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PERMIT NUMBER e
Installer -e: Z-1�,4r�_ License
Addressofhoms 7TA
being Installed
Manufacturer 4/'? S Length xwidth 7 �7
NOTE • if home Is a single wide fill out one hall of the biocklag plan
If home [so triple or quad wide sketch in remainder of home
I understand Lateral Arm Systems cannot be used on any home (new or used)
More the sidewall ties exceed 5 ft 4 in.
Installer's initials
PERMIT WORKSHEET
New Home . Q Used Home �-
Page 1 of 2
Home Installed to the Manufacturer's Installation Manual ❑
Home is Installed in accordance with Rule 16•0
Single wide ❑ Wind Zone II Wind Zone III ❑
Double wide � Installation Decal
TriplelOuad ❑ Serial eole J dOL
PIER SPACING TABLE FOR USED HOMES
Load
Footer
bearing
size
166x16'
IS I&x t8112' 201x20'
22'x22+
24'XZ4'
26'%26'
capwlty
(sq In)
(266
2 (400)
(464)•
(576)'
(b76)
100
e
9
00
6
6 16
00 a
6
s
2 00 s
6
8 6
g
s000
s
0 psi I
e. 6
- PIER PAD SIZES
I-beam pier pad size
12
Perimeter pier pad size
/% �� X 2 2 r r
Other pier pad sizes
_ 7, r� x;? 2 rr •
(required by the mfg.)
MIDraw the approximate locations of marriage
wall openings 4 toot or greater. Use this
symbol to show the piers.
List all marriage wall openings greater than 4 foot
and .their pier pad sizes below.
POP AR PAD SIZES
ANCHORB
4 it
FRAME TIES
within 2' of end of home
spaced at 5' 44 oo
OTHER TIES
LongRudlnal Sfablllzing Device (LSD Sidewall N ben
Manufacturer We, Longitudinal
Longitudinal StabillzingDevlce w/Larera/Arprs Marriage wall
Manufaelurer 1n. u O. i
F
Opening Pier pad:size
ri %f �1 of
TIEDOWN COMPONENTS
PERMIT WORKSHEET I Page 2of 2
PERMIT NUMBER `.....::::...:.,
POCKET PENETROMETER TES
Thepbcket penetrometer tests are rounded �'to pat
or check here -to declare 1000 lb. soil _f` without testing.
X_ X_ X_
POCKET PENETROMETER TESTING METHOD
i. Test the perimeter of the home at 6 locations.
2. Take the reading at the depth of the footers
S. Using 500 Ib. increments, take the lowest
reading end round down to that increment.
X X__
TORQ E. PROBE TEST - -.
The results of the torque probe test Is :2 N '� 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 It
anchors are allowed atihe sidewall locations. 1 understand 5 it
anchors are required at all centerline tie pointp where the torque test
reading Is 275 or less and where the mobile home manufacturer may
requires anchors with 4000 .ding capacity.
Installer's Initials
ALL TESTS MUST BE PERFORMED BY A LICENSED INSTALLER
//< ` Installer Name e %`•e• _�� e �p 1 ?14
Date Tested
Fre�ulpal
Ibnnect electrical conductors between multi -wide units, but not to the main power
Durce. This-ingludes the bonding wire between mutt -wide units. Pg,
- Plumb no lity,
onnect all sewer drains to an existing sewer tap or septic tank Pp.
onnect all potable water supply plPing to an existing water meter, water tap, or other
idependent water supply systems. Pg.
Site Preparation -
Debris and organic material removed
Water drainage: Natural _Swaie Pad Other
Fastenlno mull' wide units
Floor. Type Fastener Len rr
Length: �a Spacing: 2 n
Walls: Type Fastener. Length: � Spacing: J s •'
Roof: Type Fastener, Length: �_ Spacing: t1
For.used homes asnin. 30 gauge, S' wide, galvanized metal strip
will be centered "over the peak of theroof and fastened with galy,
roofing nails at 20 on center on both sides of lha centerline.
Gasket lwmlhemr fl ar.a I n
I understand a property 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 gasket.
Installer's initials
Type gasket "4 _Installed:
Pg. Between Floors Yes
Between Walls Yes Bottom of of ridnebeam Yes r--
Wmtherprootlnn
The bottomboard will be repaired and/or taped. Yes `' pp,
Siding on units is installed to manufacturer's specifications. Yes
Fireplace chimney Installed so as not to allow intrusion of rain water. Yes &/01
Mlaeellnnecus
Skirting to be Installed Yes ---,?To
Dryer vent Installed outside R skirting. Yes • � NIA
Range downflow vent installed -outside of skirting. Yes WA A
Drain lines supported at 4 foot intervals, Yes 4i
Electrical crossovers protected. Yes
Other:
Is accurate and true based -on the
Installer Signature
Dat�1-/.1 -�ULG