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NERMIT-NUMBER
Installer �(® r� �y` f"r� License ff .^I 0a0� �-77
Address of home
being installed
Manufacturer C100-0 f
Length x width C .. 9,
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 remainder'af home
l understand Lateral Arm Systems cannot be used on any home (newer uypd)
where the sidewall ties exceed 5 It 4 in. l_
Installer's initials
Typical pier spacin�
2' lateral
Show locations of Longitudinal and Lateral Systems
longitudinal (use dark lines to show these locations)
marriage wall plers within V ar end of home par Ruts ISC
1. MUST BE INEPT ON J06 vA
NO INSPECTION WILL BE MADE
PERMIT WORKSHEET
1 pugo 1 of 2 r,
New Home lJsd dome fl
Home installed to the Manufacturer's Installation Manual
[]
Nome is installed in. accordance with Rule 15-C
((7�
Single wide ❑ Wind Zone Il [� Wind Zone Ill
El
QoO fe wide ;«; Installation Decal #
Triple/Quad ❑ Serial 0 :3 G
S-f,4
PIER SPACING TABLE FOR USED HOMFs
Load
bearing
capacity
Fouler
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. s
3
4
5
8
11500 sf
4r 6
6
7
8
2000 sf
g
2500- s
7 6
8
8
8
8
g
-3000 s
8
61
a
8
8
3500 psi
I 8
8
8
8
PIER PAD SIZES D
I-beam pier pad size d 7C x
Perimeter pier pad size X ,;;"y
Other pier pad sizes
(required by the mlq.)
Draw the approximate locations of marriage
wall openings 4 foot or greater._ Use this
rr symbol io show the piers.
List all marriage wall openings greater than 4 toot
and their pier pad sizes below.
Opening Pier pad size
81, l _2-y x;-y
WORK TIEDOWN COMPONENTS
is Longitudinal Stabit((zingg Device (LSD)
HAVanufaclur . dl I✓le, ?-
Longitudinal Stabillzi De lce w/ Lateral Arms
• -Manufacturer�� _
POPULAR PAID SIZES
�I"• si�YE��-YIGI
h3'iei i 1ldi ['ti
i WA MAOWN
�%3'�Id•■R9.
ANCHORS
4 It 5 It
FRAME TIES
within -2' of On(] of home
spaced at 5' 4" oc
OTHER TIES
Number
sidewall 0__
Longitudinal �-'-
Marriaqe wall ��-
Shearwall
PLHMII WCJRKSHEET
PER,Nlti NUMBER .'
POCKET PENETROMETER TEST
The pocket penetrometer tests are roundedwn to psf
or check here to declare 11000 Ib. soil without testing.
x150p x ti oo x 35D D
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 1 '900 x 1500 x i Ed-'?
TORQUE PROBE TEST
The results of the torque probe test is 4257 inch pounds or check
here if you are declaring 5' anchors withouttesting fJ ^ . A test
showing 275 inch pounds or less will require 5 toot anchors.
Note: A state approved lateral arm system is being used and 4 ft.
anchors are allowed at the sidewall locations. i understand 5 it
anchor's 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 4 0k4 holding capacitV•
(lp� ti Installer's initials
ALL TESTS MUST BE PERFORMED BY A LICENSED INSTALLER
Installer Name
Date Tested
I page 2 of 2 1.
Debris and organic material removed 1-1
Water drainagw,Natural d Swale Pad Other
Floor: Type Fastener: ~ mat f Length: fi_ Spacing:
Walls: Type Fastener. �� Length: Cs Spacing:
Root; Type Fastener: Length: _"_ Spacing:
For used homes a n. 30 gauge, B" wide, galvanized metal strip
will be centered over the peak of the root and fastened with galy.
roofing nail's at 2" on center on both sides of the centerline.
Gasket (weelherpmafing requleement)
I understand a properly installed gasket is a requirement of all new and us rri
homes and that condensation, mold,meldew 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\
0 t 614 �6_A e
Type gasket T' y Installed:
Pg, Between Floors Yes
Between Walls Yes
j Bottom of ridgebeam Yes I_
Electrical
7onnect electrical conductors between multi -wide units, but not to the main power
source. This includes the bonding wire between mull -wide units. Pq._
Plumbing
;onnect all sewer drains to an existing sewer tap or septic tank. Pq. 'p,5 -t
,onnecl all potable water supply piping to an existing water meter, water lap, or other
idependenl water supply systems. Pq. �.NW
Weatherproofing
The bottomboard will be repaired and/or taped. Yes Pq.
Siding on units is installed to manufacturer's specifications. Yes
Fireplace chimney installed so as not to allow intrusion of raiq-water, Yes -tdA
Miscellaneous
■
Skirting to be installed'. Yes `/ No
Dryer vent installed outside of skirting. Yes N/A -
Range downflow vent installed outside of skirting. Yes -N/A ■
Drain lines supported at 4 foot intervals. Yes
Electricagv oroers rolected. Yes r/ .
Other- I,c a rs'� _0
1+ O a 6 i e� • _
er verifies all information given with this permit worksheet
is accurate and true based on the
Installer Signature
D"ato