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' PERAAIT NUMBER,
installer 1P_A r I C14 yYt•� L �✓ Ucense o Kw2i/
�.s'/
Address of home
being Installed
Manufacturer Length x width &3r
NOT>:: 11 home 1s a single w/de rut out one hair of the blocking plan '"S L11.1 X0 " THO
if home Is triple or quad wide sketch In lemalnder'of home w Q
I understand Lateral Arm Systems cannot be used on any home (new or used) 4W
where the sidewall ties exceed 8 it 4 In.
Installer's initials W
Typical pier spacing • �
WNW
Show locatlons_of Lonphudinal and Lateral Systems.
.,��e dark lines to show these locations)
Wa"Piea wph r at" at h me pot
yERWIIT W09K.SHEET page 1 of 2 I
New Home Used Home
lnstWIW to the Manufacturer's Installation Manual
is Installed in accordance with Rul 16
wide ❑ Wind Zone 11 [30'0' Wlnd Zone I II
i wide ' Call"' Installation Decal 4
quad ' [] Serial #
Pia SPACING TABLE FOR USED HOMO
Q
W FbaW 16'xis, 181/11081/2' 20'x20' '22'x22' 24'X24' 26•X26'
(� �
Q 4 ►in8 size (�� ig42) (400) (4s4)' (8 a (676)
lid
(� 0o s
0 8 t3 g
0 fi 8 fi 8
30 D o g
MUDs 8' .' 8
1111AaIpw1299W 11441"mum low -I ptnTspawny lnoio.
IV L.J PIER PAb Sp:EbTij
I-beam pier pad size J 2" X o
Li Perimeter pier pad size ,L% x 22,x "
1,1 ) Other pier pad sizes LZ X ;2A 'r
(required by the mfo.)
6c ®Draw the approximate looatlons of marde
wail apeningie 4 foot or greater. Use this
symbol to show the piers.
List all mardepe wall openirios greater than 4 foo
�7_.___I -1-_- l._._...
POP PA SIZES
_......,.,... ,...,. ,.,.., �tiw ..�,...., ANCHORS
Opening Pier padsize
i• FRAMETiES
within
a1 of a
4 of home
TIEOOWN COMPONENTS OTHER TiES
Lflng11 1 r7al Stabl/Jz•!ng Device I%D Sidewall
Num er
Manufacturer m-'.� u?`.o s�� Longitudinal
Longltud/na1 Stabllizlny Device w/�a1 Arras Marriage wall
Manufacturer_ c �, u7-r�r Shsanvail
1111AaIpw1299W 11441"mum low -I ptnTspawny lnoio.
IV L.J PIER PAb Sp:EbTij
I-beam pier pad size J 2" X o
Li Perimeter pier pad size ,L% x 22,x "
1,1 ) Other pier pad sizes LZ X ;2A 'r
(required by the mfo.)
6c ®Draw the approximate looatlons of marde
wail apeningie 4 foot or greater. Use this
symbol to show the piers.
List all mardepe wall openirios greater than 4 foo
�7_.___I -1-_- l._._...
POP PA SIZES
_......,.,... ,...,. ,.,.., �tiw ..�,...., ANCHORS
Opening Pier padsize
i• FRAMETiES
within
a1 of a
4 of home
TIEOOWN COMPONENTS OTHER TiES
Lflng11 1 r7al Stabl/Jz•!ng Device I%D Sidewall
Num er
Manufacturer m-'.� u?`.o s�� Longitudinal
Longltud/na1 Stabllizlny Device w/�a1 Arras Marriage wall
Manufacturer_ c �, u7-r�r Shsanvail
4
' PERMIT NUMS9A
Pff
CrR—OMTE5 ;
The pboket penetromete eptaar nded down to per
or check hereto di t030 Ib. soil without testing.
x'_. X.,,_„+ xr._..
POCKET PENETROMETER TESTING METHOD
i. Test the perimeter of the horhe at 6 locations.
2. Take the reading at the death of thsjcoter. .
a Using 500 lb. 14c;rements,-1ak® the lowest
reading end round down to that increment.
X„_
oPROBE
The results of the torque probe test Is - inch pounds or check
here if you are declaring 5' anchors about testing - Most
showing 276 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 requk*ed at all oenterilne_tie-points where -the -torque -test-. -- -
- — -readtng-is 278 orle s and Where the rriobile homa manufacturer may
requires anchors with 4000 lb ho ding capacify.
Installer's ingtale
ALLTESTS MUST BE P FORMED BY A LJOENSED INSTAU.9R'
' Installer Name / 1 it ! L �`, e L �-ec
Date Tested -
' eo
tbnneot electrkial conductors between multi -wide units, but not to the main.power
ource. This-Ingludes the bonding wire between mul&wlde unita . Pg:
q
nnneot all sewer drains to an existing sewer tap or septic tank -pp.
onneot all potlk4le water supply piping to an existing water meter, water tap, or other
idependerlt Water suppig systems, pg.
PERMIT WORKSHEET
Site epara on
Page 2 of 2 I
Debris and organic material reMoved '
Water drainap•� Natural 8wale Fad. Other
e en n� ma B wide un to
Floor. Type Fastener. �_ . length: Spacing; ,2 �I
Walls: Type Fastener. A Spacing:
Roof; Type Fastener � Length. �' Spaoin .' _
For.used homes a n.130 gauge;; 8 wi e, ga(yanized m al dripwill be centered over the peak of themroof end fastened With gale,
roofing Halle at 2" on venter cn both sides of the oertteritne► '
1 understand a property Installed gasket Is a requirement of all new and used
homes and that condensation, mold, meldew and buckled marriage wags are,
a result of a poorly Installed or no gasket being instelled. I understand a strip
Of tape will not serve as a gasket. ,�
(nstalie►'s initials 4.' 1-04
Type gasket � o'cM Installed:
Pg. Between Floors You
Between Walls Yes
Bottom of ridgebearn Yes
nw�nwprwnng — --- -
The bottomboard will be repaired and/or taped. Yes Pg,
Sidin on units is installed to manufacturer's epeofticat one, es
Flrep�op chimney installed so as not to -allow intrusion of rain water. Yes h�n�
. ►anmoum
SkIrUng to be Installed. Yes No
Dryer vent Installed outside of sldrtt. YTS/' Wit
Range downflow vent inehWed•outside of sldtting WA,,;_,_
Draln lines supported at 4 fobt intervals, Yes_____,_„
Eleotricai crossovers protected Yes,;_
Other;
Installer
Is accurate and true based'on the
.._. Date�11