Living roof Declaration Form

Page 1

IF NONE, CHECK HERE: 

EMAIL

block/lot(s)

DATE

Modular Tray-Based system

/

Built-Up Layers

N

6. Will it be accessible to the public? Y

Landscape Architect: _________________________________ Contractor/Installer: __________________________________ Plant Supplier: _______________________________________ Maintenance Team: ___________________________________

/

N

9. Expected completion date: ___________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

8. What is the overall goal for the living roof, or what benefits are you hoping to maximize?

Project Architect: _____________________________________

7. Please list the different professionals involved with the project: (as applicable)

5. Will the roof be occupiable? (circle one) Y /

4. Depth of Growing Media: _____________________________ (list as range, i.e. 10-12”)

3. Living Roof System Type (select one):

2. Estimated Vegetated Area: ________________________________ (sq. ft.)

1. Total Roof Area: __________________________________ (sq. ft.)

PROJECT DESCRIPTION

Have you consulted a Certified Green Roof Professional (GRP)? (A GRP can help ensure that your project will have the greatest chance for success. A list of local GRPs can be found on the Green Roofs for Healthy Cities website: www.greenroofs.org)  YES  NO

CASE NO./PERMIT NO.

Project Address

NAME

When submitting for a building permit on a project that contains a living roof, please also include this form with your submittal.

Living Roofs

DECLARATION FORM

52 SAN FRANCISCO LIVING ROOF MANUAL

Appendix D


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