Submit Form
A P P L I C A T I O N F O R R O O F G U A R A N T E E One form must be completed for each building prior to shipment of materials Date: __________________________________ Estimated start date: ___________________________________ Total no. of squares: ____________________________ GUARANTEE COVERAGE REQUESTED
DURATION:
□
□
□
COVERAGE TYPE: (must select one below)
□ Roof Membrane Guarantee
15 year – Materials Guarantee
10 year
10 + 5 year* Prepaid?
□
Yes
□
OTHER OPTIONS:
No
□ 10 +10 year* Prepaid? □ Yes □ No
□
□
15 year*
□
Other ____________________________
□ Insulation Inclusion Addendum
(Includes Siplast roofing and flashing membranes)
(Includes rigid insulation not supplied by Siplast)*
□ Roof System Guarantee
□ Paraguard/Proform Inclusion Addendum
(Also includes Siplast Lightweight Insulating Concrete
System and related accessories supplied by Siplast)
□ Roof Membrane/System Guarantee
□ Other
*Additional guarantee charge applicable
(Also includes rigid insulation and related
20 year*
NOTE: A $300 charge applies to all jobs under 50 squares
accessories supplied by Siplast)
□ Submitted herewith □ To follow
Roof drawing showing dimensions and penetrations:
Does project require payment and performance bonds? □ Yes □ No □ Submitted herewith □ To follow Project Specifications:
Project name: ___________________________________________________________
Address: _______________________________________________________________
Building name or area:____________________________________________________
City/state/zip: __________________________________________________________
Use of building: __________________________________________________________ Tax exempt no: ________________________________________________________
Owner of building:________________________________________________________
Address: _______________________________________________________________
Owner contact (name & phone no.): ____________________________________ City/state/zip: __________________________________________________________
Architect: ________________________________________________________________
Address: _______________________________________________________________
Phone number: __________________________________________________________ City/state/zip: __________________________________________________________
General contractor: ______________________________________________________
Address: _______________________________________________________________
Phone number: __________________________________________________________ City/state/zip: __________________________________________________________
Lightweight concrete applicator: ________________________________________
Address: _______________________________________________________________
Phone number: __________________________________________________________ City/state/zip: __________________________________________________________
Roofing contractor: _____________________________________________________
Address: _______________________________________________________________
Phone number: __________________________________________________________ City/state/zip: __________________________________________________________
SIPLAST MATERIALS:
SIPLAST MATERIALS:
QUANTITIES:
QUANTITIES:
1. ________________________________________________________________________ 4. ______________________________________________________________________
2. ________________________________________________________________________ 5. ______________________________________________________________________
3. ________________________________________________________________________ 6. ______________________________________________________________________
SIPLAST ACCESSORIES: □ PA-1125 Primer □ PA-917 Primer □ PA-1021 Cement □ PS-304 Sealant □ Paracoat Coating □ PC-227 Coating
□ PA-828 Cement □ SFT Cement □ PS-209 Sealant
Mopping Asphalt: Asphalt note: Approved ASTM D 312 Type IV asphalt is required. Asphalt manufacturer: _____________________________________________________
To be certified?
□ Yes □ No
SIPLAST • 1000 Rochelle Blvd.
D-206-21-006
Location: _____________________________________________________________
•
Irving, Texas 75062-3940
•
469-995-2200
•
Toll Free 800-922-8800
•
Fax 469-995-2206
Effective Date: 1/16/15
Job Name: ______________________________________________________________________________________________________Application for Roof Guarantee – page 2
ROOF CONSTRUCTION NO. 1
Specific roof area name/no: ________________________________________________ Squares: ________________________________________________________________
Siplast roof system: __________________________________________ / __________________________________________ / __________________________________________
(Base ply)
Siplast flashing membrane:
(Intermediate ply)
(Finish ply)
□ Veral Aluminum □ Veral Spectra Polar White □ Parapro □ Paradiene 40 FR □ Parafor 50 LT
□ Paradiene 50 TG □ Parafor 30 □ Parafor 30 TG □ Paradiene 40 FR TG
Flashing application method: ____________________________________________________________________________________________________________
Project type:
□ New construction
□ Complete tear-off
□ Partial tear-off
□ Re-cover If New Construction or Complete Tear-off, skip to next section. If Re-cover or Partial Tear-off, complete the remainder of this section:
Age of existing assembly: _______ yrs. Cause of failure: ______________________________________________________________________________________________
Composition (including all assembly components above the structural deck): ________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________
Method of attachment (include type of fastener): _____________________________________________________________________________________________________
Quality of attachment:
□ Well secured □ Needs reattachment
Does water stand more than 24 hours after a rain?
