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["第七号様式（第五条関係）"]
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[]
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["建 設 住 宅 性 能 評 価 申 請 書（新 築 住 宅）"]
[]
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[]
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["日本ＥＲＩ株式会社　殿"]
[]
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[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,"申請者の氏名又は名称"]
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[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,"代表者の氏名"]
[]
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["　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,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,"工事施工者の氏名又は名称"]
[]
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[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,"代表者の氏名"]
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[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,"工事監理者の氏名"]
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["※受付欄",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,"※料金欄"]
[]
[]
[]
["第　　　　　　　　　　　　号"]
[]
["申請受理者氏名"]

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[null,null,null,"申請者等の概要"]
[null,null,"【1.申請者】"]
[null,null,null,"　【氏名又は名称のフリガナ】"]
[]
[null,null,null,"　【氏名又は名称】"]
[]
[null,null,null,"　【郵便番号】"]
[null,null,null,"　【住　　所】",null,null,null,null,null,null,null,null,"（都道府県）",null,null,null,null,null,null,null,null,null,null,null,null,null,"（市 区 郡）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"（区 町 村）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"（番 　 地）"]
[null,null,null,"　【電話番号】"]
[null,null,"【2.代理者】"]
[null,null,null,"　【氏名又は名称のフリガナ】"]
[]
[null,null,null,"　【氏名又は名称】"]
[]
[null,null,null,"　【郵便番号】"]
[null,null,null,"　【住　　所】",null,null,null,null,null,null,null,null,"（都道府県）",null,null,null,null,null,null,null,null,null,null,null,null,null,"（市 区 郡）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"（区 町 村）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"（番 　 地）"]
[null,null,null,"　【電話番号】"]
[null,null,"【3.建築主】"]
[null,null,null,"　【氏名又は名称のフリガナ】"]
[]
[null,null,null,"　【氏名又は名称】"]
[]
[null,null,null,"　【郵便番号】"]
[null,null,null,"　【住　　所】",null,null,null,null,null,null,null,null,"（都道府県）",null,null,null,null,null,null,null,null,null,null,null,null,null,"（市 区 郡）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"（区 町 村）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"（番 　 地）"]
[null,null,null,"　【電話番号】"]
[null,null,"【4.設計者】"]
[null,null,null,"　【資　　格】",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,"） 登録第",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"号"]
[null,null,null,"　【氏　　名】"]
[null,null,null,"　【建築士事務所名】"]
[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,null,null,"）知事登録第",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"号"]
[null,null,null,"　【郵便番号】"]
[null,null,null,"　【所 在 地】",null,null,null,null,null,null,null,null,"（都道府県）",null,null,null,null,null,null,null,null,null,null,null,null,null,"（市 区 郡）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"（区 町 村）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"（番 　 地）"]
[null,null,null,"　【電話番号】"]
[null,null,"【5.工事監理者】"]
[null,null,null,"　【資　　格】",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,"）　登録第",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"号"]
[null,null,null,"　【氏　　名】"]
[null,null,null,"　【建築士事務所名】"]
[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,null,null,"）知事登録第",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"号"]
[null,null,null,"　【郵便番号】"]
[null,null,null,"　【所 在 地】",null,null,null,null,null,null,null,null,"（都道府県）",null,null,null,null,null,null,null,null,null,null,null,null,null,"（市 区 郡）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"（区 町 村）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"（番 　 地）"]
[null,null,null,"　【電話番号】"]
[null,null,"【6.工事施工者】"]
[null,null,null,"　【氏名又は名称】"]
[]
[null,null,null,"　【営業所名】",null,null,null,null,null,null,null,null,null,"建設業の許可（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）第",null,null,null,null,null,null,null,null,null,null,"号"]
[null,null,null,"　【郵便番号】"]
[null,null,null,"　【所 在 地】",null,null,null,null,null,null,null,null,"（都道府県）",null,null,null,null,null,null,null,null,null,null,null,null,null,"（市 区 郡）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"（区 町 村）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"（番 　 地）"]
[null,null,null,"　【電話番号】"]
