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-Pt=RMiT NUMBER
Installer Celwt Le- Lloense # 1/
Address of home
being Installed
Manufacturer —/i %_rP Length x width L �c` 40
NOTE: 'it home is a single wide fill out one half of the blocking plan
- lthorde is a trlpfe 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 it 4 In.
Installer's Initials
7ypIcW jpie/r�sp�aorinq
!„ 1/�rjr✓ �� aja Metal
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Longitu• - l and Lateral Systems
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. .. v DEC 10 2019FILE COPY
PERMIT WORKSHEET L page 1 of 2
New Home . Used Home
Home installed to the Manufaoturees Installation Manual' ❑
Home is installed in accordance with Rule 15.0
SinAlp wide Wind Zone ll ❑ Wlnd Zone III
Double wide ❑ installation Decal # ' 2 gl .9
Triple(Quad ❑ Serial # i A2 -6{F/ xm ob
PIER SPACING TA®LE FOR USED HOMES
.
size
za
(aq in)
16XiS'
(256)
181/2'X181/2'
(342)
20'x20•
(400)
22'x22+
(4aa4y )'
24" X24'
(� si(61
2WX2r
)
jFo
1000
s
6
s�'
lr Ol�J
PIER PAD SIZES
I-beam pier pad size 22S,Z2 rr
Perimeter pier pad size �' `� �•� �r
Other plat pad sues
(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 openings greater than 4 toot
and.thelr pier pad sizes below. .
Opening Pier pad:size
0
TIEDOWN COMPONENTS
Lnngltudlnal Stabilizing Devloe (LSDJ
Manufacturer l'���"�l r 1��� //'%� ,-o p
Longltudlnal StabAlz(ng DevLafera/Arms
Manufacturer__ !mot �- �1 �.?' .•�s�
E—POPULAR PAD Sizes
- •
EYILII
iL•�3[i��I>'
I iI>,ssy
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ir�r�s��.�r�.ai■a=�
ice[■
NENVJWr:r
KALM
ANCHORS
4 It50
FRAMETIES
Within 2' of end of home
spaced at 5140 o0
OTHER ES
Nuroar
Sddewall 1
Longitudinal
Marriage wall
Sheatwall
Y
i
. . .... ..... .
PE* �Q�
RMIT NUAIBi:R .''�:.:�<:N,k;r .
POCK lR PENETRO ETER TES
The pboket penetrometer tests are rounded down to psi
or check hereto declare t0oo lb. soil --Mout 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 footer,
S. Using 600 lb• increments, take the lowest
reading and round down to that Increment.
_ ORQ P OB EST '
The results of the torque probe test is ---, 0 Inch pounds or check
here 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 at4he sidewall locations. I understand 5 ft
anchors are required at all centerline tie points where the torque test
reading is 275 or hiss and where the ntoblle home manufacturer may
requires anchors with 4000 k h!glding capacity.
Installer's Initials
ALL TESTS MUST BE PERFORMED BY A LICENSED i?9STALL9R
Installer Name r —e jpk K. 2_, Zoo�;�
Date Tesfed _ /'/
' cetrlonl
bn' nW electrical conductors between multi -wide units, but not to the main power
ource. This includes the bonding wire between mutt-wide'untts. Pg.
Pigmb na
onnect all sewer drains to art existing sewer tap or septic tank Pg.
�I onnect all potable water supply piping to an eXlsting water meter, water tap, or other
idependent water supply systems, Pg.
PERMIT WORKSHEET page 2 of 2
site Preptratlon
Debris and organic material r ed
Water drainage: Natural Swale Pad Other
asters ndl multi wide un to
Floor, Type Fastener pth: pacing:
Walls: Type Fastener. Length: ,/ Spacing:
Roof; Type Fastener Length: / Spacing:
For. used hom a min. 30 gauge, t3" wide, galvanized m , al strip
will be centared'over the peak of the -roof and fastened with gals.
roofing nails at Von center on both sides of the centerline,
Gasket 6umthe►picafinamulrwenn .. .
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. 1 understand a strip
of tape will not serve as a gasket.
Installer's Initials
Type gasket Installed:
Pg. Between Floors Yes
Between Walls Yes
Bottom of ridgebeam Y
Weatherproolina
The bottomboard will be repaired and/or taped. Yes
Siding on units Is installed to manufacturer's specifications, Yes ,,�
Fireplace chimney Installed so as not to allow intrusion of rain water. Yee;4
Miscellaneous
Skirting to be installed, Yes 4,"� No J
Dryer vent Installed outside of skirting. Yes ci'�WA
Range downflow vent tnstalled•outside.of skirting. Yes WA
Drain lines supported at 4 foot Intervals, Yes
Electrical crossovers protected Yes
Other:
o all Information given with this pi
Is accurate and true based on the
Installer Signature
Date "0'