Method of reattachment: ________________________________________________________
□ Yes □ No
If yes, to what extent: _________________________________________________________
Condition of existing assembly: _______________________________________________________________________________________________________________________
Proposed preparation of exiting assembly (Re-cover): ________________________________________________________________________________________________
What components will be torn off? (Partial Tear-off)___________________________________________________________________________________________________
Preparation of surface to be roofed: ____________________________________________________________________________________________________________________
NOTE: ALL AREAS HAVING EXISTING INSULATION OR OTHER COMPONENTS WITH EXCESSIVE MOISTURE MUST BE REMOVED PRIOR TO THE INSTALLATION OF A SIPLAST ROOF SYSTEM
Roof deck: Type: ________________________________________________________
Temporary roof/Vapor Retarder: Type: ___________________________________
Thickness/gauge: ___________________ Slope per foot: __________________
Method of application: __________________________________________________
Substrate Board: _______________________________________________________
New Lightweight Insulating Concrete:
□ NVS® □ ZIC® □ Insulcel® □ Other
Vent sheet or base sheet: □ Parabase Plus P □ Parabase FS □ Parabase Plus □ Other: _________________________________________________________________ _____________________ New slope per foot: _____________________
Manufacturer: ___________________________________________________________
Method of application: __________________________________________________
Fastener type: ___________________________________________________________
New Rigid Insulation: Note: When applied in hot asphalt or insulation adhesive, insulation panel size cannot exceed 4 feet by 4 feet. Bottom layer (or single layer if insulation is applied in one layer):
Type: ____________________________________________________________________ Thickness: _____________________________ Size: ___________________________ Type of fastener:
Manufacturer: ___________________________________________________________
Attachment method:
□ Parafast □ Other _______________________________ □ Para-Stik □ Parafast Insulation Adhesive
□ Other ________________________________________
Fastener Manufacturer: _________________________________________________
Intermediate layer-1 (if insulation is applied in multiple layers):
Type: ____________________________________________________________________ Thickness: _____________________________ Size: ___________________________
Manufacturer: ___________________________________________________________
Attachment method:
□ Para-Stik □ Parafast Insulation Adhesive
□ Other ________________________________________
Intermediate layer-II (if insulation is applied in multiple layers):
Type: ____________________________________________________________________ Thickness: _____________________________ Size: ___________________________
Manufacturer: ___________________________________________________________
Attachment method:
□ Para-Stik □ Parafast Insulation Adhesive
□ Other ________________________________________
Cover Board (if insulation is applied in multiple layers):
Type: ____________________________________________________________________ Thickness: _____________________________ Size: ___________________________
Type of fastener:
Manufacturer: ___________________________________________________________
Attachment method:
□ Parafast □ Other _______________________________
□ Para-Stik □ Parafast Insulation Adhesive
□ Other ________________________________________
Fastener Manufacturer: _________________________________________________
Overburden Systems: (If applicable, list all components): ___________________________________________________________________________________________
Authorized Contractor Representative
Authorized Siplast/Icopal Representative
Signed: _________________________________________________________________ Approved by: __________________________________ Date: ________________
Print Name: _____________________________________ Date: _______________ Comments: _____________________________________________________________
SIPLAST • 1000 Rochelle Blvd.
D-206-21-006
•
Irving, Texas 75062-3940
•
469-995-2200
•
Toll Free 800-922-8800
•
Fax 469-995-2206
Effective Date: 1/16/15
Job Name: _____________________________________________________________________________________________________Application for Roof Guarantee – page 3
Please note: Page 3 is only necessary where more than one roof construction exists.
