总监理工程师 Chief Supervision Engineer项目监理机构：工程管理六站 日 期CS/CMC DateSH/T 3903-A.2施工组织设计（方案）报审表Construction Organization Design Approval Request工程名称 Works Title：采油六厂马厂联合站防洪排涝工程编号 Item No：致 濮阳中油工程管理有限公司（监理单位）To （CS/CMC） 我方已根据施工承包合同的有关规定完成了采油六厂马厂联合站防洪排涝工程质量检验计划的编制，并经我单位技术负责人审查批准，请予以审查。According to the regulations of the construction contract, we have completed the preparation of the construction organization design ,and it has been reviewed and approved by the technical responsible people of our company, please review it.附Attached施工组织设计/施工方案。Construction Organization Design/Construction Plan项目经理 Project Manager承包单位（章） 日 期Contractor(Chop) Date专业监理工程师审查意见 专业监理工程师 Discipline Supervision Engineer 日 期 Date总监理工程师审核意见 Review comments from chief supervision engineer：总监理工程师 Chief Supervision Engineer项目监理机构：工程管理六站 日 期CS/CMC Date