[null,null,"【7.建設住宅性能評価を希望する性能表示事項】"]
[]
[null,null,null,null,null,"別紙７による"]
[]
[]
[]
[null,null,"【8.備　考】"]
[]
[null,null,"（建築物名称：",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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]

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[null,null,null,"申請する工事の概要"]
[null,null,"【1.建築場所】"]
[null,null,null,null,null,"地名地番：",null,null,null,null,null,null,"（都道府県）",null,null,null,null,null,null,null,null,null,null,null,null,null,"（市 区 郡）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"（区 町 村）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"（番 　 地）"]
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[null,null,null,null,"（住居表示）",null,null,null,null,null,null,null,"（都道府県）",null,null,null,null,null,null,null,null,null,null,null,null,null,"（市 区 郡）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"（区 町 村）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"（番 　 地）"]
[]
[null,null,"【2.設計住宅性能評価書の交付番号】",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"第",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"～",null,null,null,null,null,null,null,null,"号"]
[]
[null,null,"【3.設計住宅性能評価書交付年月日】",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,"年",null,null,null,"月",null,null,null,"日"]
[]
[null,null,"【4.設計住宅性能評価書交付者】"]
[]
[]
[null,null,"【5.確認済証番号】",null,null,null,null,null,null,null,null,null,null,null,"第",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"号"]
[]
[null,null,"【6.確認済証交付年月日】",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日"]
[]
[null,null,"【7.確認済証交付者】"]
[]
[]
[null,null,"【8.工事着手（予定）年月日】",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日"]
[]
[null,null,"【9.工事完了予定年月日】",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日"]
[]
[null,null,"【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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"検査時期"]
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[null,null,null,null,null,"第",null,3,null,"回",null,null,null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日",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,"第",null,4,null,"回",null,null,null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日",null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
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[null,null,null,null,null,"第",null,6,null,"回",null,null,null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日",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,"第",null,7,null,"回",null,null,null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日",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,"第",null,8,null,"回",null,null,null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日",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,"第",null,9,null,"回",null,null,null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日",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,"第",null,10,null,"回",null,null,null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日",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,"第",null,11,null,"回",null,null,null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日",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,"第",null,12,null,"回",null,null,null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日",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,"第",null,13,null,"回",null,null,null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日",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,"第",null,14,null,"回",null,null,null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日",null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[]
[null,null,"【11.その他必要な事項】"]
[]
[]
[]
[]
[null,null,"【12.備　考】"]

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[]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"委任状"]
[]
[]
[]
[]
[]
[]
[null,null,null,"　私は下記の者を代理人と定め、日本ＥＲＩ株式会社に対する申請に関する手続き"]
[]
[null,null,null,"及び交付される文書の受領の権限を委任します。"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"記"]
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[]
[]
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[null,null,null,"（該当項目をチェック）",null,null,null,null,null,null,null,null,null,null,null,"■",null,"建設住宅性能評価",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□",null,"変更建設住宅性能評価"]
[null,null,null,"建築物名称"]
[]
[null,null,null,"地名地番"]
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[null,null,null,"委任先",null,null,null,null,null,null,null,null,null,"（氏名）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"（会社名）"]
