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["現地検査チェックシート 　／　既存建築物省エネ化推進事業　"]
["1. 建築物の概要",{"$nulls":6},"平成　　　　年　　　　月　　　　日"]
["応募番号",null,"　17Ａ　-　",null,null,"事業名"]
["建物名"]
["建築物の所在地"]
["バリアーフリー　　　改修工事",null,"　□ 実施する　　　　□ 実施しない"]
["提案者",null,"建築主",{"$nulls":6},"（□ 代表提案者 ）"]
[null,null,"事業者",{"$nulls":6},"（□ 代表提案者 ）"]
["建設事業者",{"$nulls":4},"住所"]
["施工管理者",{"$nulls":4},"連絡先"]
["立会者",{"$nulls":4},"検査予定日時",null,"　　　　月　　日　（　）　○○：○○～"]
[]
["2. 省エネ改修の提案内容の変更",null,null,null,"※交付申請時から変更のある場合は記入"]
[null,"□ 有　　・　　□ 無"]
["変更事項",{"$nulls":4},"変更内容"]
[]
[]
[]
[]
["※提案内容に変更がある場合は、補助金交付を受けられない場合がありますので、変更が生じた時点で当協議会にご連絡ください。"]
[]
["3. 書類検査（原本確認）　　　　"]
["①","　契約見積書の原本",{"$nulls":5},"□ 有","□ 原本確認"]
["②","　工事請負契約書又は注文請書の原本",{"$nulls":5},"□ 有","□ 原本確認"]
["③","　出荷証明書、納品書の原本",{"$nulls":5},"□ 有　","□ 原本確認"]
["④","　支払済領収書の原本",{"$nulls":5},"□ 有　","□ 原本確認"]
[]
["4. 検査結果等　　　　",{"$nulls":6},"　※　          部分は現場検査員が記入　"]
["検査年月日",{"$nulls":4},"検査結果",null,"適　　・　　不適　"]
[]
["立会者",null,"※検査終了時に署名（会社名・氏名）"]
[]
["現地検査員"]

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["5. 施工状況報告欄（施工管理者記入欄）",null,null," ※　   　　　　　部分は現地検査員が記入　"]
["施工状況報告欄（施工管理者記入欄）",{"$nulls":4},"現地検査員確認欄"]
["改修項目",null,"改修内容","実物検査"," 施工関連図書","適"]
[{"$nulls":5},"１次","2次"]
["躯体改修","□　開口部",null," □ 実物目視"," □ 写真","　","　"]
[null,"□　断熱",null," □ 実物計測"," □ 出荷証明書等"]
[null,"□　フィルム",null,null," □ カタログ、証明書他"]
[null,"□　日射遮蔽",null,null," □ 施工図"]
[]
[]
["空調設備改修","□　熱源設備",null," □ 実物目視"," □ 写真","　","　"]
[null,"□　搬送設備",null," □ 実物計測"," □ 出荷証明書等"]
[null,"□　二次側機器",null,null," □ カタログ、証明書他"]
[{"$nulls":4}," □ 施工図"]
[]
[]
["受変電設備","□キュービクル",null," □ 実物目視"," □ 写真"]
[null,"□動力盤",null," □ 実物計測"," □ 出荷証明書等"]
[null,"□電灯盤",null,null," □ カタログ、証明書他"]
[{"$nulls":4}," □ 施工図"]
[]
[]
["換気設備","□　換気ファン",null," □ 実物目視"," □ 写真","　","　"]
[null,"□　自動制御",null," □ 実物計測"," □ 出荷証明書等"]
[{"$nulls":4}," □ カタログ、証明書他"]
[{"$nulls":4}," □ 施工図"]
[]
[]
["照明設備改修","□　照明器具",null," □ 実物目視"," □ 写真","　","　"]
[null,"□　自動制御",null," □ 実物計測"," □ 出荷証明書等"]
[{"$nulls":4}," □ カタログ、証明書他"]
[{"$nulls":4}," □ 施工図"]
[]
[]
["給湯設備改修","□　熱源設備",null," □ 実物目視"," □ 写真","　","　"]
[null,"□　搬送設備",null," □ 実物計測"," □ 出荷証明書等"]
[null,"□　自動制御",null,null," □ カタログ、証明書他"]
[{"$nulls":4}," □ 施工図"]
[]
[]
["昇降設備","□　昇降機",null," □ 実物目視"," □ 写真","　","　"]
[null,"□　自動制御",null," □ 実物計測"," □ 出荷証明書等"]
[{"$nulls":4}," □ カタログ、証明書他"]
[{"$nulls":4}," □ 施工図"]
[]
[]
["エネルギー計測","□　空調設備",null," □ 実物目視"," □ 写真","　","　"]
[null,"□　照明設備",null," □ 実物計測"," □ 出荷証明書等"]
[null,"□　給湯設備",null,null," □ カタログ、証明書他"]
[null,"□　換気設備",null,null," □ 施工図"]
[]
[]
["省エネ性能評価表示","□　プレート",null," □ 実物目視"," □ 写真","　","　"]
[null,"□　シール",null,null," □ 評価書"]

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["5. 施工状況報告欄（施工管理者記入欄）",null,null," ※　   　　　　　部分は現地検査員が記入　"]
["施工状況報告欄（施工管理者記入欄）",{"$nulls":4},"現地検査員確認欄"]
["改修項目",null,"改修内容","実物検査"," 施工関連図書","適"]
[{"$nulls":5},"１次","2次"]
["バリアフリー工事","□　",null," □ 実物目視"," □ 写真","　","　"]
[null,"□　",null," □ 実物計測"," □ 出荷証明書等"]
[{"$nulls":4}," □ カタログ、証明書他"]
[{"$nulls":4}," □ 施工図"]
[]
[]
[null,"□　",null," □ 実物目視"," □ 写真","　","　"]
[null,"□　",null," □ 実物計測"," □ 出荷証明書等"]
[{"$nulls":4}," □ カタログ、証明書他"]
[{"$nulls":4}," □ 施工図"]
[]
[]
[null,"□",null," □ 実物目視"," □ 写真","　","　"]
[null,"□",null," □ 実物計測"," □ 出荷証明書等"]
[{"$nulls":4}," □ カタログ、証明書他"]
[{"$nulls":4}," □ 施工図"]
[]
[]
[null,"□　",null," □ 実物目視"," □ 写真","　","　"]
[null,"□",null," □ 実物計測"," □ 出荷証明書等"]
[{"$nulls":4}," □ カタログ、証明書他"]
[{"$nulls":4}," □ 施工図"]
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[null,"□　",null," □ 実物目視"," □ 写真","　","　"]
[null,"□　",null," □ 実物計測"," □ 出荷証明書等"]
[{"$nulls":4}," □ カタログ、証明書他"]
[{"$nulls":4}," □ 施工図"]
[]
[]
[null,"□",null," □ 実物目視"," □ 写真","　","　"]
[null,"□",null," □ 実物計測"," □ 出荷証明書等"]
[{"$nulls":4}," □ カタログ、証明書他"]
[{"$nulls":4}," □ 施工図"]
[]
[]
[null,"□",null," □ 実物目視"," □ 写真","　","　"]
[null,"□",null," □ 実物計測"," □ 出荷証明書等"]
[{"$nulls":4}," □ カタログ、証明書他"]
[{"$nulls":4}," □ 施工図"]
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[null,"□　",null," □ 実物目視"," □ 写真","　","　"]
[null,"□　",null," □ 実物計測"," □ 出荷証明書等"]
[{"$nulls":4}," □ カタログ、証明書他"]
[{"$nulls":4}," □ 施工図"]