HomeMy WebLinkAboutPermit Worksheets• PERMIT NUMBER IN 6-��
Installer 514 l��S14 4fzJC,7c License # �d2ck:2' 3 e
Address of home �' `? A-70 44,04
being installed
Manufacturer Length x width .2
NOTE; ' If home Is a single wide fill out one half of the blocking plan
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 or used)
where the sldewall ties c 5 ft 4 In. /,[T
initials
Typicapier spacing
9. Nw Isl�rat
show locations- _
(use dark lines to show these locations)
r r tism
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a Dome
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New Home [] Used Home
7132
I Page 1 of 2 I
Home Installed to the Manufacturer's Installation Manual ❑ '
Home is installed In accordance with Rule 15-0 ❑
Single wide ❑ Wind Zone II e Wind Zone III ❑
Double wide Installation Decal #
Triple/Quad ❑ Serial # �L a��-3•�`�'� �� "
F't fL .2 W O-3t .905. 5 a
PIER SPACING TABLE FOR USED HOMES
Load
n
Footer
size
(sq in)
16' x 16'
(256)
18 1/9' x 18 1/2'
(342)
20' x 20'
(400)
22' x 2T
(484)•
24' X 24'
(676)•
26' x 26'
(676)
0 s
3
0. s
6
OOD s
8
8
2 00 s
8
8
e
��-c1haa15n1
'3000 s
8
8
3 s
8'
Interpolated from mule 1 bu-i pier spacing =is.
PIER PAD SIZES
I-beam pier pad size
Perimeter pier pad size / "�•g� 'r
Other pler pad sizes
(required by the mfg.)
Draw the approximate locations of marriage
FM
wall openings 4 foot or greater. Use this
symbol to show the piers.
List all marriage wall openings greater than 4 foot
and.their pier pad sizes below.
Opening Pler pad -size
'nEDOWN COMPONENTS
Longitudinal Stabilizing Device (LSD),
Manufactureryni'yt.u1--e iff �, (LSD),
Longitudinal Stabilizing Device wilatera/Arrifs
Manufacturer
POPULAR PAD SlZE3
1l3!
it-1F-'1�i 'iE•i�.�
i�(:3�•i.�1iL:1�i
]i7[l
ANCHORS
4 ft •5 ft
FRAME TIES
within 2' of end of home
spaced at 6' 4" oc
OTHER TIES
Nu, ber
Sldewall
Longitudinal
Marriage wall
Shearwall
1
.1
d' PERMIT NUMBERf .�
POCKET PENETROMETER TEST
The pbcket penetrometer tests are ro down to psi
or check hereto declare 1000 lb. soil t 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 footer.
3. Uping 500 lb. ihcrements, take the lowest
reading and round down to that increment.
X X •X
TORQUE PROBE TEST
The results of the torque probe test Is P— & 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 atthe sidewall locations. I understand 5 ft
anchors are required at all centerline tie pointy where the torque test
reading Is 275 or less and where the mobile home manufacturer may
requires anchors with 400,p lb bolding capacity.
Installer's initials
ALL TESTS MUST BE PERFORMED BY A LICENSED INSTALL9R
Installer Name L/ 146 n v4 G
Date Tested �` !9-,'leg 9
Electrical
:bnneot electrical conductors between multi.wide units, but not to the m in ower
ounce. This•Ingludes the bonding wire between mult-wide units. Pg.�
PiUrnIng c S A+
onneot all sewer drains to an existing sewer tap or septic tank Pg. /'e f
onneot all potable water supply piping to gn, existing or meter ter tap, or other
idependent-water supply systems. Pg.
PERMIT WORKSHEET
. t.
page 2 of 2
Site Preparation
Debris and organic material removed /�o ki'
Water drainage: Natural .>5, Swale Pad Other
Fastening muitl wide units
Floor. Type Fastener. 41A R Length: Spacing:
OPYType Fastener. Length: - fr Spacing:
Type Fastener. Length: 1�I Spacing: Ir
For used homes' a rffn. 30 gauge, 8e wide, galvanized metal strip
will be centered'over the peak of the -roof and fastened with gaiv.
roofing nails at 2" on center on both sides of the centerline.
Gasket (weetherproorrng requirement)
I understand a properly Installed gasket Is a requirement of all new and used
homes and that condensation, mold, meldew and buckled marriage wails 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 Initials
Type gasket � Installed: v. '
Pg. Between Floors Yes
Between Walls Yes
Bottom of ridgebeam Yes
Weatherproollng
The bottomboard will be repaired and/or taped. Yes /v- Pg.
Siding on units is installed to manufacturer's specifications. Yes -k_
Fireplace chimney Installed so as not to allow intrusion of rain wate Yes
JY0 Ai' o e —44C
Skirting to be Installed. Yes x -No
Dryer vent Installed outside of skirting. Yeses- WA
Range downflow vent installedoutside of skirting. Yes WA .X "
Drain lines supported at 4 foot Intervals. Yes yC
Electrical crossov rs protected. Yes_
Other: -Oa 7u G.cow
verifies ap information given with this permit worksheet
is accurate and true based 'on the
Installer Signature
Date %�a 16