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Installer 44a.1.5 License #
Address of home 3Z,00
being Installed
Manufacturer %z✓i/1 Length x width �1 SAX 2 e l r
NOT!~• ' if home is a s/ngle wide fill out one hall of the blocking plan
If home Is a triple or quad wide sketch In remainder of home
I understand Lateral Arm Systems cannot be used on any home (new or used)
where the sldewall ties exceed 5 It 41n.
Installer's Initials
Typical pier spa Ing
,.i 'reI Ie1�N
tShow locations of Longitudinal and Lateral Systems
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PERMIT WORKSHEET
page 1 of 2
New Home
Used Home
Home Installed
to the Manufacturer's Inslellatlon Manual
❑
Home Is Installed In accordance with Rule 16-0
❑
Single wlds
❑ Wind Zone II 92/ Wlnd Zone III
❑
Double wide
[� Installation Decal #
TdplalQuad '
❑ Serlal # r AV9 / 4e T V V A
PIER SPACING TABLE FOR USED HOMES
Lmd I Poorer eoll
116ad It alzey .(eq In)
eap
16'X16'
(298)
181/2'X181/2'
(s42)
20'X20'
(400 )
22x22+
(484)•
241X24'
(676)•
29, KZV
(676)
1000 s
. 3
t ,
0
g
00 a
6
B
2 00 s
B
B
B
3 00 s
B
35yu Ral
imorpuimm rrum nine ,av, pier spamnp mme. -
PIER PAD SIZES ��
N
I-beam pier pad size Y ZZ
Perimeter pler pad size �� 2
Other pier pad sizes
(required by the mfg.)
®Draw the approximate locations of marriage
wall openings 4 foot or greater. Use this
symbol to show the piers.
List all marriage wall openings greater than 4 foot
and.their pier pad sizes below.
Opening Plevad:slze
I ?,eZZ"
TIEDOWN COMPONENTS
POP AR AO S ZES
ANCHORS
4It 5f1
FRAME TIES
within 2' of end of ho
spaced at 5' 4" co PI
OTHER E6
Number
Longitudinal Stabilizing Device (LSD)
Sidewall 'V_
Manufacturerdt3d . Si.c4rrD'
Lanpltudinel
Longitudinal Ste )74- ng Device w Le eral
Marriage wall
jams
Manufacturer �Yie xv/I alas j'I r- V.'riiSheaiwaII
4
l M „
PERMIT NUMBER
POC)Cgy PENETROM Mi=KTES
The
chpebck herpenetrometer
eto declare 1 00 Ib. are
nllunde j dowithout testing, psi
X— X__ . X—
POCKET PENETROMETER TESTING METHOD
t, Test the perimeter of the horns at 6 locations.
2. Take the reading at the depth of the.fcoter.
S. Using 600 lb. Increments, take the lowest
reading and round down to that Increment
X— X— X—
idlX PROBE TEST.
The results of the torque probe test Is , Inch pounds or check
here If you are declaring V anchors without testing - A test
showing 275 inch pounds or less will require s foot anchors,
Note: A state approved lateral arm system is being used and 4 it
.anchors are allowed at -the aldewall locations, I utdemtand 5 ft
anchors are required at all oanterllne tie points where the torque test
reading Is 275 or lass and where the rrlobile home manufacturer may
requires anchors with 40Cp�b holding capacity.
�c Installers initials
ALL TESTS MUST BE PERFORMED BY LIC SEDINSTALLFER
Installer Name �CJJ?Pi G7C�L/ i
Date Tested _ O Z- l d o Zp
eetr sal
lonnect electrical conductors between multi -wide units, but not to the main power
ource. Thls•Ingludss the bonding wire between must -wide units. Pg.
Plumb no
cnneot 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. Pg.
PERMIT WORKSHEET
Debris and organic material rem
Water drainage: Natural
Page 2 of 2 I
Other
Fastening multi wide units
Floor. Type Fastener ! Length: 8
Walls: Type Fastener � Spacing: f(a
_3t,7r Length: Spaoing: I
Roof. Type Fastener. ,AmLength: Spacing: _ . s
For.used homes am So pauge, a° wde, galvanized metal strip
will be centered'over the peak of theroof and fastened With gaiv.
roofing nails at 2° on center on both sides of the centerllne.
aasketfW Ih.m' Iln r I n
I understand a property Installed gasket Is a requirement of all hew and used.
homes and that condensation, mold, meldew and buckled marriage walls are
a result of a poorly Installed or no packet being Installed, I understand a step
Of tape will not serve as a gasket.
Installers initials_
Type gasket — Installed:
Pg. Between Floors Yes
Between Walls Yes -T�p—
Bottom of rldpebsam Yes
The bottomboard will be repaired andror taped, Yes „j�,/� pg.
Siding on units is Installed to manufacturers speolfloations. Yes
Fireplace chimney Installed so as not to allow intrusion of rain water, Yes
Mlles lnnoous
Skirting to be Installed. Yes No
Dryer vent Installed outside of skirting. Yes WA
Range downflowvent installed'outslds of skirting. Yes WA
Drain lines supported at 4 foot intervals. Yes ✓�
Electrical crossovers protected. Yes A/'
Other:
is accurate and true based on
Installer signature
Date r'✓-/b-ZcZV