HomeMy WebLinkAboutPermit Worksheets PERMIT WOIIKSHEET , page 1 of 2 l
f�1(T NUMBER :»�. ���'`'�� r�` �r'•.: .
Y
New Home ❑ Used Home -
Installer ��rs-t��C 'I d. 4, License# -��y//0 / /3'l
Home installed to the Manufacturers Installation Manual ElAddress of home y / �/L 11 les 121y�t )je-e,_[f Home is installed in accordance with Rule 15-0 [/
being Installed
Single wide ❑ Wind Zone it Wind Zone III ❑
Manufacturer > �� Length x width y-2 / Double wide 2 Installation Decal x
NOT5. 'it home Is a single wide fill out one half of the blocking plan Triple/Quad ❑ Serial; Y ✓� `t�T 9� >� J�
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 o ed PIER SPACING TABLE FOR USED HOMES
where the sidewall ties exceed 5 ft 4 in; '
Installer's initials
.. Load Footer 16`x 16` i 8 112'x 1 S i!2' 20'x 20' 22'x 22• 24'X 24' 26'x 26'
Typical pier Spacing• bearing size (256) (342) (400) (4e4)' (576)' (676)
capacity (sq In)
j D laterrl 1000 s 3
2'
I Sl ow locations of Longitudinal and Lateral Systems 1 0.0 s 4 6 6 8
I. itu'unal (use dark lines to show these locations) 600 s 6 8 8 6
2 00 pst8 a $
3000 osl 8
3500 pst $ 8
Interpolated from Rule 15C-1 pier spacing table. POPULAR PAD 51ZES
PIER PAD SIZES
I-beam pier pad size Co icreul' Fad 61ze bq In.
16 x lb 256
El ElPerimeter pier pad size �'�" r� x
Lj Li Li Li Li • - 18.5 x
Other pier pad sizes i a Cre4_04_" 16 x
374
(required by the mfg.) x
x
Draw the approximate locations of marriage 20 x
wall openings 4 foot or greater. Use this x
symbol to show the piers, x
1/2
me[rlapr wall plot within 2'of end of home vat Rule t5C )( 576
List all marriage wall openings greater than 4 foot x
and.their pier pad sizes below. ANCHORS
Opening Pier pad:size 4 ft 5 fi
s FRAME TIES
within 2'of end of ho�n�
spaced at V 4"oc
TIEDOWN COMPONENTS OTHER TIES
Number
Longitudinal Stabilizing Device(LSD) Sidewall
Manufacturer Longitudinal
Longitudinal Stablllzing Device w/Lateral Arms Marriage wall _—
Manufacturer-- Sheanval!
* - :::' j.,.• - PERMIT WORKSHEET I page 2 of 2 I
PERMIT NUMBER : >.
NO , ...
Site Preparation
POCKET PENETROMETER TEST
Debris and organic material removed
The pocket penetrometer tests are rounded down to psf Water drainage: Natural Swale Pad Other
or check hereto declare 1000 lb,soil without testing.
Fastening multi wide units
X — X X
Floor Type Fastener L Length: Spacing;
Waifs: Type Fastener Length: Spacing:
POCKET PENETROMETER TESTING METHOD Roof: Type Fastener;[� Length: Spacing:
For.used homes a 30 gauge, 8"wide, galvanized metal strip
1. Test the perimeter of the home at 6 locations, will be centered over the peak of the-roof and fastened With galy,
2. Take the reading at the depth of the Tooter. roofing nails at 2"on center on both sides of the centerline.
Gasket(wmtherpiocfing requln_ment)
3, Using 500 lb, increments,take the lowest
reading and round down to that increment. I understand a properly installed gasket Is a requirement of all new and used
homes and that condensation,mold,maldew and buckled marriage walls are
a result of a poorly installed or no gasket being installed. I understand a strip
X X X of tape will not serve as a gasket.
Installer's initials e-
TORQUE PROBE TEST
Type gasket b� Installed:
The results of the torque probe test is Inch pounds or check Pg. Between Floors Yes
here if you are declaring 5'anchors without testing , Atest Between Walls Yes
showing 275 inch pounds or less will require 5 foot anchors, Bottom of ridgebeam Yes
Note: A state approved lateral arm system is being used and 4 ft.
.anchors are allowed at-the sidewall locations. I understand 5 ft Weatherproofing
anchors are required at all centerline tie points where the torque test
reading is 275•or less and where the mobile ljome manufacturer may The bottomboard will be repaired and/or taped. Yes %Pg.
requires anchors with 4000 lb holding capacity. Siding on units is installed to manufacturer's specifications. Yes•_[1_
Installer's initials Fireplace chimney Installed so as not to allow intrusion of rain water, Yes
ALL TESTS MUST E PERFORMEDW A LICENSED INSTALLER Mlscellaneous
Installer Name /,�/�� ��► �-7 Skirting to be installed. Yes No
Dryer vent installed outside of skirting. Yes_4z:::f`wA
to Tesfed WA Range downflow vent install Ed,outside of skirting. Yes
Drain lines supported at 4 foot intervals. Yes
Electrical crossovers protected. Yes
N Other:
Electrical
lbnnect electrical conductors between multi-wide units,but not to the main power
ource. This includtas the bonding wire between mutt-wide units. Pq. installer verifies al•i information iven with this permit worksheet
Piumbin g
is accurate and true based on the
onnect all sewer drains to an existing sewer tap or septic tank. Pp, manufacturer's install on instructions a d or Rule 150-1 & 2
onnect all potable water supply piping to an existing water meter,water tap, or other
Installer Signature:
tdependent water supply syslems, Pg,