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PERMIT WORKSHEET
PERMIT NUMBER
Installer ;�2"i-) 1:n7 // 1rGtf�i z_ License �//23/ �6
Owner Name & /
Address of home U!r ToX/,�k
being installed -
Manufacturer /i11.R, Length x width
NOTE: if home is a single wide fill out one half of the blocking plat
1f 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 sidewall ties exceed 5 ft 4 in. Z
Installer's initials
Typical pier spacing 7
lateral
2' S� !llrrr r
.a-�_ Show locations of Longitudinal and Lateral Systems
cony udmat (use dark lines to show these locations)
L_j u u �u u u u u
'-'--- LEI - -- - - -- -----• J -j ------
within 2' of end of home per Rule 15C
New Home ❑
page 1 of 2
Used Home (� Year Model [ /
Home installed to the Manufacturer's Installation Manual ❑
Home is installed in accordance with Rule 15-C 9.01
Single wide ❑ Wind Zone II Wind Zone III ❑
Double wide Installation Decal #
Triple/Quad ❑ Serial # 7-Z K 3 2 y8 2 V
PIER SPACING TABLE FOR USED HOMES
Load
bearing
capacity
Footer
size
(sq in)
16" x 16"
(256)
18 1/2" x 18 1/2"
(342)
20" x20"
(400)
22" x 22"
(484)•
24" X 24"
(576)•
26" x 26"
(676)
1000 psf
&
5'
6
T
8'
1500 psf
4' 6"
6'
7'
8'
8'
8'
2000 psf
6'
8'
8'
8'
8'
8'
2500 psf
T 6"
8'
8'
8'
8'
8'
3000 pst
8'
1 8'
8'
8'
8'
8'
— -3500 psf- -
---8'
1 8y-
g- -
8
- -8'- -
8,__
interpolatea from mule i ou-i pier spacing tams
PIER PAD SIZES
I-beam pier pad size �':l' Z v,
Perimeter pier pad size / Z z,p
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 openings greater than 4 foot
and their pier pad sizes below.
POPULAR PAD SIZET71
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ITI
iritF,K4M '4%►PaNEICIS
Emu r•' 3wM71 r:1 •
Ems
ANCHORS
Opening Pier pad size
Xz2>> a 5ft
�X 2P
-7 FRAME TIES
within 2' of end of home L11
spaced at 5' 4" oc
TIEDOWN COMPONENTS OTHER TIES
Number
Longitudinal Stabilizing Device (L.SD. Sidewall
Manufacturer �' 2 �^ Sy.sfZw' Longitudinal
Longitudinal Sfabi izing Device w/Lateral Arms Marriage wall
ManufacturerySvwS Shearwall
co
PERMIT WORKSHEET ge 2 of 2
PERMIT NUMBER
POCKET PENETROMETER TEST
The pocket penetrometer tests are rounded down to psi
or check here to declare 1000 lb. soil 2_,�- 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 X
TORQUE PROBE TEST
The results of the torque probe test is 'Q-(g 7 inch pounds or check
here if you are declaring 5' anchors without testing . A test
showing 27.5 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 tie points where the torque test
reading is 275 or less and where the mobile home manufacturer may
requires anchors with 40Q0 lb holding capacity.
-71 Installer's initials
ALL TESTS MUST BE PERFORMED BY A LICENSED INSTALLER
Installer Name Cain P�
Date Tested % / - o
Electrical
Connect electrical conductors between multi -wide units, but not to the maid power
source. This includes the bonding wire between mult-wide units. Pg. '✓
Plumbing /
Connect all sewer drains to an existing sewer tap or septic tank. Pg. 1-
Connect all potable water supply piping to an existing water meter, water tap, or other
independent v9ter supply systems. Pg. rl�
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Site Preparation
Debris and organic material removed
Water drainage: Natural Swale Pad Other
Fastening multi wide units
Floor: Type Fastener: 6.0 Length: 8 " Spacing: / Z �
Walls: Type Fastener: Ian Length: Spacing: I Zi'
Roof- Type Fastener: Length: y�>' Spacing: / •Z21
For used homes a rmn. 30 gauge, 84de, galvanized metal strip
will be centered over the peak of the roof and fastened with gals.
roofing nails at 2" on center on both sides of the centerline.
Gasket (weatherproofing 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 Z. -Z
Type gasket Installed:
Pg. Between Floors Yes
�® Between Walls Yes ��
Bottom of-ridgebeam Yes
The bottomboard will be repaired and/or taped. Yes 6/ . 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' N/� N/A
Range downflow vent installed outside of skirting. Yes
Drain lines supported at 4 foot intervals. Yes,
Electrical crossovers protected. Yes
Other:
Installer verifies all information given with this permit worksheet
is accurate and true based on the
Installer Signature _ Date
All information on Is wg sP ee nusAle filled out completely to be accepted.
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