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PERMIT WORKSHEET" � prig 2ai2 -
PERMIT NU1MBM - - ---.........
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_ - _ srre Preparattan POCKET -
1_11Ef't3{ TES _
Debrls and organic matsriat_ ►�4�oved_
The Oxicel pen+elmmetertesfs are roundwn fa Wafer dtabage:Natural V Sale Pad Oihez
Or check herelb declare 1 WO lb soil1. w tozii tsstlhg.
- Fastenlne multi Wide un is
X X X I r
f=loor' Type Fastener; t. na h:
Wafts: Type Fastener: Lon sith:� ung
POCKET f�U EMOM1=7�R TE'"Ta 3Nt�TJ OHOD Root Type fastener. Lonli#b: SpacinS� `► ,:-
Far_used homes a - SO 47auge.8M de,�nh
i. Test She perim�er of the hotrre at 6 Tocatlorys� - will be centered Duro the beak of themf and fastened Qh galy.
roofing traits at r on Mettler an both sides of the amimdina
2 Take the t ead"ing at the depth of the footer. - -
a UAing Stat lb,fircrrrnenm;take the lowest
reaft and round down to flat ihmment. l under-44nd a property Installed gasket Is a requirement of as newmnd used
- - hordes and that condemsetlor4 mold,meldew and buckled mactfage wralls are
' a result of a poorty Installed or no gasket beinglnstalletL l tinderstsnd a strip.
•X X _X of tapd MR not save as a Saskef.
T&W- insli�ller's Inittals�����aJ
QEPffOE Si
Type gasket �C?U14[1 Installed: f -
The results of the torque probe test Is ___.,.kmh pounds or check` - P8- Between Floors Yes v
here if you are derhrIng V anchom w8lout testima , _ A test - Between Walls Yes
showlnlf 275 kmji pounds or less will require 5 foot andhom _ Bottom of ftebeam Yes
• Note; A state approved ietetaf atm system fs baI#rg used and tit. -
znchom ere allowed attle sidewtmU locatl m f midemiand b ft wean+
kidhots are requited at aft centerline tie pokil;;vAU30 the torque test
reading is 275or low and where the mobile Rome umnulaolurer may l ha bottomboard wM be repaired amVorteped. Yes Pg.
requGas anchors w73htdiny7 capacity- ME=on toots is inst<
installed to manukic er's spec atlorm- Yes
� � irh atlet's Fireplace cfftney installed so as not to aP�of telt water. Yes
ALL TI STs MUST 13E PERFOFI ED BY A L COISED TNSTAUIER a our
Installer Nemre - Slitting to be insta i& Yes No -
DateTested CWarvcnt itrstalled oiA da of sldrflrtg. Y~s�W!� _
Ran#e dawntlow vent imstatted-outrJde of ski_ WA
�� Drain&nes supparted of 4 fo6t Intervals Y
Electrical crossovem protected. Yes
tbnneot electrical conductors bahveem rYh4fi-wide urft but not to the main pDwer
ounce- •r'Wwlr eludes the bonding woe between roa It-wilder=Am F,�,
Installer verlfi[es aU information givers w tfr this permit WOTksheet
inq - M �. is accurate and true based on the
zrnnpd all sewer drains to brt MdsllnA seweriaP ar:ept9c tank Pg-
all s TTatla In `oras and of Rule ISQ-1 & S�
[rtsralter slgnsiure - 1 /
nrtn+ect elf potable wafer amply PIptny7 to an existing wafer meter,wafer tap,orathet — ---
DDeettfepsncler�t yrafer supply sys3arns, Pg.