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[]
["建設住宅性能評価　質疑等連絡先シート"]
[]
[]
["○建築物の概要"]
[null,"  建 築 物 の 名 称"]
[null," 建　築　主　名"]
[null,"建築物の所在地"]
[]
["●審査手数料等の送付先等"]
[null,"会社名",null,null,null,null,null,null,null,null,null,null,null,null,null,"フリガナ"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　名"]
[null,"所　属",null,null,null,null,null,null,null,null,null,null,null,null,null,"TEL"]
[null,"住　所",null,null,"〒",null,null,null,null,null,null,null,null,null,null,"FAX"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"E-mail"]
[null,"請求書名宛先"]
[]
[]
[]
["●現場対応者（日程等連絡対応者）"]
[null,"会社名",null,null,null,null,null,null,null,null,null,null,null,null,null,"フリガナ"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　名"]
[null,"所　属",null,null,null,null,null,null,null,null,null,null,null,null,null,"TEL"]
[null,"住　所",null,null,"〒",null,null,null,null,null,null,null,null,null,null,"FAX"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"E-mail"]
[]
["●評価書・副本等の返送先"]
[]
[null,"会社名",null,null,null,null,null,null,null,null,null,null,null,null,null,"フリガナ"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　名"]
[null,"所　属",null,null,null,null,null,null,null,null,null,null,null,null,null,"TEL"]
[null,"住　所",null,null,"〒",null,null,null,null,null,null,null,null,null,null,"FAX"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"E-mail"]

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[]
["第七号様式（第五条関係）"]
[]
["建設住宅性能評価申請書（新築住宅）"]
[]
["（第一面）"]
["一般財団法人ベターリビング",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,null,"年",null,null,"月",null,null,"日"]
[null,null,"理事長　眞鍋　純　様"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"申請者の氏名又は名称"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"代表者の氏名　　　　　　　　　　　　　"]
[]
[]
[]
[]
["　住宅の品質確保の促進等に関する法律第５条第１項の規定に基づき、建設住宅性能評価を申請します。\nこの申請書及び添付図書に記載の事項は、事実に相違ありません。"]
[]
[]
[]
[]
[]
[null,null,"工事施工者の氏名又は名称"]
[]
[null,null,null,null,"代表者の氏名"]
[]
[null,null,null,"工事監理者の氏名"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,"※受付欄",null,null,null,null,null,null,null,null,null,null,null,null,"※料金欄"]
[null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,"第",null,null,null,null,null,null,null,null,"号"]
[null,"申請受理者印"]

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["（第二面）"]
["申請者等の概要"]
["【１．申請者】"]
["　【氏名又は名称のフリガナ】",{"$f":"PHONETIC(B5)","v":""}]
["　【氏名又は名称】"]
["　【郵便番号】",null,null,null,"―"]
["　【住所】"]
["　【電話番号】",null,null,null,null,null,null,null,null,null,null,null,"―"]
["【２．代理者】"]
["　【氏名又は名称のフリガナ】",{"$f":"PHONETIC(B11)","v":""}]
["　【氏名又は名称】"]
["　【郵便番号】",null,null,null,"―"]
["　【住所】"]
["　【電話番号】",null,null,null,null,"―",null,null,null,null,null,null,"―"]
["【３．建築主】"]
["　【氏名又は名称のフリガナ】",{"$f":"PHONETIC(B17)","v":""}]
["　【氏名又は名称】"]
["【郵便番号】",null,null,null,"―"]
["　【住所】"]
["　【電話番号】",null,null,null,null,"―",null,null,null,null,null,null,"―"]
["【４．設計者】"]
["　【資格】　　　　","（",null,null,"）建築士",null,null,null,null,null,"（",null,null,null,null,"）登録",null,null,null,null,null,null,"号"]
["　【氏名】"]
["　【建築士事務所名】　","（",null,null,"）建築士事務所（",null,null,null,null,null,null,null,null,"）知事登録第",null,null,null,null,null,null,null,null,"号"]
[]
["　【郵便番号】",null,null,null,"―"]
["　【所在地】"]
["　【電話番号】",null,null,null,null,"―",null,null,null,null,null,null,"―"]
["【５．工事監理者】"]
["　【資格】　　　　","（",null,null,"）建築士",null,null,null,null,null,"（",null,null,null,null,"）登録",null,null,null,null,null,null,"号"]
["　【氏名】",null,{"$f":"建設評価申請一面!M27","v":0}]
["　【建築士事務所名】　","（",null,null,"）建築士事務所（",null,null,null,null,null,null,null,null,"）知事登録第",null,null,null,null,null,null,null,null,"号"]
[]
["　【郵便番号】",null,null,null,"―"]
["　【所在地】"]
["　【電話番号】",null,null,null,null,"―",null,null,null,null,null,null,"―"]
["【６．工事施工者】"]
["　【氏名又は名称】　　　　"]
["　【営業所名】","営業の許可（",null,null,null,null,null,null,null,null,null,"　）　　","第","（",null,null,null,"）","第",null,null,null,"号"]
["　【郵便番号】",null,null,null,"―"]
["　【所在地】"]
["　【電話番号】",null,null,null,null,"―",null,null,null,null,null,null,"―"]
["【７．建設住宅性能評価を希望する性能表示事項】"]
[]
[null,null,"別紙による"]
[]
["【８．備考】"]

