Roof Historical Record

2002L Commercial Roof Historical Record Form wMidwest Roofing Contractors Association w 800/497-6722 w www.mrca.orgPage 1

Building Information

Building ID: Used For:

No.: Year Roof Applied:

Building Description: Permanent Temporary Building Type: Retail IndustrialResidential Other:

Building Name: Building Contact:

Building Address: Building Phone:

Building City/ST/Zip Building E-Mail:

Key Contact Information

Owner/Tenant: Roofing Contractor:

Owner/Tenant Contact: Roofing Co. Contact:

Owner/Tenant Address: Roofing Co. Address:

Owner/Tenant City/ST/ZIP: Roofing Co. City/ST/ZIP:

Owner/Tenant Phone: Roofing Co. Phone:

Owner/Tenant E-Mail: Roofing Co. E-Mail:

Architect: General Contractor:

Architect Contact GC Contact:

Architect Address: General Contractor Address

Architect City/ST/ZIP: General Contractor City/ST/ZIP

Architect Phone: GC Phone:

Architect E-Mail: GC E-Mail:

Is the Roof guaranteed? Yes* No * Attach copy of guarantee to this record

Roof Historical Record

2002L Commercial Roof Historical Record Form wMidwest Roofing Contractors Association w 800/497-6722 w www.mrca.orgPage 2

Roof Deck Type

Cement-Wood Fiber Composite: Concrete Plank Concrete Precast

Concrete Slab Lightweight Ins. Concrete Gypsum Slab/Plank Oriented Strand Board

Plywood Poured Gypsum Steel Tongue in Groove Wood

Wood Plank Other:

Roof Measurements Description:

Roof Slope: Inches per foot Roof Area: Squares (100 sq. ft.)

Roof Type Total Number of Plies:

Built-up Asphalt Built-up Coal-Tar Built-up Cold Process

Standing Seam Metal Sheet Metal Residential Metal Other Metal

EPDM PVC Thermo-Poly Olefin Other Single-Ply

Asphalt Shingle Slate Clay Tile Rubber composite

Torch-Applied APP Torch-Applied SBS Other:

Surfacing

None Crushed Stone Gravel Slag

Promenade Tile Slate Smooth Asphalt

Cap Sheet

None Mineral-surfaced Smooth-Surfaced Other:

Roof Coating

None Asphalt Emulsion Solvent Based Water Based

Description (Include Manufacturer, product number and/or brand name):

Roof Historical Record

2002L Commercial Roof Historical Record Form wMidwest Roofing Contractors Association w 800/497-6722 w www.mrca.orgPage 3

Felt Type

Glass Fiber Organic Asbestos Other:

Base Ply Type

Glass Fiber Organic Asbestos Other:

Roof Access

Ladder Hatch Penthouse Other:

Insulation (Indicate Layer Number next to check box and Thickness to the right)

None Cellular Glass Glass Fiber Perlite

Phenolic Foam Polyisocyanurate Polystyrene Urethane

Wood Fiberbrd Other:

Insulation Fastened To Deck With (Indicate Layer Number next to check box)

Mechanical Fasteners Hot Asphalt Cold Adhesive Other:

Vapor Retarder

None Bituminous Kraft Paper Vinyl Film

Other:

Roof Ventilation Check Types of vents used, and indicate approximate Number of each type in the blank

Edge Vents Peak Vents Exhaust Vents Other:

Cant Strips

None Wood Fiberboard Other:

Roof Historical Record

2002L Commercial Roof Historical Record Form wMidwest Roofing Contractors Association w 800/497-6722 w www.mrca.orgPage 4

Flashing Describe how top of flashing is fastened:

Metal Base Flashing: (Type of metal) Composition Base Flashing: (Felt type)

Counter-flashing ThroughWall Flashing: (Type of material) Other:

Drainage System (Briefly describe the roof drainage system, including drains, scuppers, gutters, downspouts and sumps,if any.)

Historical Data

Original Roof Type: Installed:

First Re-roof Type: Installed:

Second Re-roof Type: Installed:

Third Re-Roof Type: Installed:

Additional Modifications

Notes

Form Completed By

Name: Signature: Phone: Date

*All information, documents and records pertinent to this roof system should be part of the historical record file, including meetingminutes, copies of repair records, roof plan grid, etc.