ROOF CONSTRUCTION NO. 2
Specific roof area name/no: ________________________________________________ Squares: ________________________________________________________________
Siplast roof system: __________________________________________ / __________________________________________ / __________________________________________
(Base ply)
Siplast flashing membrane:
(Intermediate ply)
(Finish ply)
□ Veral Aluminum □ Veral Spectra Polar White □ Parapro □ Paradiene 40 FR □ Parafor 50 LT
□ Paradiene 50 TG □ Parafor 30 □ Parafor 30 TG □ Paradiene 40 FR TG
Flashing application method: ____________________________________________________________________________________________________________
Project type:
□ New construction
□ Complete tear-off
□ Partial tear-off
□ Re-cover If New Construction or Complete Tear-off, skip to next section. If Re-cover or Partial Tear-off, complete the remainder of this section:
Age of existing assembly: _______ yrs. Cause of failure: ______________________________________________________________________________________________
Composition (including all assembly components above the structural deck): ________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________
Method of attachment (include type of fastener): _____________________________________________________________________________________________________
Quality of attachment:
□ Well secured □ Needs reattachment
Does water stand more than 24 hours after a rain?
Method of reattachment: ________________________________________________________
□ Yes □ No
If yes, to what extent: _________________________________________________________
Condition of existing assembly: _______________________________________________________________________________________________________________________
Proposed preparation of exiting assembly (Re-cover): ________________________________________________________________________________________________
What components will be torn off? (Partial Tear-off)___________________________________________________________________________________________________
Preparation of surface to be roofed: ____________________________________________________________________________________________________________________
NOTE: ALL AREAS HAVING EXISTING INSULATION OR OTHER COMPONENTS WITH EXCESSIVE MOISTURE MUST BE REMOVED PRIOR TO THE INSTALLATION OF A SIPLAST ROOF SYSTEM
Roof deck: Type: ________________________________________________________
Temporary roof/Vapor Retarder: Type: ___________________________________
Thickness/gauge: ___________________ Slope per foot: __________________
Method of application: __________________________________________________
Substrate Board: _______________________________________________________
New Lightweight Insulating Concrete:
□ NVS® □ ZIC® □ Insulcel® □ Other
Vent sheet or base sheet: □ Parabase Plus P □ Parabase FS □ Parabase Plus □ Other: _________________________________________________________________ _____________________ New slope per foot: _____________________
Manufacturer: ___________________________________________________________
Method of application: __________________________________________________
Fastener type: ___________________________________________________________
New Rigid Insulation: Note: When applied in hot asphalt or insulation adhesive, insulation panel size cannot exceed 4 feet by 4 feet. Bottom layer (or single layer if insulation is applied in one layer):
Type: ____________________________________________________________________ Thickness: _____________________________ Size: ___________________________ Type of fastener:
Manufacturer: ___________________________________________________________
Attachment method:
□ Parafast □ Other _______________________________ □ Para-Stik □ Parafast Insulation Adhesive
□ Other ________________________________________
Fastener Manufacturer: _________________________________________________
Intermediate layer-1 (if insulation is applied in multiple layers):
Type: ____________________________________________________________________ Thickness: _____________________________ Size: ___________________________
Manufacturer: ___________________________________________________________
Attachment method:
□ Para-Stik □ Parafast Insulation Adhesive
□ Other ________________________________________
Intermediate layer-II (if insulation is applied in multiple layers):
Type: ____________________________________________________________________ Thickness: _____________________________ Size: ___________________________
Manufacturer: ___________________________________________________________
Attachment method:
□ Para-Stik □ Parafast Insulation Adhesive
□ Other ________________________________________
Cover Board (if insulation is applied in multiple layers):
Type: ____________________________________________________________________ Thickness: _____________________________ Size: ___________________________
Type of fastener:
Manufacturer: ___________________________________________________________
Attachment method:
□ Parafast □ Other _______________________________
□ Para-Stik □ Parafast Insulation Adhesive
□ Other ________________________________________
Fastener Manufacturer: _________________________________________________
Overburden Systems: (If applicable, list all components): ___________________________________________________________________________________________
Authorized Contractor Representative
Authorized Siplast/Icopal Representative
Signed: _________________________________________________________________ Approved by: __________________________________ Date: ________________ Print Name: _____________________________________ Date: _______________ Comments: _____________________________________________________________ SIPLAST • 1000 Rochelle Blvd.
D-206-21-006
•
Irving, Texas 75062-3940
•
469-995-2200
•
Toll Free 800-922-8800
•
Fax 469-995-2206
Effective Date: 1/16/15
Job Name: _____________________________________________________________________________________________________Application for Roof Guarantee – page 4
Please note: Page 4 is only necessary where more than one roof construction exists.