[]
[]
[]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"住　所"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　名"]

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[null,null,null,null,null,null,null,null,"　【電話番号】"]
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[null,null,null,null,null,null,null,null,"　【氏名又は名称のフリガナ】"]
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[null,null,null,null,null,null,null,null,"　【氏名又は名称】"]
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[null,null,null,null,null,null,null,null,"　【郵便番号】"]
[null,null,null,null,null,null,null,null,"　【住　　所】"]
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[null,null,null,null,null,null,null,null,"　【電話番号】"]
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[null,null,null,null,null,null,null,null,"　【氏名又は名称のフリガナ】"]
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[null,null,null,null,null,null,null,null,"　【氏名又は名称】"]
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[null,null,null,null,null,null,null,null,"　【郵便番号】"]
[null,null,null,null,null,null,null,null,"　【住　　所】"]
[]
[null,null,null,null,null,null,null,null,"　【電話番号】"]
[null,null,null,null,null,null,null,"【その他必要な情報】"]

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[null,null,null,null,null,null,null,null,"　【氏名又は名称のフリガナ】"]
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[null,null,null,null,null,null,null,null,"　【氏名又は名称】"]
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[null,null,null,null,null,null,null,null,"　【郵便番号】"]
[null,null,null,null,null,null,null,null,"　【住　　所】"]
[]
[null,null,null,null,null,null,null,null,"　【電話番号】"]
[]
[null,null,null,null,null,null,null,null,"　【氏名又は名称のフリガナ】"]
[]
[null,null,null,null,null,null,null,null,"　【氏名又は名称】"]
[]
[null,null,null,null,null,null,null,null,"　【郵便番号】"]
[null,null,null,null,null,null,null,null,"　【住　　所】"]
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[null,null,null,null,null,null,null,null,"　【電話番号】"]
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[null,null,null,null,null,null,null,null,"　【氏名又は名称のフリガナ】"]
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[null,null,null,null,null,null,null,null,"　【氏名又は名称】"]
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[null,null,null,null,null,null,null,null,"　【郵便番号】"]
[null,null,null,null,null,null,null,null,"　【住　　所】"]
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[null,null,null,null,null,null,null,null,"　【電話番号】"]
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[null,null,null,null,null,null,null,null,"　【氏名又は名称のフリガナ】"]
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[null,null,null,null,null,null,null,null,"　【氏名又は名称】"]
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[null,null,null,null,null,null,null,null,"　【郵便番号】"]
[null,null,null,null,null,null,null,null,"　【住　　所】"]
[]
[null,null,null,null,null,null,null,null,"　【電話番号】"]
[]
[null,null,null,null,null,null,null,null,"　【氏名又は名称のフリガナ】"]
[]
[null,null,null,null,null,null,null,null,"　【氏名又は名称】"]
[]
[null,null,null,null,null,null,null,null,"　【郵便番号】"]
[null,null,null,null,null,null,null,null,"　【住　　所】"]
[]
[null,null,null,null,null,null,null,null,"　【電話番号】"]
[null,null,null,null,null,null,null,"【その他必要な情報】"]

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[null,null,null,null,null,null,null,null,"複数申請者等の概要"]
[null,null,null,null,null,null,null,"【設計者】（代表者となる設計者以外の設計者）"]
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[null,null,null,null,null,null,null,null,"　【建築士事務所名】"]
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[null,null,null,null,null,null,null,null,"　【郵便番号】"]
[null,null,null,null,null,null,null,null,"　【所 在 地】"]
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[null,null,null,null,null,null,null,null,"　【電話番号】"]
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[null,null,null,null,null,null,null,null,"　【氏　　名】"]
[null,null,null,null,null,null,null,null,"　【建築士事務所名】"]
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[null,null,null,null,null,null,null,null,"　【郵便番号】"]
[null,null,null,null,null,null,null,null,"　【所 在 地】"]
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[16,null,"□","□","□","□","□","□","□","□","□","□","□","□","□","□","□","□","□","□"]
[17,null,"□","□","□","□","□","□","□","□","□","□","□","□","□","□","□","□","□","□"]
[18,null,"□","□","□","□","□","□","□","□","□","□","□","□","□","□","□","□","□","□"]
