Residential Roof Historical Record

Date Structure Erected: / Builder:
Structure Information
Structure ID: / Used For:
Job No.: / Year Roof Applied:
Structure Description: / Permanent Temporary
/ Building Type: / Single-family Apartments
Multi-family Other:
Resident Key Contact Name: / Owner/Mgr. Contact (if different):
Structure Address: / Owner/Mgr. Phone:
Structure City/ST/Zip / Owner/Mgr. E-Mail:

Roofing Company Contact Information

Roofing Contractor Company: / Roofing Co. Address:
Roofing Company Contact: / Roofing Co. City/ST/ZIP:
Roofing Company Phone: / Roofing Co. E-Mail:
Previous Maintenance and Repair Work
(Briefly describe membrane and flashing work done, including dates and who did the work)
Date of Last Inspection: Is the Roof guaranteed? No Yes - Attach copy of guarantee to this record
Has occupancy or use of the building changed since last inspection? No Yes - Describe:
Have any changes, additions or new penetrations been made to roof since last inspection?No Yes - Describe:
Has there been leakage?No Yes - Describe Conditions: Light Rain Heavy Rain Wind Leaks Continuously
Other:
Were emergency repairs performed?No Yes - Describe:

Roof Measurements

/

Description:

Roof Slope: / Inches per foot / Roof Area:

Roof Type

/

Total Number of Plies:

Asphalt Shingle / Clay Tile / Slate / Residential Metal
Composite Shingle / Cedar Shake/Shingle / Standing Seam Metal / Other Metal
EPDM / Torch-Applied APP/SBS / Single-Ply / Other:

Roof Access

Ladder / Hatch/Attic / Door/Window / Other:
Insulation(Indicate Layer Number next to check box and Thickness to the right)
None / Fiberglass / Polystyrene / Other:
Vapor Retarder
None / Bituminous / 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:

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 structure’s historical record file, including meeting notes, copies of repair records, structure plans, etc.

2002N Residential Historical Record Form.doc Midwest Roofing Contractors Association  800/497-6722 

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