Bottom ROOF CONSTRUCTION NO. 3
Specific roof area name/no: ________________________________________________ Squares: ________________________________________________________________
Siplast roof system: __________________________________________ / __________________________________________ / __________________________________________
(Base ply)
Siplast flashing membrane:
(Intermediate ply)
(Finish ply)
□ Veral Aluminum □ Veral Spectra Polar White □ Parapro □ Paradiene 40 FR □ Parafor 50 LT
□ Paradiene 50 TG □ Parafor 30 □ Parafor 30 TG □ Paradiene 40 FR TG
Flashing application method: ____________________________________________________________________________________________________________
Project type:
□ New construction
□ Complete tear-off
□ Partial tear-off
□ Re-cover If New Construction or Complete Tear-off, skip to next section. If Re-cover or Partial Tear-off, complete the remainder of this section:
Age of existing assembly: _______ yrs. Cause of failure: ______________________________________________________________________________________________
Composition (including all assembly components above the structural deck): ________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________
Method of attachment (include type of fastener): _____________________________________________________________________________________________________
Quality of attachment:
□ Well secured □ Needs reattachment
Does water stand more than 24 hours after a rain?
Method of reattachment: ________________________________________________________
□ Yes □ No
If yes, to what extent: _________________________________________________________
Condition of existing assembly: _______________________________________________________________________________________________________________________
Proposed preparation of exiting assembly (Re-cover): ________________________________________________________________________________________________
What components will be torn off? (Partial Tear-off)___________________________________________________________________________________________________
Preparation of surface to be roofed: ____________________________________________________________________________________________________________________
NOTE: ALL AREAS HAVING EXISTING INSULATION OR OTHER COMPONENTS WITH EXCESSIVE MOISTURE MUST BE REMOVED PRIOR TO THE INSTALLATION OF A SIPLAST ROOF SYSTEM
Roof deck: Type: ________________________________________________________
Temporary roof/Vapor Retarder: Type: ___________________________________
Thickness/gauge: ___________________ Slope per foot: __________________
Method of application: __________________________________________________
Substrate Board: _______________________________________________________
New Lightweight Insulating Concrete:
□ NVS® □ ZIC® □ Insulcel® □ Other
Vent sheet or base sheet: □ Parabase Plus P □ Parabase FS □ Parabase Plus □ Other: _________________________________________________________________ _____________________ New slope per foot: _____________________
Manufacturer: ___________________________________________________________
Method of application: __________________________________________________
Fastener type: ___________________________________________________________
New Rigid Insulation: Note: When applied in hot asphalt or insulation adhesive, insulation panel size cannot exceed 4 feet by 4 feet. Bottom layer (or single layer if insulation is applied in one layer):
Type: ____________________________________________________________________ Thickness: _____________________________ Size: ___________________________ Type of fastener:
Manufacturer: ___________________________________________________________
Attachment method:
□ Parafast □ Other _______________________________ □ Para-Stik □ Parafast Insulation Adhesive
□ Other ________________________________________
Fastener Manufacturer: _________________________________________________
Intermediate layer-1 (if insulation is applied in multiple layers):
Type: ____________________________________________________________________ Thickness: _____________________________ Size: ___________________________
Manufacturer: ___________________________________________________________
Attachment method:
□ Para-Stik □ Parafast Insulation Adhesive
□ Other ________________________________________
Intermediate layer-II (if insulation is applied in multiple layers):
Type: ____________________________________________________________________ Thickness: _____________________________ Size: ___________________________
Manufacturer: ___________________________________________________________
Attachment method:
□ Para-Stik □ Parafast Insulation Adhesive
□ Other ________________________________________
Cover Board (if insulation is applied in multiple layers):
Type: ____________________________________________________________________ Thickness: _____________________________ Size: ___________________________
Type of fastener:
Manufacturer: ___________________________________________________________
Attachment method:
□ Parafast □ Other _______________________________
□ Para-Stik □ Parafast Insulation Adhesive
□ Other ________________________________________
Fastener Manufacturer: _________________________________________________
Overburden Systems: (If applicable, list all components): ___________________________________________________________________________________________
Authorized Contractor Representative
Authorized Siplast/Icopal Representative
Signed: _________________________________________________________________ Approved by: __________________________________ Date: ________________ Print Name: _____________________________________ Date: _______________ Comments: _____________________________________________________________ SIPLAST • 1000 Rochelle Blvd.
D-206-21-006
•
Irving, Texas 75062-3940
•
469-995-2200
•
Toll Free 800-922-8800
•
Fax 469-995-2206
Effective Date: 1/16/15