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[]
["第二面（別紙）"]
[]
[null,"【建設住宅性能評価を希望する性能表示事項】"]
[null,"１．構造の安定に関すること"]
[null,null,"□","1-2　耐震等級（構造躯体の損傷防止）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false]
[null,null,"□","1-4　耐風等級（構造躯体の倒壊等防止及び損傷防止）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,true]
[null,null,"□","1-5　耐積雪等級（構造躯体の倒壊等防止及び損傷防止）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,true]
[null,"２．火災時の安全に関すること"]
[null,null,"□","2-1　感知警報装置設置等級（自住戸火災時）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,true]
[null,null,"□","2-2　感知警報装置設置等級（他住戸火災時）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,true]
[null,null,"□","2-3　避難安全対策（他住戸等火災時・共用廊下）"]
[null,null,"□","2-4　感知警報装置設置等級（他住戸火災時）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,true]
[null,null,"□","2-5　耐火等級（延焼の恐れのある部分（開口部以外））",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,true]
[null,null,"□","2-6　耐火等級（延焼の恐れのある部分（開口部））"]
[null,null,"□","2-7　耐火等級（界壁及び界床）"]
[null,"4．維持管理・更新への配慮に関すること"]
[null,null,"□","4-4　更新対策（住戸専用部）"]
[null,"５．温熱環境・エネルギー消費量に関すること"]
[null,null,"「５－１」「５－２」のいずれか１つ、もしくは両方の選択が必要となります。"]
[null,null,"■","5-1　断熱等性能等級",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,true]
[null,null,"□","5-2　一次エネルギー消費量等級",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false]
[null,"６．空気環境に関すること"]
[null,null,"□","6-1　ホルムアルデヒド対策（内装及び天井裏等）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,true]
[null,null,"□","6-2　換気対策",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,true]
[null,"７．光・視環境に関すること"]
[null,null,"□","7-1　単純開口率",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false]
[null,null,"□","7-2　方位別開口比",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,true]
[null,"８．音環境に関すること"]
[null,null,"□","8-1　重量床衝撃音対策"]
[null,null,"□","8-2　軽量床衝撃音対策"]
[null,null,"□","8-3　透過損失等級（界壁）"]
[null,null,"□","8-4　透過損失等級（開口部）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,true]
[null,"９．高齢者への配慮に関すること"]
[null,null,"□","9-1　高齢者等配慮対策等級（専用部分）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,true]
[null,null,"□","9-2　高齢者等配慮対策等級（共用部分）"]
[null,"１０．防犯に関すること"]
[null,null,"□","10-1　開口部の侵入防止対策",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,true]
[null,"（注意）"]
[null,null,"※","必須事項以外に評価を希望する性能表示事項にチェックを入れてください。"]
[null,null,"※","「5.温熱環境・エネルギー消費量に関すること」は必須事項です。「5-1　断熱等性能等級」"]
[null,null,null,"「5-2　一次エネルギー消費量等級」のいずれか１つ、もしくは両方の選択が必要となります。"]
[]
[null,"【地盤の液状化に関する情報提供】"]
[null,null,"下記のいずれか１つを選択してください。"]
[null,null,"□","地盤の液状化に関する情報提供を行う（情報提供の内容は申出書による）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false]
[null,null,"■","地盤の液状化に関する情報提供を行わない",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,true]

