เทศบาลตำบลป่าซาง อ.แม่จัน จ.เชียงราย โทร. 053-602660-2 แฟกซ์. 053-602737

<table border="0" cellpadding="0" cellspacing="0" width="732" style="border-collapse:
    collapse;width:552pt">
    <colgroup><col width="45" style="mso-width-source:userset;mso-width-alt:1645;width:34pt" />  <col width="46" style="mso-width-source:userset;mso-width-alt:1682;width:35pt" />  <col width="257" style="mso-width-source:userset;mso-width-alt:9398;width:193pt" />  <col width="110" style="mso-width-source:userset;mso-width-alt:4022;width:83pt" />  <col width="82" style="mso-width-source:userset;mso-width-alt:2998;width:62pt" />  <col width="110" style="mso-width-source:userset;mso-width-alt:4022;width:83pt" />  <col width="82" style="mso-width-source:userset;mso-width-alt:2998;width:62pt" />  </colgroup>
    <tbody>
        <tr height="34" style="mso-height-source:userset;height:26.1pt">
            <td height="34" class="xl138" colspan="2" align="left" width="91" style="height:26.1pt;
            mso-ignore:colspan;width:69pt">สถานที่ก่อสร้าง </td>
            <td class="xl139" colspan="2" align="left" width="367" style="mso-ignore:colspan;
            width:276pt">บ้านปางปูเลย  หมู่ที่ 5   ตำบลป่าซาง อำเภอแม่จัน จังหวัดเชียงราย</td>
            <td class="xl140" width="82" style="width:62pt"> </td>
            <td class="xl137" width="110" style="width:83pt"> </td>
            <td class="xl141" width="82" style="width:62pt"> </td>
        </tr>
        <tr height="34" style="mso-height-source:userset;height:26.1pt">
            <td height="34" class="xl138" colspan="2" align="left" style="height:26.1pt;
            mso-ignore:colspan">แบบเลขที่</td>
            <td class="xl163">ตามแบบ ทต.ป่าซางกำหนด</td>
            <td class="xl140"> </td>
            <td class="xl140"> </td>
            <td class="xl137"> </td>
            <td class="xl141"> </td>
        </tr>
        <tr height="34" style="mso-height-source:userset;height:26.1pt">
            <td height="34" class="xl138" colspan="4" align="left" style="height:26.1pt;
            mso-ignore:colspan">หน่วยงาน             เทศบาลตำบลป่าซาง       อำเภอแม่จัน    จังหวัดเชียงราย</td>
            <td class="xl140"> </td>
            <td class="xl137"> </td>
            <td class="xl141"> </td>
        </tr>
        <tr height="34" style="mso-height-source:userset;height:26.1pt">
            <td height="34" class="xl138" colspan="2" align="left" style="height:26.1pt;
            mso-ignore:colspan">แบบ ปร.4 </td>
            <td class="xl138" align="left"> มีจำนวน          <font class="font6">  2  </font><font class="font5">           แผ่น</font></td>
            <td class="xl140"> </td>
            <td class="xl140"> </td>
            <td class="xl137"> </td>
            <td class="xl141"> </td>
        </tr>
        <tr height="34" style="mso-height-source:userset;height:26.1pt">
            <td height="34" class="xl142" colspan="2" align="left" style="height:26.1pt;
            mso-ignore:colspan">เมื่อวันที่</td>
            <td class="xl143">7 กันยายน 2558</td>
            <td class="xl144"> </td>
            <td class="xl144"> </td>
            <td class="xl144"> </td>
            <td class="xl144"> </td>
        </tr>
        <tr height="34" style="mso-height-source:userset;height:26.1pt">
            <td rowspan="2" height="68" class="xl193" style="border-bottom:2.0pt double black;
            height:52.2pt;border-top:none">ลำดับ</td>
            <td colspan="2" rowspan="2" class="xl195" style="border-right:2.0pt double black;
            border-bottom:2.0pt double black">รายการ</td>
            <td rowspan="2" class="xl199" width="110" style="border-bottom:2.0pt double black;
            border-top:none;width:83pt">ค่างานต้นทุน</td>
            <td rowspan="2" class="xl193" style="border-bottom:2.0pt double black;border-top:
            none">Factor F</td>
            <td rowspan="2" class="xl199" width="110" style="border-bottom:2.0pt double black;
            border-top:none;width:83pt">ค่าก่อสร้าง</td>
            <td rowspan="2" class="xl193" style="border-bottom:2.0pt double black;border-top:
            none">หมายเหตุ</td>
        </tr>
        <tr height="34" style="mso-height-source:userset;height:26.1pt">
        </tr>
        <tr height="34" style="mso-height-source:userset;height:26.1pt">
            <td height="34" class="xl145" style="height:26.1pt;border-top:none">1</td>
            <td colspan="2" class="xl175" style="border-right:2.0pt double black;border-left:
            none">ถังพักน้ำคอนกรีตเสริมเหล็ก ชุมชนโค้งงาม หมู่ 5</td>
            <td class="xl146" align="right" style="border-top:none;border-left:none">141,322.18</td>
            <td class="xl145" style="border-top:none;border-left:none">1.2726</td>
            <td class="xl164" align="left" style="border-top:none;border-left:none">         179,846.61</td>
            <td class="xl165" style="border-top:none"> </td>
        </tr>
        <tr height="34" style="mso-height-source:userset;height:26.1pt">
            <td height="34" class="xl168" style="height:26.1pt"> </td>
