HomeMy WebLinkAboutPermit WorksheetsERMITNUMBER
Installer 1-01-77 f7Vy�� License 4 U
Address of home
being installed
Manufacturer % % G �/I/ Length x width
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 of home
I understand Lateral Arm Systems cann a used on any home (new or used)
where the sidewall ties exceed 5 ft 4 in.A A$Fp
RF,,Qp, I r� jiJtl lals
Typical pier spacing l{gq R16��iRF®BrFrC16 q� �pR®p®S
j 114 I lateral COMP/,lvFCEs0 A - D fN.e �RRFCA/�� WCRk
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PERMIT WORKSHEET
page 1 oC 2 I
New Home [] Used Home jid
Home installed to the Manufacturer's Installation Manual
Home is installed in accordance with Rule 15-C f�
Single wide El Wind Zone II Wind Zone III ❑
Double wide Installation Decal #
Triple/Quad [] Serial # OA q Sj / 2c7" �5
PIER SPACING TABLE FOR USFn wrwi=c
Load
Footer
bearing
size
16' x 16'
18 1/2' x 18 1/2'
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
57-
1g
500
g
7
200ELI
6
8
8
250
7 6
8
8
g
8
8
3000 s
8
8
8
8
8
3500 QST8
8
g
8
PIER PAD SIZES
I-beam pier pad size A 11A.2
Perimeter pier pad size �f, X /6
Other pier pad sizes
(required by the mfq.)
I 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
TIEDOWN COMPONENTS
Longitudinal Stabilizing De 1. (LSD)
Manufactureri__ i7u 7�
Longitudinal Stabilizing Device w/Lateral Arms
Manufacturer
POPULAR PAD SIZE--smi
ANCHORS
4ft_5ft_
FRAME TIES .
within 2' of end of home
spaced at 5' 4" oc
OTHER TIES
Number
Sidewall 0
Longitudinal
Marriage wall
Sh ea rwal l 2
PLHMI I WURKSHEET
PERMIT NUMBER ... ..
POCKET PENETROMETER TEST
The pocket penetrometer tests are rounde(ldown to psf
or check here to declare 1000 lb. soil _ij!!� 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, lake the lowest
reading and round down to that increment.
X
TORQUE PROBE TEST
X
The results of the torque probe test is ( / inch pounds or check
here if you are declaring 5' anchors without testing . At e-st
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 lb ho capacity. '
Installer's initials
ALL TESTS MUST BE PERFORMED BY A LICENSED INSTALLER
Installer Name
Date Tested /. I - YC / —
'onnect electrical conductors between multi -wide units, but not to the main 'we
iource. This includes the bonding wire between mult-wide units. Pg.
Plumbina
;onnect all sewer drains to an existing sewer tap or septic tank. Pg. AlICIV
,onnect all potable water supply piping to an exist ater meter, water tap, or other
idependent water supply systems. Pg.
r•
Ipage 2 of 2 1
Site Preparation
Debris and organic material re oved
Water drainage: Natural Swale Pad Other
Fastening multi wide units
Floor: Type Fastener: _66Z5 Length: /(%"r- Spacing:
Walls: Type Fastener:o Length: 10/1 Spacing:
Roof: Type Fastener: _L, Length: 0,tr_ Spacing:
For used homes a min. 30 gauge, 8" wide, galvanized metal strip
will be centered over the peak of the roof and fastened with galy.
roofing nails at 2" on center on both sides of the centerline.
Gasket (weatherproofing 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. I understand a strip
of tape will not serve as a gasket. LaL
Installer's initials
Type gasket At/664w— Installed:
Pg. Between Floors Yes
Between Walls Yes V .
Bottom of ridgebeam Yes
Weatherproofing
The bottomboard will be repaired and/or taped. Yes h/ Pg.
Siding on units is installed to manufacturer's specifications. Yes
—
Fireplace chimney installed sous not to allow intrusion of rain water. Yesi94
Miscellaneous
Skirting to be installed. Yes No /
Dryer vent installed outside of skirting. Yes N/A V
Range downf low vent installed outside of skirting. Xes N/A �_
Drain lines supported at 4 foot intervals. Yes i/
Electrical crossovers protected. Yes
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
Installer Signature
Date�i't-(