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PERMIT -NUMBER , :..... :........:.:.:::-.:.
1
Installer _ pM License
Address of home
being installed
Manufacturer c5cYt/ Length x width I/ )( �
NOTE: if home is a single wide fill out one half of the blocking plan
if home is a triple or quad tide sketch in remainder of home
I understand Lateral Arm Systems ca► t 7:9s ny home (new or used)
where the sidewall ties exceed 5 It 4 iq�^ St'�eJEC AC
�9q °� iREd ��jS
Typical pier spacing lateral cO4f;4YW % gyly p� C7CRSCNS ORS
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'PERMIT WORKSHEET
New Home El Used Home
l P!90 1 of 2
Home installed to the Manufacturer's Installation Manual
Home is installed in accordance with Rule 15-C
Single wide [] Wind Zone II
Wind Zone III El
Double wide [] Installation Decal # 9 % 43Il3
Triple/Quad D Serial # -5l ®D 170
PIER SPACING TABLE FOR USFn Wr) uFc
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
5
8
1500 s
4 6
6
7
8
2000 psf
6
8
818
2500 psf
7 6
8
8
8
8-
8
3000 nzf
8
g
8
8
8
3500 psf
8
8
8
8
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PIER PAD SIZES
I-beam pier pad size
Perimeter pier pad size
Other pier pad sizes
(required by the mfg.)
} Draw the approximate locations of marriage
g DJ ; 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
Longitudinal Stabilizing Device (LSD)
Manufacturer _ dA_h A.;f,
Longitudinal Stabllr ng Device w/Lateral Arms
Manufacturer 4-r-V _/1
POPULAR PAD SIZES
ANCHORS
4 ft 5 it
FRAME TIES
within 2' of end of home
spaced at 5' 4" oc _�
OTHER TIES
Number
Sidewall
Longitudinal
Marriage wall
Shearwall
• f; -- : /j,,. "`-�.... PLHMI 1 WURKSHEET l page 2 of 2
PERMIT NUMBERZ/yI�
POCKET PENETROMETER TEST
The pocket penetrometer tests are rounded own to psf
or check hereto declare 1000 Ib. soil V 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 inch pounds or check
here if you are declaring 5' anchors without testing . 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 lb h Idi capacity.
Installer's initials
ALL TESTS MUST BE PERFORMED BY A LICENSED INSTALLER
Installer Name
Date Tested
Electrical
connect electrical conductors between m.ulti-wide units, but not to the main
source. This includes the bonding wire between mult-wide units —Pa. ,
;onnect all sewer drains to an existing sewer tap or septic
:orinect all potable water supply piping to a g water meter, water tap, or other
idependent water supply systems. Pg.
Site Preparation
Debris and organic material removed
Water drainage: Natural 'Swale f Pad Other
Fastening multi wide units
Floor: Type Fastener: cing:
Walls: Type Fastener: gth: Spacing:
Roof: Type Fastener: Le Spacing:
For used homes a min. 30 uge, 8" wide, galvanized metal strip
will be centered over t eak of the roof and fastened with gals.
roofing nails at 2" center on both sides of the centerline.
Gasket (ww1herprooling 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 under a strip
of tape will not serve as a gasket.
Type gasket
Pg.
;taller' ' gals
stalled:
Between Floors. Yes
Between Walls Yes
Bottom of ridgebeam Yes
The bottomboard will be repaired and/or taped. es P
Siding on units is installed to manufacturer's s ecificati Yes —
Fireplace chimney installed so as not to allow intrust of rain water. Yes
Miscellaneous
Skirting to be installed. Yes _� No —
Dryer vent installed outside of -skirting. Yes ✓ N/A /
Range downf low vent installed outside of skirting. Yes N/A
Drain lines supported at 4 foot intervals. Y t/
Electrical crossovers protected. Yes
Other:
knstal!e`"t,,yerifies 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 11- V-o7