[19,null,"□","□","□","□","□","□","□","□","□","□","□","□","□","□","□","□","□","□"]
[20,null,"□","□","□","□","□","□","□","□","□","□","□","□","□","□","□","□","□","□"]
[21,null,"□","□","□","□","□","□","□","□","□","□","□","□","□","□","□","□","□","□"]
["【地盤の液状化に関する情報提供】","1401","□","□","□","□","□","□","■","□","□","□","□","□","□","□","□","□","□","□"]
[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（別添）による）"]
[null,null,"□","地盤の液状化に関する情報提供を行わない"]
["（注意）"]
["① 数字は算用数字を、単位はメートル法を用いてください。"]
["② 1欄は通し番号を記入して下さい。"]
["③ 記入は1行につき1住戸としてください。"]
["④ ３欄は該当するチェックボックスを塗りつぶしてください。"]

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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"第二面（別紙７の２）"]
["【6-3　室内空気中の化学物質の濃度等を選択する住戸】"]
["1.No","2.住戸番号","５．測定する特定測定物質"]
[null,null,"【必須】",null,null,"ホルムアルデヒド"]
[null,null,"【選択】"]
[null,"3.住戸番号","トルエン",null,null,null,null,"キシレン",null,null,null,null,"エチルベンゼン",null,null,null,null,"スチレン"]
[1,null,"□",null,null,null,null,"□",null,null,null,null,"□",null,null,null,null,"□"]
[2,null,"□",null,null,null,null,"□",null,null,null,null,"□",null,null,null,null,"□"]
[3,null,"□",null,null,null,null,"□",null,null,null,null,"□",null,null,null,null,"□"]
[4,null,"□",null,null,null,null,"□",null,null,null,null,"□",null,null,null,null,"□"]
[5,null,"□",null,null,null,null,"□",null,null,null,null,"□",null,null,null,null,"□"]
[6,null,"□",null,null,null,null,"□",null,null,null,null,"□",null,null,null,null,"□"]
[7,null,"□",null,null,null,null,"□",null,null,null,null,"□",null,null,null,null,"□"]
[8,null,"□",null,null,null,null,"□",null,null,null,null,"□",null,null,null,null,"□"]
[9,null,"□",null,null,null,null,"□",null,null,null,null,"□",null,null,null,null,"□"]
[10,null,"□",null,null,null,null,"□",null,null,null,null,"□",null,null,null,null,"□"]
[11,null,"□",null,null,null,null,"□",null,null,null,null,"□",null,null,null,null,"□"]
[12,null,"□",null,null,null,null,"□",null,null,null,null,"□",null,null,null,null,"□"]
[13,null,"□",null,null,null,null,"□",null,null,null,null,"□",null,null,null,null,"□"]
[14,null,"□",null,null,null,null,"□",null,null,null,null,"□",null,null,null,null,"□"]
[15,null,"□",null,null,null,null,"□",null,null,null,null,"□",null,null,null,null,"□"]
[16,null,"□",null,null,null,null,"□",null,null,null,null,"□",null,null,null,null,"□"]
[17,null,"□",null,null,null,null,"□",null,null,null,null,"□",null,null,null,null,"□"]
[18,null,"□",null,null,null,null,"□",null,null,null,null,"□",null,null,null,null,"□"]
[19,null,"□",null,null,null,null,"□",null,null,null,null,"□",null,null,null,null,"□"]
[20,null,"□",null,null,null,null,"□",null,null,null,null,"□",null,null,null,null,"□"]
[21,null,"□",null,null,null,null,"□",null,null,null,null,"□",null,null,null,null,"□"]

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["地盤の液状化に関する情報提供　申出書（別添）"]
[]
["住宅の品質確保の促進等に関する法律施行規則第一条第十一号に基づいて以下の情報を提供しますので評価書に記載してください。"]
["項目",null,null,null,null,null,null,"提供を行う液状化に係る参考情報の内容"]
[null,null,null,null,null,null,null,"情報の種別",null,null,null,null,"情報の有無",null,null,null,"表記内容等"]
["液状化に",null,null,null,"（イ）",null,null,"液状化マップ",null,null,null,null,"□","有",null,null,"【液状化に関する表記】"]
["関すること",null,null,null,"広域的",null,null,null,null,null,null,null,"□","無",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,null,null,null,"情報",null,null,null,null,null,null,null,"□","不明",null,null,"【備考・出典】"]
[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,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[]
[null,null,null,null,null,null,null,"液状化履歴",null,null,null,null,"□","有",null,null,"【住宅敷地周辺の液状化履歴】",null,null,null,null,null,null,null,null,"□","あり",null,"□","なし"]
[null,null,null,null,null,null,null,"に関する情報",null,null,null,null,"□","無",null,null,"【備考・出典】"]
[null,null,null,null,null,null,null,null,null,null,null,null,"□","不明",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,null,null,null,null,null,null,"地形分類",null,null,null,null,"□","有",null,null,"【該当する地形名称】"]
[null,null,null,null,null,null,null,null,null,null,null,null,"□","無",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,null,null,null,null,null,null,null,null,null,null,null,"□","不明",null,null,"【備考・出典】"]
[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,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[]
[null,null,null,null,null,null,null,"その他土地利用",null,null,null,null,"□","有",null,null,"【旧土地利用】"]
[null,null,null,null,null,null,null,"履歴に関する資料",null,null,null,null,"□","無",null,null,null,"種別：",null,"□","水田",null,"□","池沼・川",null,null,"□","海",null,"□","その他（",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,"□","不明",null,null,"【備考・出典】"]
