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[null,"株式会社ＬＩＸＩＬ 行き",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"依頼日：　            年        月        日"]
[]
[]
[]
[null,"こどもみらい住宅支援事業 窓性能証明書発行依頼書【取替PG】"]
[]
[]
[]
[null,"証明書発行区分\n※いずれかにレ点を記入してください",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,"省エネ",null,null,null,null,null,null,null,null,"省エネ＋防犯"]
[]
[]
[null,"下記物件の窓リフォーム改修の『性能証明書』の発行依頼をお願いします。"]
[]
[null,"依  頼  区  分",null,null,null,null,null,null,null,"取替PG障子           "]
[null,"依 頼 会 社 名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"依  頼  者  名"]
[null,"組 立 事 業 者 名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"担  当  者  名"]
[null,"元 請 業 者 名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"担  当  者  名"]
[null,"施 工 現 場 名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"地  域  区  分",null,null,null,null,null,null,null,4,null,null,null,null,null,null,"5～7"]
[]
[null,"施 工 現 場 住 所"]
[null,null,null,null,null,null,null,null,null,"※本書類に記載された個人情報は性能証明書発行および送付する場合のときのために使用します。"]
[]
[null," 性能証明書 作成情報",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ガラス情報"]
[]
[null,"符号",null,"納品日",null,null,null,"製品名",null,null,null,null,null,"開閉形式",null,null,null,null,"サイズ（ＷＨ）",null,null,null,null,null,null,"ガラスの仕様",null,null,null,null,null,null,null,null,null,null,null,null,"中空層の仕様\n※最低中空層厚と\n   ガスの有無",null,null,null,null,null,null,null,"防犯建物部品\n（ＣＰ）適合",null,null,null,null,null,null,"ガラスメーカー",null,null,null,null,null,null,"備考欄"]
[]
[null,1,null,"     月      日",null,null,null,"取替PG障子\nアルミ",null,null,null,null,null,"引違い",null,null,null,null,"W＝",null,null,null,null,null,null,"LowE複層        複層"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"H＝"]
[null,2,null,"     月      日",null,null,null,"取替PG障子\nアルミ",null,null,null,null,null,"引違い",null,null,null,null,"W＝",null,null,null,null,null,null,"LowE複層        複層"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"H＝"]
[null,3,null,"     月      日",null,null,null,"取替PG障子\nアルミ",null,null,null,null,null,"引違い",null,null,null,null,"W＝",null,null,null,null,null,null,"LowE複層        複層"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"H＝"]
[null,4,null,"     月      日",null,null,null,"取替PG障子\nアルミ",null,null,null,null,null,"引違い",null,null,null,null,"W＝",null,null,null,null,null,null,"LowE複層        複層"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"H＝"]
[null,5,null,"     月      日",null,null,null,"取替PG障子\nアルミ",null,null,null,null,null,"引違い",null,null,null,null,"W＝",null,null,null,null,null,null,"LowE複層        複層"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"H＝"]
[null,6,null,"     月      日",null,null,null,"取替PG障子\nアルミ",null,null,null,null,null,"引違い",null,null,null,null,"W＝",null,null,null,null,null,null,"LowE複層        複層"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"H＝"]
[null,7,null,"     月      日",null,null,null,"取替PG障子\nアルミ",null,null,null,null,null,"引違い",null,null,null,null,"W＝",null,null,null,null,null,null,"LowE複層        複層"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"H＝"]
[]
[null,"◆窓性能証明書発行依頼に必要な添付書類"]
[null,null,null,"□ ㈱ＬＩＸＩＬが発行した出荷案内書もしくは納品書（コピー可）"]
[null,null,null,"□ ガラスメーカーが発行した納品書（コピー可）"]