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- PtRMIT NUMBER
Installeran Dense #
Address of home Z
being Installed
Manufacturer s ACl Gl Lenpthxwidth
NOTE: ' if home to a single We flll out one half of the blocking plan
If home Is a triple or quad w1de sketch In remainder of home
I understand Lateral Arm Systems cannot be used on any home (new o used)
where the sidewall ties exceed 5 ft 41n:
Installer's initials
Typical pierspacing - .•
PERVI[T WORK -SHEET
page l of 2
New Home Used Home ❑
,
Home Installed to the Manufacturer's Installation Manual ❑ ,
Home is Installed 1� rdance with Rule 15-0
Sinple wide Wind Zone It
Wind Zane III
Double wide ' ❑ Installation Decal #
J
Tdple(Quad ❑ Serial #/�
' PIER SPACING TABLE FOR USED HOMES
d
toad, Footar 76'x!6' l81/2'x�8!!2' 2o'x20' 22'x22' 24'X24' 26'X26'
beadnq `size
capacity (SQ6) (2) (40) (�' (�6�r (76 .
POP R P g_ ES�I
aNcHDRs
Ott Sfl
FRAMETIES
Within Vol and of ho�n-
-------� spaded at 5' 4' oc
TIEDOWN GoMpo,4 S 1-0THEA'r7Es
Longitudinal sibIl g Devi D Sidewall Number
Manufacturer fiec �ivrtiyo Longitudinal
Longitudinal $j;bllb Devlre�v/Lateral Arms Marriage wall
Manufacturer _ t ovn �7►�Il �_
I-beam pier pad size
Perimeter pier pad size
Other pier pad sizes
(remilred by the mf
!?raw the show the
locations of marriage
wall op�nrugs 4 foot or greater. Use this
symb12 he plers,
List all marriage watt openings greater than 4 toot
and.thelr pier pad sizes below.
Opening Pier pad -size
' � I
v
•S .4 L
PERMIT NUMBS?
The pbcket penetrometer tests are rounded
orcheokhereto declare 1090lb.,soil
n� r
'Without testing, psi
X
TESTING METHOD
1. Test the ' star of the hoMs at 6 locatlons.
2 tnoa!-500
e reading -bike depth of the.faoter.
lb, increments, . rawest
reading and round down to that increment.
X X
'Re TnT
MUM Mra
The results of the torque probe test is Inch ds or check
here if you are declaring V anchors without testing •n q test
Showing 275 Inch pounds or less will require 5 foot anchors.
NOW A state approved lateral arm system is being used and 4 ft.
anchars are allowed stills sldewall locations I understand 5 ft
anchors are required at all oenterllne tie points where the torque test
reading Is 276 or less and where the mobile home manufacturer may
requires anchors W444 oo lb holding capaotty.
--- / ,�L 5 Installer's Initials
ALL TESTS MUST BE PERFORMED BY A UOENSED IN
STAU.Fa
Installer Name r14 v r s
Date Tesfed
ibnneot electrical conductors between multi -wide units, but not to the main power
ourom This•inOudes the bonding wire between nruit-wide units. pg.
P Um o
ennW all sewer drains to an erdsfing sewer tap or septic tank pg. A / �yn�'
onnect all -potable water supply piping to an existing water meter. water tap, or of er '
!dependent water supply systems, pg.
PERMIT WORKSHEET
2012
Debrls and organic material removed
Water drainage: Natural Swale Pad ✓ Other
Floor Type Fastener, Length: pacing:
Walls: Type Fastener. _ _ Spacing:
Roof; Type Fastener. Length: Spacing:
For.used homes a min. 30 gauge, 8" wide, .gWvaNzed metal stdP
will be centered over the peak of the -roof and fastened With gWv.
roofing halls at 2° on center an both sides of the centerline.
• dasket�ivalherpranfingteWlranent�
1 understand a properly installed siasket Is a requirement of all new and used
aresult of a poorly Installed omes and that r noogaskett beinInstalled. I ud budded nderstand ers and a sts walls rip
Of tape will not serve as a gasket.
Installer's initials _
Type gasket Installed:
pg. Between Floors Yes
Between Walls Yes
Bottom of ridgsbeam Yes
t ottomboard wiII be repaired and/or taped. Yes _ pA,
rC/ irePIace chImney in�illeded �ro as notallowintrusionvol off min water. yes.V\'K
Mr eous
Skirting to be installed. Yes No
Dryer vent installed outsideot sldrting. Y;e- WA
Range downflow vent Instalied•outsids of skirting, Yes NIA
Drain lines supported at 4 foot intarvals. Yes - �/
Electrical cro�ov�r�prbtec d. Yes
Other s�ao 0
14 accurate and true based'on the
Installer Signature Date ���