            <td colspan="2" class="xl177" style="border-right:2.0pt double black;border-left:
            none">ขนาด กว้าง 3 เมตร ยาว 7 เมตร สูง    2.50 เมตร</td>
            <td class="xl169" style="border-left:none"> </td>
            <td class="xl168" style="border-left:none"> </td>
            <td class="xl170" style="border-left:none"> </td>
            <td class="xl171"> </td>
        </tr>
        <tr height="34" style="mso-height-source:userset;height:26.1pt">
            <td height="34" class="xl148" style="height:26.1pt;border-top:none"> </td>
            <td colspan="2" class="xl177" style="border-right:2.0pt double black;border-left:
            none">ตามแบบเทศบาลตำบลป่าซางกำหนด</td>
            <td class="xl149" style="border-top:none;border-left:none"> </td>
            <td class="xl148" style="border-top:none;border-left:none"> </td>
            <td class="xl147" style="border-top:none;border-left:none"> </td>
            <td class="xl166" style="border-top:none"> </td>
        </tr>
        <tr height="34" style="mso-height-source:userset;height:26.1pt">
            <td height="34" class="xl148" style="height:26.1pt;border-top:none"> </td>
            <td colspan="2" class="xl177" style="border-right:2.0pt double black;border-left:
            none">พร้อมป้ายประชาสัมพันธ์โครงการ</td>
            <td class="xl149" style="border-top:none;border-left:none"> </td>
            <td class="xl148" style="border-top:none;border-left:none"> </td>
            <td class="xl147" style="border-top:none;border-left:none"> </td>
            <td class="xl166" style="border-top:none"> </td>
        </tr>
        <tr height="34" style="mso-height-source:userset;height:26.1pt">
            <td height="34" class="xl148" style="height:26.1pt;border-top:none"> </td>
            <td colspan="2" class="xl179" style="border-right:2.0pt double black;border-left:
            none"> </td>
            <td class="xl149" style="border-top:none;border-left:none"> </td>
            <td class="xl148" style="border-top:none;border-left:none"> </td>
            <td class="xl147" style="border-top:none;border-left:none"> </td>
            <td class="xl167" style="border-top:none"> </td>
        </tr>
        <tr height="34" style="mso-height-source:userset;height:26.1pt">
            <td height="34" class="xl148" style="height:26.1pt;border-top:none"> </td>
            <td colspan="2" class="xl181" style="border-right:2.0pt double black;border-left:
            none">Factor F งานอาคาร  (4/4/54)</td>
            <td class="xl149" style="border-top:none;border-left:none"> </td>
            <td class="xl148" style="border-top:none;border-left:none"> </td>
            <td class="xl147" style="border-top:none;border-left:none"> </td>
            <td class="xl150" style="border-left:none"> </td>
        </tr>
        <tr height="34" style="mso-height-source:userset;height:26.1pt">
            <td height="34" class="xl148" style="height:26.1pt;border-top:none"> </td>
            <td colspan="2" class="xl183" style="border-right:2.0pt double black;border-left:
            none">เงินล่วงหน้าจ่าย           0 %</td>
            <td class="xl149" style="border-top:none;border-left:none"> </td>
            <td class="xl148" style="border-top:none;border-left:none"> </td>
            <td class="xl147" style="border-top:none;border-left:none"> </td>
            <td class="xl150" style="border-top:none;border-left:none"> </td>
        </tr>
        <tr height="34" style="mso-height-source:userset;height:26.1pt">
            <td height="34" class="xl148" style="height:26.1pt;border-top:none"> </td>
            <td colspan="2" class="xl183" style="border-right:2.0pt double black;border-left:
            none">เงินประกันผลงาน         0 %</td>
            <td class="xl149" style="border-top:none;border-left:none"> </td>
            <td class="xl148" style="border-top:none;border-left:none"> </td>
            <td class="xl147" style="border-top:none;border-left:none"> </td>
            <td class="xl150" style="border-top:none;border-left:none"> </td>
        </tr>
        <tr height="34" style="mso-height-source:userset;height:26.1pt">
            <td height="34" class="xl148" style="height:26.1pt;border-top:none"> </td>
            <td colspan="2" class="xl183" style="border-right:2.0pt double black;border-left:
            none">ดอกเบี้ยเงินกู้              7 %</td>
            <td class="xl149" style="border-top:none;border-left:none"> </td>
            <td class="xl148" style="border-top:none;border-left:none"> </td>
            <td class="xl147" style="border-top:none;border-left:none"> </td>
            <td class="xl150" style="border-top:none;border-left:none"> </td>
        </tr>
        <tr height="34" style="mso-height-source:userset;height:26.1pt">
            <td height="34" class="xl148" style="height:26.1pt;border-top:none"> </td>
            <td colspan="2" class="xl185" style="border-right:2.0pt double black;border-left:
            none">ภาษีมูลค่าเพิ่ม             7 %</td>
