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NUMBER ? r'h: �.`av;• ?2 4,yi?�v�rts IN., ,w,•k}'0u ,a',R} • .:�L..'—^�+•
Installer _ Lyr1-k1-! « License
D•1 f-( —(b! C l 2
Address of home C..lkS O f q-,5
being installed
Manufacturer _8e__1L-s o F tq,1Qr;?RTL-engthxwidth 27 tc S.2
IVOM, ' It -home to a single wide fill out one half of the blocking plan
ihome is a triple or quad wide sketch in remainder of home
1 uriderstand Lateral Arm Systems cannot be used on any home (new or u )
where the sldswall ties exceed 5 It 4 in,
Installer's initials_
Yvoical elar sr,ar_inn . _
PER -MIT WORKSHEET
New Home • ® Used Hcme
Home installed to the Manufacturer's Installation Manual C3
Home is installed in accordance with Rule 15-0 13
Single wide ® Wind Zone il- 0--_ Wind Zone 11! ®
�,
Double wide ��jnstailation Decal # ��
.
Triple/Quad ® serial # FG #et a ! U Zo t Z 7) 1
PIER SPACINl3 TABLE FOR USED HOME
Load
ng
Footer
sire
f r X•16°
18 i12' X 18 112'
20' X20'
221x 22' 24' X 24' 6°
olly
(sq in)
(256).
(342)
(400)(4a4)°
(576)° (676)
0D0
5
3
00
s
46
6
D00
S
OD0
s
D
s-
g
g
PIER PAD SIZES
I-beam pier pad size 17 �x 2 a
Perimeter pier pad size
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 Pier padsize
a
TIEQDWN COMPONENTs
Longitudinal Stab111zIn Device (LSAj
Manufacturer o Sc,
s S
Longitudinal zlrLq Device w Lateral Arms
Manufacturer__ fffrrr���ttt rN Uft,..eo., 4sf a `"�
POPULAR PAD 51ZES
ANCHORS
4 ft 5 ft
FRAME TIES
within 2' of end of home
spaced at 5' 4° oc
ETHER TIES
Sldewall . Number
Longitudinal
Marriage wall
Shea' 11
I
f• r u
PERMIT NUMBER
POCKET PENETROMETER TEST
The
check herokel e-to declare i 0eter olb. soilund�oWitto thout testing. psf
X� X X
POCKET PENETROMETER TESTING METHOD
i. Test the perimeter of the home ate locations.
2. Take the reading at the depth of the•footer
S. Usinq 500 lb. increments, take the lowest
reading and round down to that Increment.
X®
X®. X
TORQUE PROBE TEST
"a results of the torque probe test is inch pounds or check
here if you are-deolaring 5' anchors without testing _ - A test
showing 275 inch pounds or less will require 5 foot anchors,
Note: -A state approved lateral aim system is being used and 4 ft.
anchors are allowed at the sidewall locations I understand 5 ft
anchors are required at all centerline tie points where the torque test
reading Is 275•or less and where the Mobile dome manufacturer may
requires anchors with 4000 lb holding capacity,
installer's initials
ALL TESTS MUST BE PERFORMED BY A LICENSED INSTALLER
Installer Name W yti i,4_
Date Tesfed
Eleoiileal
Ibnngot electrical conductors between multi -wide units, but not to the main power
ource. This•ingludes the bonding wire between mult-wide units. Pg.
Pkimbino -
onneot all sewer drains to an existing sewer tap or septic tank Pg. e
onnect all potable wafer supply piping to an existin water meter, water tap, or other
idependerlt water supply systems, Pg. !�
PERMIT WORKSHEET I page 2 of 2
Site Preparation
Debris and organic material r ed
Water drainage: Natural Swals Pad Other ----
Fastening multi wide unite
Floor. Type Fastener: t .f Length:
Spacing: Z y `•
Walls: Type Fastener. Length:_ Spacing:y
Roof: Type Fastener: --- - Length:. _ 6 Spacing: 2.y
For.used homes a min. so gauge,Z" wide, galvanized mgtal strip
will be centered •over the peak of the•roof and fasteried With galy.
roofing nails at 2" on center on both sides of the centerline.
Gasket rweelhemroelln; ngulranae,tl
i understand a properly installed gasket Is a requirement of all no wand used
homes and that condensation, mold, meldew grid 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 F_�� Installed:
Pg. —_ Between Floors Yes !%
Between Walls Yes v
Bottom -of ridgebeam
weatherprooflnW
The bottomboard will be repalred and/or taped. Yes_pg.
Siding on units is installed to manufacturer's specifications, Yes �-
Fireplace chimney Installed so as not to allow intrusion of rain water, Yes `464-
Mlsoelianeotis
Skirting to be.installed. Yes �No
Dryer vent installed outside of skirting. Yes & NIA
Range downflow vent installed -outside of skkting �-WA
Drain lines supported at 4 foot intervals, Yes
Electrical crossovers protected, Yes
Other:
all. inform- ati®n given, with this pe
is accurate and true based on the
Installer Signature _
Date�i✓�.�~ y o
' J