HomeMy WebLinkAboutPermit WorksheetPERMIT NUMBER
Installer iL6e,-+ 67,,v_re_tf License It T14 0 000 Y?7
Address of home 4j 1 L?
being Installed
Manufacturer 1241� Length x width
.NOTE., If home is asingle wide fill Out one half of the blocking plan
If home Is a triple or quad Wide sketch In remainder -of h9me
I understand Lateral Arm Systems cannot be used on any home (n
where the sidewall ties exceed 5 It 4 in. Installer's initials
Typical plor spacing
9, . :;-- - I lalaraf
Show locations of Longitudinal and Lateral Systems
(use dark lines to show theso locations)
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PERMIT WORKSHEET F I E pugc.. !iPY
New Home
Home installed to the Manufacturer'sinstallatiori Manual
❑
Home is installed In accordance with Rule 1 5-c
oil
Single Vida ❑ Wind Zone 11 Wind zone III n
P-0-0bW Installation Decal it ;2- 9 3
TriplelQuad ❑ Sorial # 0
PIER SPACING TABLE FOR USED HOMES
Load Footer —
bearing size 16*X1s* 18112-XI8I/2. 2v ill 110 2;4'X24' 26'X26'
(57sfl
(2") (342) ) (676)
CaPa-Ity I (sqln) 4 (576), (676)
In 02-U—U sl
Interpolated from ',Rufe —160t piar_spacfnp table.
PIER PAD SIZ#_Sj t POP__R PAD S12EES-1
I-beam pier pad size- )CA Al
a SIM q n
Perimeter pier pad size x _7M
Col, x _�Nn
Other pier pad sizes /Y X
(required by the mfg.) - W16M_x' _1
Draw the aPPr0x'-IMaIQ "locations -of-marria5W&II openings 4footorgreater.
Use this
symbol to show the piers,
List all marriage wall openings greater than 4 tool
and their pier pad sizes below,
Opening Pier pad size,
X
TIEDOWN COMPONENTS
Longitudinal StabiftingpevIce (LSD)
Manufacturer rvU I ve- r-
Longitudinal S-11'4i-iAbli'I'Ll'lz-�ln�De—vic Zr , a- , - --
Manufacturer e W/ Lateral Aii�s_
4 ft
Z5
FRAME TIES
within Vol and of home
spaced at 5' 4" oc 1.
OTHER TIE8
Sidawall Number
Laniltudinal
Marriage wall
Shoarwall
PE.RIJiIT NUMBER
�j NIwIiMI t WORK -SHEET Pale 2 of 2
i�'�xr.a`:,f;*'►r'�;�.''L,N,",,t•:f�!!"1:1`�`�.xs'r'X...�i�^.,:'"; ` I
POCK PENETROMETER EST
The pocket penetrometer tests are roundedAown to pal
or check hereto declare 1000 Ib. soil %F without testing,.
POCKET PENETROMETER TESTING METHOD
1. Test the perimeter of the home at 6 locations.
2. Take the reading at the depth of the tooter.
3, Using 500 lb. increments, take the lowest
reading and round down to that Increment.
TORQUE P OBE TEST
' The'rosults of the torque probe test is fin nds or check
here tl you are declaring 5' anchors without tin A test
showing 2751nch pounds or less will require 5 to anchors.
Note: A state approved lateral arm system is being used and 4 it,
anchors are allowed at the sidewail locations. I understand 5 it
anchors are required at all centerline lie points where the torque test
reading is 275 or less a5,q,ding
e the mobile home manufacturer may
requires anchors with capacity.
Installer's initials .
_ ALL TESTS MUST -BE PERFOR ED BY A LICENSED INSTALLER
i Installer Name r, 'c,r��r� /I
Date Tested Pr i D $
Electrical
?onnect electrical conductors between multi -wide units, but not to the
source. This includes the bonding wire between mull -wide units. Pg. ,
:onnect all sewer drains to nn oxisling sewer tap or septic lank. Pg. �
:onnect all potable water supply piping to an existing water meter, water tap, or other
id6pondcnl water supply systems. Pg. V 01 4
Site Pre 'arutIdn _ �.. __ ..
Debris and organic material reryoved
Water drainage: Natural t/ Swale Pad Other
Fastening multi wide units
i
Floor: Type Fastener: —^_ Length: CQ 's Spacing:
Walls: Type Fastener. Length: dor Spacing:
Roof; Type Fastener; Length:!_- Spacing:r`
For used homes a min. 30 gauga, 8" wide, galvanized metal sirilf
will be centered over the peak of the root and fastened with gaiv,
roofing nails at 2" on center on both sides of the centerline.
Gasket (weorharp;zing regulrennm)
I understand a properly Installed gasket is a requirement of all, new and used
homes and that condensation, mold, meldew and buckled arriage walls are
a result of a poorly Installed or no gasket being installed. n orstand a side
of tape will not serve as a gasket.
Installer's initials
Type gasket n �Y� `�h (' Installed:
Pg. �r— Between Floors Yes 1
Between Walls. Yes�_y_3 �
Bottom of ridgebeam Yes
weatherprconng i
The boltomboard will be repaired and/or taped. Yes Pa.
Siding on units is Installed to manufacturer's specifications. as` —
Fireplace chimney installed .so as.not.to allow
Miscellaneous
Skirting to be installed. Yes ✓ No
Dryer vent installed outside of skirting. Yes NIA
Range downf low vent installed outside of skirling, Yes N/A
Drain lines supported at 4 foot intervals. Yes ✓
Electrical crossovers protected. Yes ✓
Other:
Installer verities all information given with this permit worksheet
Is accurate and true based on t
manufacturer's in la n in eti or Rule 1510-1 & 2
Installer Signatur Date, 1 A S ,