HomeMy WebLinkAboutPermit WorksheetPERMIT NUMBER
Installer 6�► r re-- f - License # 1 ' 0000,r% 7
Address of home �70 y �• GtS—! _ �'�". Qi�?('eC�, �1 3Y9Y&
being installed
Manufacturer '�i,Jii✓I Length x width MO,
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 re►nalrider'of home
I understand Lateral Arm Systems cannot be used on any home (ne45-
where the sidewall ties exceed 5 It 4 in.
Installer's initials
Typical pier spacing
2 lateral
Show locations of Longitudinal and Lateral Systems
lo71 udmal (use dark lines to show these locations)
TNES
ARE S
RE I I
MAY BI
QQMPI
1;
FILE COPY
PERMIT WORKSHEET ( pugo 1 of 2
New Hom® ❑ "UsdciiHQ
Home installed to the Manufacturer's Installation Manual ❑
Home is installed in accordance with Rule 15-C
Single wide ❑ Wind Zone II []1 Wind� Zone III ❑
tTaut fe'�iaylde w Installation Decal Il --Al
I , 7 2 2
Triple/Quad ❑ Serial # %Y AP 3141,4 I % aY 74 3` 16
PIER SPACING TABLE FOR USED HOMFs
Load
bearing
capacity
Fouler
size
(sy in)
16' x 16'
(256)
18 1/2' x 18 1/2'
(342)
20' x 20-
(400)
22' x 22'
(484)'
24' X 24'
(576)'
26' x 26'
(676)
1000 ps
3.
4
5
8
1 00 s
4 fi
6
7
8,6
2000 nsf
6
8
6
g
2500 s
6
8
8
8
8
8
3000 s
8
8
g
a
g
3 0 s
8
8
Fi
.v'.uuuu ui �v .:v- 1 Nlcl aNq:ll lrl M1VItl.
PIER PAD SIZES
I-beam pier pad size
Perimeter pier pad size
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 toot
and their pier pad sizes below.
Opening Pier pad size
TIEDOWN COMPONENTS
Longitudinal Stab ilt ng Device (LSD)
Manufacturer Myer
✓er
Longitudinal StablikIng Device w/Lateral Arms
Manufacturer 0i
POPULAR PA_Q_S_1Z_ES---
Pad Size
S In
.x 16
116 x 78
18,5 x 16.5
6 x 22.5
360
17 x 22
13 1/4 x
20 x 20
400
x
17 1/2 X 25 172—
X
26 x
AN/C'HORS
4 it V 5 It
FRAME TIES
within "2' of bnd of home
spaced at 5' 4" oc 4
OTHER TIES
Number
S nl �(P
Lonpitultiludinal _s__
Marriage wall 3—
Shearwall
FILE COPY
F'ktiMII WURKSHEET
;✓`k;!''''�+`�;�"'�..,�e,,r�'K: (.;^�1�...�:��s,;:...,.. � I pogo 2 of 2 I
KRiJlf NUMBER_
Isomer PENETROMETER TES
The pocket penetrometer tests are round own to psi
or chock hereto declare 100011). soil SC 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. Using 500 lb. increments, take the lowest
reading and round down to that Increment.
XX X_
TORQUE PROBE EST
The results of the torque probe test is ?-5 c unds or check
here if you are declaring 5' anchors without testing . A test
showing 275 Inch pounds or less will require 5 toot hors.
Note: A slate approved lateral arm -system is being used and 4 ft.
anchors are allowed at the sidewall locations. I understand 5 It
anchors are required at all centerline tie points where the torque lest
reading is 275 or less and where the mobile home manufacturer may
requires anchors with 4000 lb holding capacity.
Installer's initials
ALL TESTS MUST BE PERFORMED BY A LICENSED INSTALLER
Installer Name g66 o� j-e-d? f
Date Tested �� v
Electrical
'.onnect eleoldcal conductors between multi -wide units, but not to the mVa'in�ower
)ourco. This includes the bonding wire between mull -wide units. Pg. -�,
Plumbing
:onnect all sewer drains to an existing sewer tap or septic tank. Pg. -/t-5
)onnect all potable water supply piping to an. existing water meter, water tap, or other
dependent water supply systems. Pg.
Site Preparation
Debris and organic material r moved
Water drainage: Natural � Swafo Pad Other
Fastening multi wide units
Floor: Type Fastener..bet} Length: [per Spacing:
Walls: Type Fastener. t A WrT Length:Jp-T_ Spacing: - I ,
Roof: Type Fastener:1 Length: J__ Spacing: - 11 ,
For used homes a min. 30 gauge, all Witte, galvanized metal stilt)
will be centered over the peak of the roof anti fasteners with gals,
roofing nails at 2" on center on both sides of the centerline.
Gasket (Wealherprooling 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. understand a strip
of tape will not serve as a gasket.
Installer's inftia
Type gasket sl G��P�rG,I @ Installed; ICJ
Pg. Between Floors Yes
Between Walls Yes e�
Bottom of rldgebeam Yes
Fireplace chimney installed so as not to allow intrusion of rain walor. Yes _&P
Miscellaneous, _--
Skirting to be Installed. Yes t/ No ✓
Dryer vent installed outside of skirling. Yes N/A
Range downf low vent installed outside of skirting. Yes NIA
Drain lines supported at 4 fool Intervals. Yes &/
Electrical crossovers protected. Yes Lo
Other ;
verifies all information given with this permit worksheet
is accurate and true based on the
Installer Signature