[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,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[]
[null,null,null,null,"（ロ）",null,null,"敷地の地盤調査",null,null,null,null,"□","有",null,null,"【地盤調査】"]
[null,null,null,null,"個別の",null,null,"の記録",null,null,null,null,"□","無",null,null,null,"方法："]
[null,null,null,null,"住宅敷地",null,null,null,null,null,null,null,"□","不明",null,null,null,"仕様："]
[null,null,null,null,"の情報",null,null,null,null,null,null,null,null,null,null,null,"【試料採取】",null,null,null,"□","あり",null,"□","なし"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"【備考】"]
[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,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[]
[null,null,null,null,null,null,null,"地下水位",null,null,null,null,"□","有",null,null,"【地下水位】"]
[null,null,null,null,null,null,null,"の情報",null,null,null,null,"□","無",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,null,null,null,null,null,null,null,null,null,null,null,"□","不明",null,null,"【測定方法】"]
[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,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,"【備考】"]
[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,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[]
[null,null,null,null,null,null,null,"地盤調査から",null,null,null,null,"□","有",null,null,"【指標・備考】"]
[null,null,null,null,null,null,null,"得た液状化に",null,null,null,null,"□","無"]
[null,null,null,null,null,null,null,"関する指標"]
[]
[null,null,null,null,null,null,null,"宅地造成工事",null,null,null,null,"□","有",null,null,"【造成図面】",null,null,null,"□","あり",null,"□","なし"]
[null,null,null,null,null,null,null,"の記録",null,null,null,null,"□","無",null,null,"【備考】"]
[null,null,null,null,null,null,null,null,null,null,null,null,"□","不明",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,null,null,null,null,null,null,"液状化に関連",null,null,null,null,"□","有",null,null,"【工法分類】 （",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,null,null,null,null,"して行う地盤",null,null,null,null,"□","無",null,null,"【工法名称】 （",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,null,null,null,null,"に関する工事",null,null,null,null,"□","不明",null,null,"【施工時期】 （",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,null,null,null,null,"の記録・計画",null,null,null,null,null,null,null,null,"【工事内容】 （",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,null,null,null,null,null,null,null,null,null,null,null,null,null,"【工事報告書】",null,null,null,"□","あり",null,"□","なし"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"【備考】"]
[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,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[]
[null,null,null,null,null,null,null,"その他地盤に",null,null,null,null,"□","有",null,null,"【工法分類】 （",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,null,null,null,null,"関する工事の",null,null,null,null,"□","無",null,null,"【工法名称】 （",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,null,null,null,null,"記録・計画",null,null,null,null,"□","不明",null,null,"【施工時期】 （",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,null,null,null,null,null,null,null,null,null,null,null,null,null,"【工事内容】"]
[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,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,"【工事報告書】",null,null,null,"□","あり",null,"□","なし"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"【備考】"]
[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,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[]
[null,null,null,null,"（ハ）",null,null,"液状化に関連",null,null,null,null,"□","有",null,null,"【工法分類】 （",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,null,"液状化に",null,null,"して行う住宅",null,null,null,null,"□","無",null,null,"【工法名称】 （",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,null,"関する",null,null,"基礎等に関する",null,null,null,null,"□","未定",null,null,"【施工時期】 （",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,null,"当該住宅",null,null,"工事の記録・計画",null,null,null,null,null,null,null,null,"【工事内容】"]
[null,null,null,null,"基礎等に",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,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,"おける",null,null,null,null,null,null,null,null,null,null,null,"【備考】"]
[null,null,null,null,"工事の",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,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,"情報"]
["備考"]
[]
["※上記の記載事項以外で評価書に記載したい事項がありましたら別紙に記載して添付してください。"]