            <td class="xl149" style="border-top:none;border-left:none"> </td>
            <td class="xl148" style="border-top:none;border-left:none"> </td>
            <td class="xl147" style="border-top:none;border-left:none"> </td>
            <td class="xl150" style="border-top:none;border-left:none"> </td>
        </tr>
        <tr height="34" style="mso-height-source:userset;height:26.1pt">
            <td colspan="3" rowspan="2" height="68" class="xl187" style="border-right:2.0pt double black;
            height:52.2pt">สรุป</td>
            <td class="xl151" style="border-left:none">รวมค่าก่อสร้างทั้งสิ้น</td>
            <td class="xl152"> </td>
            <td class="xl153" align="left">           179,846.61</td>
            <td class="xl154"> </td>
        </tr>
        <tr height="34" style="mso-height-source:userset;height:26.1pt">
            <td height="34" class="xl155" colspan="2" style="height:26.1pt;mso-ignore:colspan">ขอใช้งบประมาณเพียง</td>
            <td class="xl157" align="left" style="border-top:none">         179,000.00</td>
            <td class="xl158" style="border-top:none"> </td>
        </tr>
        <tr height="34" style="mso-height-source:userset;height:26.1pt">
            <td colspan="3" height="34" class="xl172" style="border-right:2.0pt double black;
            height:26.1pt">ระยะเวลาก่อสร้าง   <font class="font6">      60  </font><font class="font5">      วัน</font></td>
            <td class="xl159" style="border-top:none;border-left:none">ตัวอักษร</td>
            <td class="xl160" style="border-top:none"> </td>
            <td class="xl161" style="border-top:none">หนึ่งแสนเจ็ดหมื่นเก้าพันบาทถ้วน</td>
            <td class="xl162" style="border-top:none"> </td>
        </tr>
        <tr height="34" style="mso-height-source:userset;height:26.1pt">
            <td height="34" class="xl137" colspan="3" align="left" style="height:26.1pt;
            mso-ignore:colspan">คณะกรรมการกำหนดราคากลาง</td>
            <td class="xl137"> </td>
            <td class="xl137"> </td>
            <td class="xl137"> </td>
            <td class="xl137"> </td>
        </tr>
        <tr height="34" style="mso-height-source:userset;height:26.1pt">
            <td height="34" class="xl137" style="height:26.1pt"> </td>
            <td class="xl137"> </td>
            <td class="xl137"> </td>
            <td class="xl137"> </td>
            <td class="xl137"> </td>
            <td class="xl137"> </td>
            <td class="xl137"> </td>
        </tr>
        <tr height="34" style="mso-height-source:userset;height:26.1pt">
            <td height="34" class="xl137" colspan="3" align="left" style="height:26.1pt;
            mso-ignore:colspan"> ลงชื่อ...............................................................................ประธานกรรมการ</td>
            <td class="xl137" colspan="4" align="left">     ลงชื่อ..................................................................................กรรมการ</td>
        </tr>
        <tr height="34" style="mso-height-source:userset;height:26.1pt">
            <td height="34" class="xl137" colspan="3" align="left" style="height:26.1pt;
            mso-ignore:colspan">                      ( นายศุภกฤต    แสนอินเมือง)</td>
            <td class="xl137" colspan="3" align="left">                               (   นายสุบรรณ์    ฟูวัน)  </td>
            <td class="xl137"> </td>
        </tr>
        <tr height="34" style="height:26.1pt">
            <td height="34" class="xl137" style="height:26.1pt"> </td>
            <td class="xl137"> </td>
            <td class="xl137"> </td>
            <td class="xl137"> </td>
            <td class="xl137"> </td>
            <td class="xl137"> </td>
            <td class="xl137"> </td>
        </tr>
        <tr height="34" style="mso-height-source:userset;height:26.1pt">
            <td height="34" class="xl137" colspan="3" align="left" style="height:26.1pt;
            mso-ignore:colspan">ลงชื่อ..................................................................................กรรมการ</td>
            <td class="xl137"> </td>
            <td class="xl137"> </td>
            <td class="xl137"> </td>
            <td class="xl137"> </td>
        </tr>
        <tr height="34" style="mso-height-source:userset;height:26.1pt">
            <td height="34" class="xl137" colspan="3" align="left" style="height:26.1pt;
            mso-ignore:colspan">                    (   พ.จ.อ.ณัฏฐศรันย์   อินแสนสืบ     )             </td>
            <td class="xl137"> </td>
            <td class="xl137"> </td>
            <td class="xl137"> </td>
            <td class="xl137"> </td>
        </tr>
        <tr height="34" style="height:26.1pt">
            <td height="34" class="xl137" style="height:26.1pt"> </td>
            <td class="xl137"> </td>
            <td class="xl137"> </td>
            <td class="xl137"> </td>
            <td class="xl137"> </td>
            <td class="xl137"> </td>
            <td class="xl137"> </td>
        </tr>
    </tbody>
</table>