HomeMy WebLinkAboutPermit WorksheetsPERMIT WORKSHEET
PERMIT NUMBER
Installer � �► /i1a e,, 72l o i License 4 Z
Owner Name &
Address of home
being installed Zoc3 _ �Tl' 3 fig e
Manufacturer _ _. Length x width f
AfOrg: if Horne is a single wide fill but one Half of the blacking plan
If home is a triple or quad wide sketch in remainder of horns
I understand Lateral Arm Systems cannot be used on any home (new or used)
where the sidewall ties exceed 6 ft 4 in. T1
Installer's initials /.
21
Typical pier spacing
,jt 40 / lateral
Show locations of Longitudinal and Lateral Systems
C77iengltudinal (use dark lines to show these locations)
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marriage
wall piers within of
end
of hems per
qule
160
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New Home rl
gaga 1 of 2
Used Name Year Model -- _
Home installed to the Manufacturer's Installation Manuel [i
Home is installed in accordance with Rule 16-0
Single wide Wind Zone II � Wind Zone III ]
Double wide installation Decal #
Triple/Quad Serial #�-
PISR SPACING TABLE FOR USED HOMES
Load
bearing
capacity
t
Footer
size
(sq in)
16" x 16"
(266)
18 112" x i8 ill"
(342)
20" x 20"
(400)
22" x 22"
(484)"
24" X 24"
(678)''
26" x 26"
(676)
- -- 1600 sf ...
4' 6'
6'
7 -
$'
2000 sf
6'
- 8
8'
8, —
8
8 _..
2600 pst
7 6'
8'
8'
81 -
8'
8.
'3500 psf-- --
—$ —
$----
8 ---
— 8
0
8 -
Interpolated from Rule 150-1 pier Spacing I8131!
Ii1g:13 PAC) S12�5_
I-beam pier pad size %-2— �� - z--
Perimeter pier pad size
Other pier pad sizes �_ X
(required by the mt.)
1 Draw the approximate locations of marriage
.,...i well openings 4 foot or greater. Use this
symbol to show the piers.
List all marriage wall openings greater than 4 foot
I----26 x_2s
and their pier pad sizes below.
ANCWi�R�
Opening Pier pad size
(:4 6 ft
YlES--
' „ >,
within 2' of end of home
spaced at 64,oc
F77TlEDOWN COMPOWNTS IU7Fi�Ft
YIDS
Number
Longitudinal Stabilizing Device ('LSD, Sidewall
Manufacturer ,�79i%7cJ7- - - 7yjjkkKongitudInaI _
Stabillzing Device Marriage wall -
Longitudinal w/Late#WArms
Manufacturer Jl,T?@ y�j - Shearwall
PERMIT WORKSHEET
page 2 of 2
MOO 311:1
PERMIT NUMBER
POCKET PENETROMETER TEST
The pocket penetrometer tests are rounded down to psi
or check hereto declare 1000 lb. soil without testing.
X
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. Using 500 lb. increments, take the lowest
reading and round down to that increment.
X
TORQUE PROBE TEST
k1l
The results of the torque probe testis 23 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 at the sidewall locations. I understand 5 ft
anchors are required at all centerline be points where the torque test
reading is 275 or less and where the mobile home manufacturer may
requires anchors with 4000 lb holding capacity.
—2 2 Installer's initials
ALL TESTS MUST BE PERFORMED BY A LICENSED INSTALLER
Installer Name
Date Tested
Electrical
Connect electrical conductors between multi -wide units, but not to the main power
source. This includes the bonding wire between mult-wide units. Pg?--
Connect al sower drains to an existing sewer tap or septic tank. Pg. �
water supply piping to an existing water meter, water -tap, or other
supply systems. Pg. c__,/
Site Preparation
Debris and organic materi I removed
Water drainage: Natural Swale Pad Other
Fastening multi wide units
Floor: Type Fastener: 41 -�:? Length- 8 ; Spacing: "2")
Walls: Type Fastener: /.✓ Length: ' ,, Spacing: / Z'
Roof: Type Fastener. /.,gg Length: Spacing:
For used homes a-rhin. 30 gauge, 8" 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 (weatherprooring requirement)
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 initials R :-Z
Type gasket Installed:
Pg. %fir Between Floors Yes J/
I1� Between Walls Yes Ooo�
Bottom of ridgebeam Yes
Weatherproofing
The bottomboard will be repaired and/or taped. Yes Pg. /
Siding on units is installed to manufacturer's specifications. Yes ✓
Fireplace chimney installed so as not to allow intrusion of rain water. Yes
Miscellaneous
Skirting to be installed. Yes &.-' No
Dryer vent installed outside of skirting. Yes ✓ NIA
Range downflow vent installed outside of skirting. Yes N/A
Drain lines supported at 4 foot intervals. Yes
Electrical crossovers protected. Yes c�
Other:
Installer verifies all information given with this permit worksheet
is accurate and true based on the
Installer Signature / Date
All information on this wor�ksf eet must be filled out completely to be accepter
1