HomeMy WebLinkAboutPermit WorksheetPERMITNUMBER
Installer lIQ / l�' 2 License 0 T41 15� Cj
T
Address of home 26 $1 —Ay
being installed
Manufacturer Length x width
NOTE. If home`YrTe 1 Ide fill out one half of the blocking plan
If homy a r f F 414,,gi4rlud� etch In remainder of home
l understand Lat�RQ&TIE yCT I6w,M gM;VS 99Kme (new or used)
where the sidetyp�ti i Se�IEL�yySp ru1VS
ECESSARYI ECT@Uli iiaitials
RD To
Typical pier spacing r11PLY 1111 HALL Ap L�A,� CODES.
2 l faleral
PERMIT WORKSHEET
New Home ❑ Used Home pO
PU90 1 of 2
Home installed to the Manufacturer's Installation Manual ❑
Home is installed in accordance with Rule 15-C
Single wide 0 Wind Zone 11 ❑ Wind Zone ill, ❑
o e IT Installation Decal # /-2� . 2 70'G9
Triple/Quad ❑ Serial it ay-5-177,46-p
PIER SPACING TABLE FOR USED HOMFS
Load
bearing
capacity
er
I F size
size
(sq 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 Dsl
4
5
g
1 00. st
14 6
6
7
8
2000 PS
51
8.
8
g
2500 s
7 6
g
g
g
g
3000 s
8.
8
8
8
3500 PSI
1 8
8
g
8
PIER PAD SIZES
I-beam pier pad size f
Perimeter pier pad size ��_ X
Other pier pad sizes. 161.446
(required by the mfg.)
Draw the approximate locations of marriage
t 0] wall openings 4 foot or greater. Use this
symbol to show tt-ie piers.
List all marriage wall openings greater than 4 fool
and their pier pad sizes below.
Opening Pier pad size
TIEDOWN COMPONENTS
Longitudinal Stabilizing Device (LSD)
Manufacturer f 1 r I? .k
Longitudinal Stab Ii7 kin Devlre w/ Lateral Arms
Manufacturer 0 le6:A
POPULAR PAD SIZES
Pad Size
Sq In
16 x16
is x Is
x 1813
6x
360-
17 x 22
—Err
x
Zu x
A -
x
x
_76x
�NCHOR5
4 ft *'O� 5 It
FRAME TIES
within •2' of end of home
spaced at 5' 4" oc
OTHER TIES
NuCllber
S ngitud
ewall
Longitudinal
Marriage wall_
Shearwall
j,; F't=HMt t W�RKSHEET ( paye 2 of 2 I
PE•RIAT NUMBER
POCKET PENETROMETER TEST
The pocket penetrometer tests are rounded 4aWn to psf
or check hereto declare 1000 11). soil t/ without tesling.
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 Tooter.
3. Using 500 lb. increments, take the lowest
reading and round down to that increment.
X X
X
TORQUE PROBE TEST
The results of the torque probe test is - �— inch pounds or check
here if you are declaring 5' anchors without testing /Y/,q A test
showing 275 inch pounds or less will require 5 foot anchors.
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 test
reading is 275 or less and where the mobile home manufacturer may
requires anchors with 4000 lb 4piding capacity.
Installer's initials
ALL TESTS MUST BE PERFORMED BY A LICENSED INSTALLER
Installer Name
r �
Dale Tested 7 5 ^ G
Electrical
Annecl electrical conductors between multi -wide units, but not to the rt
source. This includes the bonding wire between mull -wide units. Pg. f�C—S
Plumbinu
:onnect all sewer drains to an existing sewer tap or septic lank. Pg. 11 C�7!5
,onnect all potable water supply piping to an existing water meter, water lap, or other
idependent water supr)ly systems. Pg.
Site Preparation
Debris and organic material removed —
Water drainage: Natural f4 Swale Pad Other
Fastening multi wide units
Floor: Type Fastener: Length:/ Spacing:
Walls: Type Fastener. "V /gyp@r Length: it Spacing:
Hoof: Type Fastener: i �� Length: it _ Spacing: _
For used homes a min. 30 gauge, B' wide, galvanized metal scrip
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 (wmiherarwfinareaulterwan
I understand a properly installed gasket is a requirement of all new and used
homes and that condensation, mold, meld'ew and buckled marriage walls are
a result of a poorly installed or no gasket being installed. l understand a strip
of tape will not serve as a gasket.
Installer's initials
Type gasket O r Installed:
Pa, Between Floors Yes
Between Walls Yes
Bottom of ridgebeam Yes A!�—
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 AJIL
Miscellaneous
Skirting to be installed. Yes L,,,"— No
Dryer vent installed outside of skirting. Yes _% NIA
Range downflow, vent installed outside of skirting. YesN/A _
Drain lines supported at 4 foot intervals. Yes t
Electrical crossovers protected. Yes _L,—,*'
Other:
Installer verifies all information given with this permit worksheet
Is accurate and true based on the
Installer Signature
Date _-Tn(1C-07