HomeMy WebLinkAboutPermit WorksheetPERMIT WORKSHEET
PERMIT NUMBER
Installer �W (Ctk-�'_ (a(.tj a !& License#Address of of home / 41L qt) Lo` ,•q El-- being installed
l�c (� g r Manufacturer Length xWidthl
NOTE. if home is a single wide fill out one half of the blocking plan
if home is a triple or quad wide sketch in remainder of home
I understand Lateral Arm Systems cannot be used on any home (new or used)
where the sidewall ties exceed 5 ft4 in. (�
Installer's initials uo�
Typical pier spacing
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Ilateral
Show locations oT I_ongiwofnai and Lateral Jyb 11121
(use dark lines to show these locations)
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I page 1 W 2
New Home IZ Used Home ❑
Home installed to the Manufacturer's Installation Manual Lam!'
Home is installed in accordance with Rule 15-C ❑
Single wide ( ' Wind Zone II ❑ Wind Zone III
Double wide ❑ Installation Decal # I J—D
Triple/Quad ❑ Serial #(,.
PIER SPACING TABLE FOR USED HOMES
Load
bearing
capacity
Footer
size
(sq in)
16" x 16"
(256)
181/2" x 18
1/2" (342)
20" x 20"
(400)
2Z' x 22'
(484)"
24" X 24"
(575)'
'2&' x 2V'
(676)
s
S
ZDUU S
ps
s
interpolated from Mule Pwr spw'"U Winn.
PIER PAD. SIZES
1-beam pier pad sine 20 >4
Perimeter pier pad size /
Other pier pad sizes
(required by the mig.)
I Draw the approximate locations of m
f1wall openings 4 foot'orgreater. Use
symbol to show the piers.
List all marriage wall openings greater than
and their pier pad sizes below.
Opening Pier pad Size
TIE]OWN COMPONEmrs
��T3n�i1Z=J_' JIM'.17
ANCHORS
4 ft 5 ft
I . FPAMETIES
within 2' of end of home
spaced at 5' 4" oc
OTHER TIE$
Number
Longitudinal StablYzWev)cp(LSD) Sidewall
Manufacturer 11 Art MoI'll Longitudinal
Longitudinal StakYlzing Device W Lateral Arms Marriage wall
Manufacturer Shearwall
PERMIT WORKSHEET
PERMIT NUMBER
O
The pocket penetrometer tests are rounded down to 1530 psf
or check here to declare 1000 lb. soil without testing.
Xibnn X i2?D X L(eQb
POCKET PENETROMETER TESTING METHOD
1. Test the perimeter of the home at 6 locations.
2. Take the reading at the depth of the looter.
3. Using 500 1b. increments, take the lowest
reading and round down to that increment.
x.5� X t b0c) X ISDO
TORQUE PIVOSE TEST -
The results of the torque probe test is o2>� inch pounds or check
here if you are declaring 5' anchors without testing . Atest
showing 275 inch pounds or less willrequire 5 footanchors.
Note: Astate approved lateral arm system is being used and 4 ft
anchors are allowed atthe sid6wall locations: I understand 5 It
anchors are required at all centerline tie points where the torque test
reading is 275 or less and where the mobile home manufacturer may
requires anchors with 4 0 b holding capacity.
Installer's initials
ALL TESTS MUST BE PERFORMED BY A LICENSED INSTALLER
Installer Name D,,o1 qk+ 7 p� j (A s
Date Tested(}��
ectr ca
)onnect. electrical conductors between multi -wide units, but not to the main power
;outce. This includes the bonding wire between mult-wide units, Pg.
Plumbing
:onnect all sewer drains to an ebsting sewer tap or septic tank. Pg.
I page 2 of 2
Site Preparation
Debris and organic material r oved
Water drainage: Natural material
vV Pad : - Other
Type Fastener. A t
Type Fastener. t
Type Fastener: !
For used homes a min. 30
will be centered over the pe
roofing nails at2" on center
le, 8" wide, galvanized metal str
the roof and fastened with gals.
othsides of the centerline.
Gasket (weatborproofing requiroment)
I understand 0 properly installed gasket is a requirementofall 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 1-1 Installed:
Pg. Between Floors Yes .
Between Walls Yes
Bottom of ridgebeam Yes
Weatherproofing
The bottomboard will be repaired and/ortaped. Yes _- - Pg.
Siding on units is installed to manufacturer's specifications. Yes
Fireplace chimneyinstalled so as not to allow intrusion of rain water. Yes
Miscellaneous
Skirting to be installed. Yes / No
Dryer vent installed outside of skirting. Yew— N/A
Range downflow vent installed outside ofsklrting. Yes N/A
Drain lines supported at foot intervals. Yes
Electrical crossovers protected. Yes
Other:
Installer verifies all information given with this permit worksheet
Is accurate and true based on the
Installer Signature DateM&M �15
'.onnect all potable water supply piping to an wdsting water meter, water tap, or other