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F'ERMII` NU MBER � ft
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W*? w:t�rv.w:
installer W�kWe: 1? rtLC 1—A—T o(P License �l l KIC) I G I ZB
Address of home 1 Q cam
being installed
Manufacturer 1t3N+aS of W1Ex4Lengthxwidth
NOT!« ' if home is a single wide flit out one half of the blocking plan
if horde Is a triple or quad wide sketch In remainder of home
I understand Lateral Arm Systems'cannot be used on any home (new or a�Ci)
where the sidewall ties exceed b ft 4in.
Installer's Initials
Tvoical ❑tar enartnn.
Load
Footar
achyring
size
16•x'16'
181h'Xte i/2'
20'%20'
22'X22' 24'X24' '26'x2fi
a
capacity
(sq In)
(26s) _
(342)
(400) _
(48 'h' (676)• (676)
1000
s
9
00
4 6
6
8
000
S
2 00
s
6
8
g
d
3000
s
g
g
300
8
'8'
8
I t I led f
PERMIT W014K.SHEET page 1 of 2
New Home . ❑ Used Home ta/
Home Installed to the Manufacturer's Installation Manual ❑ ' +
Home is Installed in accordance with Rule 16-0 �/ •, �, o'd
Single wide ❑/WindZone II ❑ Mod Zone III ❑
Double wide Installation Decal _s y�q3
Triple/Quad ' ❑ Serial n FL 4 OAR TI I S ? — yoy 10 A 4-g Q Z
LL D
PIER SPACING TABLE FOR USED HOMES Q 00
gLL,c
LU
f�^
Into a rom RUle 16G1 pier spacing table. U v,
PIER PAD SIZES
I-beam pier pad size _ ') )c Z Z
Perimeter pier pad size 7 )C ZZ
Other pier pad sizes ' 2 2
(required by the mfg.)
®Draw th a approximate locations of marrlax
wall openings 4 foot or greater. Use this
symbol to show the piers,
List all marriage wall openings greater than 4 foot
and.thelr pier pad sizes below.
Opening Pier pad:sfze
ANC/HORS
4ity 5it
within 2' of end of home
spaced at 6' 4" oo c/
OTHER IES
Longltudlnal Stabilizing Device (LSD) Sidewall Num er
Manufacturer J'VI fa o} e.w en Longitudinal
Longitudinal Stam tzing Day
a w/Lateral Ara,s Marriage wall
Manufacturer_ k-t 1 J Sheai&l
TIEDOWN COMPONENTS
PERMIT NUMBER
POCKET PENETROMETER TEST
The packet penetrometer tests are round own to psi
or check hereto declare 1 000 Ib, soil without testing.
X X__ X_
POCKET PENETROMETER TESTING METHOD
1. Test the perimeter of the home at 6 locations.
2. Take the reading at the depth of the tooter.
S. Using 600 lb. incremants, take the lowest
reading and round down to that increment
X X—.. X.—
TORQUE ROBE TEST
The results of the torque probe test is 3 alc> Inch pounds or check
here if you are declaring 5' anchors without testing A test
showing 275 inab pounds or less will require 5 foot anchors,
Note: A state approved lateral arm system Is being used and 4 tand ft.
.anchors are allowed atihe sidewall locations. I unders5St
anchors are required at all centerline tie points where the torque test
reading Is 276or less and where the mobile home manufacturer may
requires anchors with 400D lb holding capacity.
Installer's initials
ALL TESTS MUST BE PERFORMED BY A LIOENSED INSTALLER
InstailerName
Date Tested d-u'Zp
' ' FJeatrleal
ibnnect electrical conductors between multi -wide units, but not to the main power
ource. This•includes the bonding wire between must -wide units. Pg.
_.
plembinq _ n vn �Ei o- .✓�
bnnact all sewer drains to an existing sewer tap or septic tank Pg.
onnect all potable water supply piping to an existinp or meter, water tap, or other
idepeindentwater supply systems, pg. 'l.%
IJERMiT WORKSHEET page 2 of 2 �a
O
_ site Preparation
Debris and organic material reWvedLU
Water drainage: Natural Swale
_{L Pad __ Other
Fastening mulawltle units
Floor. Type Fastener C Len d
gth: spacing: ZY
Walls Type Fastener. L ft- Length:,•(__ Spacing:
_---'7.y
Roof: Type Fastener: Length: 4 W Spacing: _
For -used homes a m 30 gauge,'$" wide, galvanized metal strip
will be centered over the peak of theroof and fastened with galy.
roofing nails at 2" on centeron both sides of the centarline.
GesketNalheroro"Iln6rewl n
I understand a properly Installed gasket is a requirement of ail newand used
homes and that condensation, mold, meldew arid 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 gasket
�
Installer's initials �'L_
Type gasket Installed:
Pg. Between Floors Yes
�—
Between Walls Yes
Bottom of rldgebeam Yes 7�
Westherprooting
The bottomboard will be repaired and/or taped. Yes pg,
Skiing on units Is installed to manufacturer's specifications. Yes ��
Fireplace chimney Installed so as not to allow iritruslon of rain water. Yes
Skirting to installed. Yes (/ No
in
Dryer vent installed outside of skirting. Yes WA T
Range downflow vent Installed -outside of skirting. Y WA
Drain lines supported at 4 fort Intervals, Y
Electrical crossovers protected. Yes
Other:
Installer
Is accurate and true based on the
Date -7/ f