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PERMIT NUMBERiO
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Installer '3' License # I N %/ 120 136
Address of home 7Zoo S ?7k $
being Installed
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Manufacturer �. s Z'Ar Length xwidth r/Sf X ZSv
N07E: • if home Is a single wide fill out one half of the blocking plan
If horrie Is a triple or quad wide sketch in remainder of home
I understand lateral Arts Systems cannot be used on any home (new or used)
where the sldewall ties exceed 5 it 4 In.
Installer's initials JF Z-
Typical pier spacing
51, LlFCR7I
ow locations of Longitudinal and Lateral Systems
(use dark lines to show these locations)
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PERMIT WOFIKSHEET
New Home Used Home
page 1 of 2
Home Installed to the Manufacturer's Installation Manual ❑
Home Is. Installed In accordance with Rule 15-0
Single wide ❑ Wind Zoha II Erll� Wind Zone III ❑
Double wide ' Installation Decal #
TriplelQuad ' ❑ Serial 25/2-A
PIER SPACING TABLE FOR USED HOMES
Load
keadng
Hui
Footer
size
size
16' x i 6'
18 1/2' x 18'1/2'
20' X 20'
22' x 227
24' X 24'
26' x 26'
eepaony
,(sq In)
(fie)
(
(40e)
(484)•
(676)•
(676)
1
00
s
3
OD 6
6
8
000
s
6
g
g
2
00 s
B
g
g
g
800D
;
g
3500
Pit Ig
g
' Inter
olated fro
1561
p M a Pier spacing labia.
PIER PAD SIZES rI
I-beam plat pad size
Perimeter pier pad size __ / � ' 71
Other Pier pad sizes
(required by the mfg.)
FMDraw the approximate locations of marriage
wall opening'; 4 toot or greater. Use this
symbol to show the piers.
List all marriage wall openings greater then 4 toot
and.thelr pier pad sizes below.
Opening )Pier ad:slze
/ 9kz Z,,
1 9X 2. Y 'I
11 TIEDOWN COMPONENTS
.
Longitudinal Stablllzlrr}}g Device (LSD)
Manufacturer lrl�:t✓�G Kati Sur�L"
Longltudlnal Stabilizingg Device w/ steral rnr s
Manufacturer
POPULAR PAD SIZES
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■r�tif
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ELLK iYtYIL'�lic�
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ANCHORS
4ft t� 5tl
FRAME 71Ea
within 2' of end of ho
spaced at 5' 4" oo
OTHER IEe
Sldewatl Nu er
Longitudinal
Marriage wall
Shearwall
'r
PERMIT NUMBER
POC ET PE ETROMETER TES
or cf eok here -to declare 1000 lbrsoilund / wnhcut testing, psi
X_ X_ X_.
POCKET PENETROMETER TESTING METHOD
1. Test the perimeter of the home at a locations.
2. Take the reading at the depth of thefootsr.
S. Uaing Boo lb. increments, take the lowest
reading and round down to that increment.
X-_ X _.. X_
TOROUE PR,BE TEST
The results of the torque probe test is _ Z R 9/ Inch pounds or check
here If you are declaring 5' anchors without testing A test
showing 275 Inch pounds or less will require 5 foot anchors,
Note: A state approved lateral arm system Is being used and 4 ft.
.anchors are allowed at the sidewall locations. I understand 5 it
anchors are required at all centerline tie points where the torque test
reading Is 275 or less and where the mobile home manufacturer may
requires anchors with 4000 I holding capacity,
Installer's Initials
ALL TESTS MUST BE PERFORMED BYy A LICENSED INSTALLER
Installer Namee,oP.
Date Tested _ _ 0
Electrical
Ibnnect electrical conductors between multi -wide units, but not to the main power
ouroe. This•Inviudes the bonding wire between mult•wide units. Pg•
piumbino
onnecl all sewer drains to an existing sewer tap or septic tank Pp.
onnect all potable water supply piping to an existing water meter, water tap, or other
idependent water supply systems, Pp,
PERMIT WORKSHEET
?l�2"di-Ia
page 2 of 2 f
Slto pre erntlon ,
Debris and organic materlal removed /
Water drainage: Natural Swale Pad ✓ Other
Floor. Type Fastener. L� . Length: op
Spacing; f6 rr
Wails: Type Fasenerf� Length: Spacing:
Roof; Type Fastener:
_Ld'2Length: Spacing:
Fonused homes a mTn.___ 30 gauge, a" wide, galvanized metal 'slop
will be centered over the peak of the roof and fastened with galy.
roofing nails at2" on center on both sides of the centerline_
l3eskeL wmlhe /"olio r vlren„nl
I understand a properly Installed gasket Is a requirement of all new and used
homes and that condensation, mold, meldew and buckled marriage walls are
a result of a poorly installed or no gasket being Installed. I understand a strip
of tape will not serve as a pasket.
Installers Initials;_
Type gasket.. a---1 Installed:
Pg. Between Floors Yes .
Between Walls Yesv
Bottom of rldpebeamYes .—
Weather roogn
The bottomboard will be repaired and/or taped, Yes ,gt, Pp.
Siding on units Is Installed to manufacturer's specifications, Yes
Fireplace chimney Installed so as not to allow Intrusion of rain water, Yes _
Mlscollanoous —
Skirting to be Installed. Yes No
Diver vent Installed outside of skirting. Yes WA
Range downflowvent Instalied•outede of skirting. Yes WA
Drain lines supported at 4 foot intervals, YSs Z/
Electrical crossovers protected. Yes
Other;
Installer
an inTormation given with this pe
is accurate and trye based on the
Date dT /b Zell