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HomeMy WebLinkAboutPermit WorksheetNERMITNUMBER �gD� ,� ✓9 t ' t C ? � Installer _VL4L�t/it/re/L License # A/ —0 000f % 1 Address of home 2 � a1y (� �d� being installed —�7_ Manufacturer L,�'/��� Length x width � r NOTE: if home is a single wide fill out one half of the blocking plan ff home is a triple � aad wide sketch in remalnderbf'home I understand Lateral Arm S4 R 'tit tier L)A ny home (new or used) where the sidewall ties ex dW I. T TO 1Op SEC V F/E�DV'i'�'a/OvS 0 Typical pier spacing 7 C, SSSARV CTORS 7/ lalera� R�'iT/�r,�Le a nr/V ORdER rn TEAT Showfocations `1�77nftdznal (use 5wifiese locations) IN fir M ■— t■ ■—' I Tw i i i i ■ i Is ■ Ii i ■ w ■ i i ■ al ■ i--a— Irl ■ M i ■ ■—' ■■ ■■�■■■■■■■■■■■■■■■■■■■■■�■■■■■■■ ... ..■■■..■■.■.�.■■■��.. ■■.�..■ .... �■ OMEN ■■■■■■■■■■ ME ■■■■■■ ■■■ :0 • MEN ■::::::::::::::::::: ::�::::■■••■.■■■■..■■■■■■■■■■No ■.. M C:::■ ■•■••••••■■:■. :■.........■■.■:■■..■...■■■■■■ ■■.■.■.■.:■■:■ ...'.■I■■■■■.■.■■....■...■.■...■■■■ ••:::'N:Noun ::::: s PERMIT WORKSHEET New Home ❑ Used Home W PU90 1 of 2 Home installed to the Manufacturer's Installation Manual ❑ Home is installed in accordance with Rule 15-C Single wide ❑ Wind Zone 11 '41 Wind Zone III ❑ u 1 e '+ Installation Decal # % Ci cj Triple/Quad [] Serial # 4-0/ PIER SPACING TABLE FOR UsEt] HnneFc Load capacity Fsiz er size e (sq In) 16' x 16' (256) 18 1/2' x 18 112' (342) 20' x 20' (400) 22' x 22' (484)' 24' X 24' (576)' 26' x 2fi' (676) 1000 DS s a 5 $ 1500 psi 4 6 6 7 8 2000 s 6 8. 8 8 2 00 psf —818 8 8 g 3000 psi 8, 8 $ 3500 pctfB 8 g B PIER PAD SIZES I-beam pier pad size Perimeter pier pad size Zt 4 2_ Other pier pad sizes / 1(a_ (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 foot and their pier pad sizes below. Opening Pier pad size .�L< 2- TIEDOWN COMPONENTS Longitudinal StabilizingDeUIc6 {LSD) Manufacturer j=C _A Longitudinal Stabilizing Devf� a w/Lateral Arms Manufacturer ��Z POPULAR PAD S[ZES Pad Size n 16 x 6 6 16 x18 T977TY7 16 x 17 x x 26 x 17 x 1/ 112 x 24 x 24 x ANCHORS_ 4ft l/ 511 FRAME -TIES within 2' of end of home spaced at 5' 4' oc vol- OTHER TIES Number �3 Sid©wall Loncliluriinal Marriage wall — Shearwall PI Rluff NUMBER POCKET PENETROMETER TEST The pocket penetrometer tests are rounded down to psi or check here to declare 1000 Ill. soil_ rt// 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. 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 . ✓V& . A test showing'275 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 at the sidewall locations. I understand 5 it anchors are required al all centerline tie points where the torque test reading is 275 or less and where the mobile home manufacturer may requires anchors with 4000 l capacity. Installer's initials ALL TESTS MUST -BE PERFORMED BY A LICENSED INSTALLER Installer Name Date Tested Electrical 'onnecl electrical conductors between multi -wide units, but not to the mainpower source. This includes the bonding wire between mull -wide units. Pg. Plumbing )onnect all sewer drains to an existing sewer tap or septic lank. Pg. V L� VLHMI 1 WURKSHEET l page 2 of 2 1 Site Preparatlon Debris and organic material removedy Water drainage: Natural Le-_ Swale Pad Olher �F�a_stteenning multi wide units _+' Floor: Type Fastener: `SL E� —Length: Spacing: Walls: Type Fastener. Length: Spacing: Roof: Type Fastener: Length: W" _ Spacing: r _ For used homes a min. 30 gauge, 8" wide, galvanized met I strip 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 (wenlherpruaflng rcqulrement) I understand a property 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. I understand a strip 01 tape will not serve as a gasket. Installer's initials Type gasket Axycr#A Installed: Pg. Between Floors Yes _ Between Walls Yes �— Bottom of ridgebeam Yes Weatherproofing Thebottomboard will be repaired and/or taped. Yes ✓ Pg. Siding on units is installed to manufacturer's specifications. Yes L;-"— Fireplace chimney installed so as not to allow intrusion of rain water. Yas1_41f Miscellaneous Skirting to he installed. Yes u-`� No Dryer vent installed outside of skirting. Yes �' NIA Range downflow vent installed outside of skirting. Yes _� WA _ Drain lines supported at 4 foot intervals. yes ✓ Electrical crossovers protected. Yes u�,' Other: Installer verifies all information given with this permit worksheet Is accurate and true based on the manufacturer's Installation instructions and or Rule 15C-1 & 2 :onnect all potable water supply piping to an existing water meter, water tap, or other na a"" -'gnaw" idependent water supply systems. Pg. �� (� S05"OPY FI