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Installer _ PL-k 2-, z v=A Lloensa#
Address of home
being Installed
Manufacturer Length x widths
NOTE 'If home is a single wide fill out one half of the blocking plan
if home Iva triple orquad wide sketch In remalnder of home
I understand Lateral Arm Systems cannot be used on any home (new or used)
where the sidewall ties exceed 5 ft 4 In.
Installer's fnitiais e
Typical pier spacing • . n
• _ocations oflines _ _ Lateral Systems
_gym de locations)
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PERMIT WORKSHEET
I page 1 of 2
New Home • M Used Home
Home installed to the Manufaoturer's installation Manual: ❑
Home is Installed in acoordanoe with Rule ib-C Q
Singlp wide [ Wind Zone II ❑ Wind Zone III
Double wide ❑ Installation Decal # 6 ,29 ! 5- ®f
Triple/Quad ❑ Serial # X - _6 #F0 ®�Si�RC�•
PiER SPACING TABLE FOR USED HOMES
Load
adng
capacity
FoS1Z
Z'i
(sqn
1 S' x 16'
(266)
181/2' x81/2'
(M)
20' x 2o'
(400).-
W x- 221
(484)•
24' X 24'
(676)
26' x Z6'
(676)
00 s.
371
O s
4
6
g
000
8
8
2 00 Fs
t3
8
g
B
300000
8'
g
nwirwniw u�w nulo 10v I p10r apncuip wun.
PiER PAD SIZES
I-beam pier pad size `eX.2.2
Perimeter pier pad size l%""K2
Other pier pad sizes
(required by the mfg.)
Draw the approximate locations of marriage
wall openings 4 foot or greater. Use this
symbol to show the piers,
List all marriage wall opentrigs greater than 4 foat
and.thelr pier pad sizes below.
Opening Pier pad;size
l��► x ya
TiEDOWN COMPONENTS
Longitudinal Stablilzing Device (LSD
Manufacturer _i/M c7 1A cA 72
Longitudinal Shi IIIzin; Device wl Lai al ArnIs
Manufacturer- `%
POP L PAD S ZES
It�1>
�ii r--�'FiI�B��c
• �,
ANCHORS
4 ft
FRAME TIES
within 2' of end of home
spaced at 5144 o0
OTHER IES
Sldewall N
er
Longitudinal
Marriage wall
Shearwall
P
_ sOcc BE o�LE COPY
PERMITNUMBER � ��<--�
�A
POCKET P NETRO ETER TE5
The pbokst penetrometer tests are roundd"wn to psf
or check hereto declare 10o0 lb. soil without testing.
X X X
POCKET PENETROMETER TESTING METHOD
1. Test the perimeter of the home at 6 locations.
2. Take the reading at the depth of the jooter.
3. Using 500 lb. increments, take the lowest
reading and round down to that Increment.
X X X
ORQUE PROBE TEST
The results of the torque probe test is.� Inch pounds or check
hers 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 atihe sidewall locations. I understand 5 ft
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 4000 Ib holding capacity.
`2 Installer's initials
ALL TESTS MUST BE PERFORMED BY A LICENSED INSTALLER
Installer Name X-C o,
Date Tested 4_ 4 r Z za CP r
Electrleal
1b n
nW. electrical conductors between multi -wide units, but not to the main power
ource. Thisingludss the bonding wire between must-wide'units. Pa.
aonneot all sewer drains to tan existing sewer tap or septic tank. Pg.
onnect all potable water supply piping to an existing water meter, water tap, or other
,dependent water supply systems. Pg.
PERMIT WORKSHEET
L pegs 2 of 2 I
site Preparation
Debris and organic material r
geogAmxi
Water drainage: Natural ter' Swale Pad Other
Fastening multi wide units
Floor, Type Fastener L S g;
Walls: Type Fastensr. ength: pacing:
Roof: Type Fastener Length: Spacing:
For- used homes min. 30 gauge, 8" ids, galvanized eta/ strip
Will be centered'over the peak of the -roof and fastened with galy.
roofing halls at 2" on center on both sides of the centerline,
Gasket Lweetherpreetina neuhementf
I understand a properly installed gasket is a requirement of all 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 initlais /?' 2 °
Type gasket Installed:
Pg. Between Floors Yes l-1
Between Walls Yes
Bottom of ridgebeam Yes
Weatherproofing
The bottomboard will be repaired and/or taped. Yes L-- . Pg.
Siding on units is installed to manufacturer's specifications. Yes _
Fireplace chimney Installed so as not to allow intrusion of rain water. Yes ?7414
Mlsaelrnneous
Skirting to be instalf6d. Yes �No
Dryer vent Installed outside of skirting. Yes • -�— WA
Range downf low vent installed,outside.of skirting. Yes WA '
Drain lines supported at 4 foot intervals. Yes c/'
Electrical crossovers protected. Yes
Other:
er verifies aU information given with this permit
Is accurate and true based on the
Installer
Date A