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["（第三面）"]
["申請する工事の概要"]
["【１．建築場所】　"]
[]
["【２．設計住宅性能評価書の交付番号】　",null,null,null,"第",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"号"]
["【３．設計住宅性能評価書交付年月日】　",null,null,null,null,"令和",null,null,"年",null,null,"月",null,null,"日"]
["【４．設計住宅性能評価書交付者】　"]
["【５．確認済証番号】　"]
["【６．確認済証交付年月日】　",null,null,null,null,"令和",null,null,"年",null,null,"月",null,null,"日"]
["【７．確認済証交付者】　"]
["【８．工事着手（予定）年月日】　",null,null,null,null,"令和",null,null,"年",null,null,"月",null,null,"日"]
["【９．工事完了予定年月日】　",null,null,null,null,"令和",null,null,"年",null,null,"月",null,null,"日"]
["【１０．検査対象工程工事終了予定年月日】　",null,null,null,null,null,null,null,null,null,null,null,null,"検査時期"]
["　　　（第１回）",null,"令和",null,null,"年",null,null,"月",null,null,"日","　（",null,null,null,null,null,null,null,null,null,"）"]
["　　　（第２回）",null,"令和",null,null,"年",null,null,"月",null,null,"日","　（",null,null,null,null,null,null,null,null,null,"）"]
["　　　（第３回）",null,"令和",null,null,"年",null,null,"月",null,null,"日","　（",null,null,null,null,null,null,null,null,null,"）"]
["　　　（第４回）",null,"令和",null,null,"年",null,null,"月",null,null,"日","　（",null,null,null,null,null,null,null,null,null,"）"]
["　　　（第5回）",null,"令和",null,null,"年",null,null,"月",null,null,"日","　（",null,null,null,null,null,null,null,null,null,"）"]
["　　　（第6回）",null,"令和",null,null,"年",null,null,"月",null,null,"日","　（",null,null,null,null,null,null,null,null,null,"）"]
[]
["【１１．その他必要な事項】"]
["【１２．備考】"]

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["（第二面）-2"]
["申請者等の概要"]
["【１．申請者-2】"]
["　【氏名又は名称のフリガナ】",{"$f":"PHONETIC(B5)","v":""}]
["　【氏名又は名称】"]
["　【郵便番号】",null,null,null,"―"]
["　【住所】"]
["　【電話番号】",null,null,null,null,"―",null,null,null,null,null,null,"―"]
["【３．建築主-2】"]
["　【氏名又は名称のフリガナ】",{"$f":"PHONETIC(B11)","v":""}]
["　【氏名又は名称】"]
["　【郵便番号】",null,null,null,"―"]
["　【住所】"]
["　【電話番号】",null,null,null,null,"―",null,null,null,null,null,null,"―"]
["【１．申請者-3】"]
["　【氏名又は名称のフリガナ】",{"$f":"PHONETIC(B17)","v":""}]
["　【氏名又は名称】"]
["　【郵便番号】",null,null,null,"―"]
["　【住所】"]
["　【電話番号】",null,null,null,null,"―",null,null,null,null,null,null,"―"]
["【３．建築主-3】"]
["　【氏名又は名称のフリガナ】",{"$f":"PHONETIC(B23)","v":""}]
["　【氏名又は名称】"]
["　【郵便番号】",null,null,null,"―"]
["　【住所】"]
["　【電話番号】",null,null,null,null,"―",null,null,null,null,null,null,"―"]
["【１．申請者-4】"]
["　【氏名又は名称のフリガナ】",{"$f":"PHONETIC(B29)","v":""}]
["　【氏名又は名称】"]
["　【郵便番号】",null,null,null,"―"]
["　【住所】"]
["　【電話番号】",null,null,null,null,"―",null,null,null,null,null,null,"―"]
["【３．建築主-4】"]
["　【氏名又は名称のフリガナ】",{"$f":"PHONETIC(B35)","v":""}]
["　【氏名又は名称】"]
["　【郵便番号】",null,null,null,"―"]
["　【住所】"]
["　【電話番号】",null,null,null,null,"―",null,null,null,null,null,null,"―"]

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[]
[]
["委　　　　任　　　　状"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,null,null,null,"年",null,null,null,"月",null,null,null,"日"]
[]
[]
[null,"一般財団法人ベターリビング"]
[null,null,null,null,"理事長　眞鍋　純　様"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"申請者の氏名または名称"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"代表者の氏名"]
[]
[]
[]
[]
[null,"　私は次の代理者を代理人と定め、下記建築物に係る「住宅の品質確保の促進等に関する法律」に基づく手続きに関する一切の権限を委任します。"]
[]
[]
[]
[null,null,"代理人："]
[]
[]
["記"]
[]
[null,null,"１．住宅の名称"]
[]
[]
[]
[null,null,"２.住宅の所在地"]
[]
[]
[]
[null,null,"３.委任の区分"]