HomeMy WebLinkAboutPermit Worksheet-10MM"IT NUMBER
InstallerI�� License #
Address of home 17 ReJ, 4 C -t*-n C Wry
being Installed
Manutacturer o `la" Length x width k 70
NOTE: ' if home is a single wide fill out one half of the blocking plan
If`honie is a triple or quad wide sketch In remainder of home
I understand Lateral Ann Systems cannot be used on any home (new or used)
Mare the sidawall ties exceed 5 ft 4 in, ---�/
Installer's rnitials t
Tvnical Oar snaclnn .
PERMIT V!f(7RKS tEE'T
page I of
New Home • ® Used Home ®�
0
< 5
Home installed fo the Manufacturer's installation Manual
L
Home is Installed in accordance with Rule 15-0
Eau
Singie wide ® Wind Zone Ii Er' Wind zone III
13
0
0
Double wide installation Decal #as
0
Triple/Quad [J Serial # FL H `'` % 13 71.297 2 Y8Z
o"S e-1—
PIER SPACING TABLE FOR USED HOMES
U)
Load
6earin
size r
I
i 6°xis°
181/2' x 98 t/2'
20' x 20°
'22° x W- 24° X a4°
-26' x a6°
rapaolty
(sq in)
t266) .
(342)
(400)
(434)" (576)'
1000
s
3
00
s
W 6
6
$
000
s
6
B .
$
2 00
s
6
8
$
8•
'3000
s
8
8
3 0-
s •
' 8 '
8
a 1.4-..::f-,-J
--- .,..-
PIER PAD SIZES
I-beam pier pad size _ 17 X?_ Z_
Perimeter pier pad size /
Other pier pad sizes
(required by the mfq.)
®Draw the approximate locations of marriag
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 Pievad:size
/ 7 k z a
TIEDOwN COMPONENTS
Longltudlnal Stab)111-g DedJce (LSDj
Manutaoturer •1 ,_
Longitudinal Stab111a1ng Device /Lateral Arms
Manutacturer_Lkt.uJt��•..c.
POPULAR P)D'SIZES
ANCHORS
4 ft -5ft
FRAME TiES
within 2' of and of home
spaced at 5' 4" oc
OTHEi `rILS
Number
Sidewal! .
Longitudinal
Marriage wall
Sheanvall
�t' P 4 � ppeuy��
` j•• PERMIT NUMSM
•en
POCKET PENETROMETER TEST
The pocket penetrometer tests are rounded-d'own to psf
or check hereto declare i 000 lb• soil 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 foster.
S. Usipq 500 lb. increments, take the lowest
reading and round down to that inoremenL
X
TORQUE PROSE TEST
The results of the torque probe test is 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 at -the sidewall locations. i understand 51
anchors are required at all centerline tie points where the torque test
reading -is 275•or less and where the njobile home manufacturer may
requires anchors with 4000 lb holdinp capacity.
Installer's initials
ALL TESTS MUST BE PERFORMED BY A PCENSED INSTALLER
Installer Name (1v %' N,t tl
Date Tesf'ed
• ' Eleotrical -
lonnect electrical conductors between multi -wide units, but not to the main power
ource. This•ingludes the bonding wire between must -wide units. Pg..
onneot all sewer drains to an existing sewer tap or septio tank. Pg.
onneot all Potable water supply piping to an a ist' water meter, water tap, or other
dependent water supply systems. Psi.
PERMIT WORKSHEET page 2 of 2
a
Z e
51te Pre aratlon ft
Debris and organic material removed
Water drainage: Natural // Swale Pad Other
Fastentn multi wide units
Floor Type
WFastener. L A% • Length: G Spacing: Zr
Walls: Type Fastener- -_ Length: Spacing: iU D
Roof: Type Fastener: � Length; �� Spacing: Z.
For. used homes a min. 30 gauge,8" wide, galvanized metal stri
will be centered over the peak of the•roof and fastened With gaiv.
roofing nails at 2" on center on both sides of the centerline,
Gasket (wealher00011110mulree=1
I understand a properly installed gasket Is a requirement of all new and used
homes and that condensation, mold, meldew -rid 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 / Installed:
Pg. Between Floors Yes
Between Walls Yes — ---
Bottom of ridgebeam Yes_
weatherprootlne
The bottomboard will be repaired and/or taped, Yes Gl--' Pg.
Siding on units Is installed to manufacturer's specifications. Yes _ t%—���
Fireplace chimney Installed so as not to allow ititruslon of rain water. Yes et- 04
M1=1Wsne7us
Skirting to be.installed. Yes,_.No
Dryer vent installed outside of skirting. Yes _ • T/WA
Range downflow vent installed'outside of skirting. Yes VA
Drain lines supported at 4 foot intervals, Y
Electfical crossovers protected. Yes
Other:
is accurate and true based on the
Installer Signature _
Date