HomeMy WebLinkAboutPermit Worksheet..: .
HERMIT NUMBER
Installer
License it 77R ®COV27? .
Address of home
being installed
Manufacturer _� /G Y4— Length x width
NOTE: if home is a single wide fill out one half of the blocking plan
if home is a triple or qW, Yvide sketch in remainder of home
I understand Lateral Arm Systeq��s
g�2Q�� yy home (new or used)
where the sidewall ties exceed `Vf ll D TDAN �op0
AySe� �yP4& yiGf�,i wo
Typical pier spacing C04;6W, CFs4gy �SpFC� �S
Ty /N p RS T
2' I lateral AftL riR�FR TO �4T
Show locations of LongROftl and Lateral Systems
longitudinal dark lines to show these locations)
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Rule
15C
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PERMIT WORKSHEET
I pztgc 1 of 2 I
New Home [j_ Used Home M
Home installed to the Manufacturer's Installation Manual
Home is installed in accordance with Rule 15-C
Sin le wide _� Wind Zone II � Wind Zone III
El
Double wide Installation Decal #
Triple/Quad [] Serial # ®/( /6 5" 7 L
PIER SPACING TABLE FOR USED HOMF5Z
Load Footer
e
bearing size
16' x 16'
18 1/2' x 18 l/2'
20- x 20-
22' x 22'
24` X 24'
26' x 26'
capacity (sq in)
(256)
(342)
(400)
(484)'
(576)'
(676)
1000 s
3
4
56,
8
1500 s
4 6-
6
7
9
8
2000 s
6.
8
g
8
2500 s
7 6
8
8
,8
8
8
3000 s
8
g
8.
8
8
3500 r, s
8
g
8 �•
8
' interpolated from
Rul 15C 1
- plerspaclnp lab/` '�
PIER PAD SIZES %,Q
I-beam pier pad size %
Perimeter pier pad size
Other pier pad sizes
(required by the mfq.)
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 siz
TIEDOWN COMPONENTS
Longitudinal Stabilizing Device (LSD)
Manufacturer
Longitudinal Stabilizing Device w/ Lateral Arms
Manufacturer ��c og
POPULAR PAD SIZES
ANCHORS---]
4ft 5ft_
FRAME TIES
within 2' of end of home/
spaced at 5' 4" oc i�
OTHER TIES
Number
Sidewall
Longitudinal
Marriage wall
Shearwall
PLHMI l WURKSHEET
PERM T NUMBER
POCKET PENETROMETER TEST
The pocket penetrometer tests are round ed-wn to psf
or check hereto declare 1000 Ib. soil ✓ without testing.
X
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
TORQUE PROBE TEST
X
The results of the torque probe test is 3 10 inch pounds or check
here if you are declaring 5' anchors without testing -A1141- . 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 ft
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 Melding capacity.
i6KII, Installer's initials
ALL TESTS MUST BE PERFORMED BY A LICENSED INSTALLER
Installer Name
Date Tested
Electrical
;onnect electrical conductors between multi -wide units, but not to the
ource. This includes the bonding wire between mutt -wide units.' Pa.
;onnect all sewer drains to an existing sewer tap or septic tank. fF_q
:onnect all potable water supply piping to an existing water meter, water tap, or other
idependent water supply systems. Pg.
Ipage 2 of 2 I
Site Preparation
Debris and organic material removed �% S
Water drainage: Natural JZ 'Swale Pad Other
Floor: Type Fastener: Le qth: Spacing:
Walls: Type Fastener:>min.
L� Spacing: _
Roof: Type Fastener:V,6 Spacing:
For used homes ge, 8" wide, galvanizedmetal strip
will be centered ok of the roof and fastened with gals.
roofing nails at 2"n both sides of the centerline.
asket (weatherproofing requirement)
I understand a properly installed gasket is a requirement of a_ll ne used
homes and that condensation, mold, meldew and buckled p5amaqe walls are
a result of a poorly installed or no gasket being install understand a strip
of tape will not serve as a gasket.
Type gasket
Pg.
Installer's initials
nstalled:
Between Floors- Yes
Between Walls Yes _
Bottom of ridgebeam Yes
The bottomboard will be repaired and/or taped. Yes
Siding on units is installed to manufacturer's specifications. --��--
Fireplace chimney installed so as not to allow intrusion of r ' wate�s
Skirting to be installed. Yes 6,--'. No
Dryer vent installed outside of skirting. Y es v*'� N/A
Range downflow vent installed outside of skirting. Yes
Drain lines supported at 4 foot intervals. Yes _
Electrical crossovers protected. Yes 4ifA
Other:
fies all information given with this permit worksheet
is accurate and true based on the
installs
nd or Rule 15C-1 & 2
Installer Signature Date��r�
z
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