HomeMy WebLinkAboutPermit Worksheet�yE�Mt NUMBER
Installer _Lll� rolia4z�( License# �l( to(6
Address of home Z ( {t)/a(� gar
being Installed
Manufacturer __ a ),a I r eyz- I eolith x width
NOT& ' ff home Is a single wide fill out one half of the blooldag plan
lf'home ve triple oT quad wide sketch frt rema/nder of home
I understandLdtaral Aim Systems cannot be used on any home (now or
where the sldewall ties exceed 5 ft 4 in.
Installer's initials
Tvnical nicer sTar6.. _
• 5l� (zt,
PERMIT WORK -SHEET page 1 of 2
New Home • ® Used Home
Home Installed to the Manufacturer's Insti liation Manual
Home Is installed —In accordance with Rule 15-0 Q
Single wide M /Wind Zone If E3 Wind Zone III ❑ /
Double wide
TdplelQuad
❑ Installation Decal 9 E)NAWq 5 s
❑ serial 3ws�A ort zq� o i
PIER SPACING TABLE FOR USED HOMES
Load
' tiBatlpg
Footer
SIZe
1S°X1e°
1af/2'XIS112'
20'x20°
22°x22'
24'xZ4' '26'x2W
. eaolty
ap
(sq In)
(266) _
(3
400
( )
. (464)•
(576)' (ere)
1000
a
D
4 6
6
6
00
00
s
6
6
6
a
'800013g
inferpotated from Rule 1SC•1 pier spacing table.
PIER PAD SIZES
I-beam pier pad size — 1"? X2Z,
Perimeter pier pad size /%gk Z>"
Other pier pad sizes
(required by the mfq.)
®Draw the approximate locations of marrlag
wall cpenings 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 Pierpadslze
FT-
TIEDOwN COMPONENTS
Lorighudlnal Stablllaing Device (LSDJ
Manufacturer Mt.., Syria, i
Longltudinal Stablardng Device /Latteral Ani7s
.Manufacturer _G4LIUdJdnu� SIe S
ANCHORS
4ft 5ft
FRAMETIES
within 2' of end of home
spaced at SW oo
GTHER'r1ES
Number
Sidawall
Longitudinal
Marriage wall
Shesrxail
' + PERMIT NUMBER
POCKET PENETROMETER TEST
The
check herboket e-to declare 1000 Ier tests h Boll_ded do out testinq. pat
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,foeter;
S. Using 600 lb. increments, take the lowest
reading and round down to that increment
Xe_
TORQUE PROBE TEST
The results of the torque probe test Is 3 / 5 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 at4he sidewall locations, I ulfderstand SA
anchors are required at all centerline tie points where the torque test
reading is 276 or Isis and wh rpthenjobile Home manufacturer may
requlres anchors with 4000 lb in aspectty.
ller's initials
ALL TESTS MUST BE PERFORMED 13Y A LICENSED lldSTALLr=R
Installer Name _w
Date Tested _V/-z a,9/ ZJ '
. Electrical
ibnnect electrical conduciors between multi•wide units, but not to the main power
ource. Thls•inoludes the bonding wire between must -wide units. Pg.
bnneot all sewer drains to an existing sewer tap or septic tank pg.
anneal all potable wafer supply piping to an exi. water meter, water tap, or other
dependent water supply systems, pg.
PERMIT WORKSHEET page 2 of 2
. site Preparatlon
Debris and organic mateilal rarnoved
Water drainage. Natural Smle�Pad Other_T,
Fastening multi wide units '
Floor. - Type Fastener, LAKr/ - Length: Spacing:_
Walls: Type Fastener: r�� Length: Spacing: 2
Roof: Type Fastener. /Ar_ Length; Spacing: r /
Focused homes a min. 90 gauge„ 6" wide, galvanized metal strip
will be centeied'over the peak of theroof and fastened with gaiv.
roofing nails at 2" on center an both sides of the centerline,
_ - easket rwmthw' ,in I e •
I understand a properly installed gasket Is a re
qulrsment of all now and used
homes and that condensation, mold, meldew and buckled Mn triage walls are
a result of a poorly installed or no gasket being installed, 1 derstand a strip
Of tape will not serve as a gasket,
Installer's initials
Type gasket Installed:
Pg. Between Floors Yes c/
Between Walls Yes
Bottom of ridgebsam Yam`
Weatharproognc
The bottomboard will be repaired andPortaped. yes_ pq,
Siding on units Is installed to manufacturer's spaciIIcaifons. Yes �—
Fireplace chimney Installed so as not to allow intrusion of rain water, Yes _
Skirting to be.installed. Yes 4'� No
Dryervent installed outside df skirting. Y� WA
Range downflow vent installed'outside of skirtinj-,,Yss =WA
Drain lines supported at 4 foot intervals. Yes
Electrical crossoversprotected. Yes —
Other:.
is accurate and true based an the
InstallerSignatura Date