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PERMIT NUMBER
Installer _ Oi'h HV,ti1_Z-7_K License # 0000179 .
y:
Address of home 9&� (�s
(U ` f�t,jY
being installed
Manufacturer Length x width % d
NOTE: if home is a singly a fill out one half of the blocking plan
if home is a lriple��g�NDAtch in remainder of home
I understand Lateral Arm S� E�iTOt®�� (�®IQ�s� new or used)
where the sidewall ties exouo _ , (Q ' t-'OgggCri �� K
COW YNECFSsq 'rMf 6b ' 9N%
Typical pier spacing (YyyiTHA((AY YIN c ®E6 4O THAr
2' lateral AB(sCO®ES
r Show locations of Longitudinal and Lateral Systems
longitudinal (use dark lines to show these locations)
marriage wall piers within 7 of end of home per Rule 15C
PERMIT WORKSHEET
l Pagc 1 of 2 I
New Home ❑ Used Home
Home installed to the Manufacturer's Installation Manual
❑
Home is installed in accordance -with Rule 15-C
El
Single wide Wind Zone II Wind Zone III
[]
Double wide ❑ Installation Decal #
Triple/Quad ❑ Serial # _
1 D"7 374-
PIER SPACING TARLF Furl t tern LJn R.co
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- j
capacity (sq in).
(256)
(342)
(400)
(484)'
(576)'
-(676)
1000 DSf
41
5
-
1500 s
q 6
g_
7
-8
8
2000 s
6
8
8
8
2500 s
7,6
8
8
8.
8
8
3000 s
8
8 ..
88.8
8
3500 s
g-
8 -
8
8
' internniatarf from
Ardn ur_i
PIER PAD SIZES
I-beam pier pad size 2y (,Z
Perimeter pier pad size
Other pier pad sizes Ti
(required by the mfg.)
Draw the approximate `locations of marriage
symbol to show the piers.
List' all marriage wall.openings greater than 4 foot
and their pier pad sizes below.
Opening Pier
TIEDOWN COMPONENTS
Longitudinal Stabilizing Device (LSD)
Manufacturer ok_z4a
Longitudinal Stabilizing Device w/Lateral Arms
Manufacturer__f^y
POPULAR PAD SIZES-
EYIO.
:
OEM
� ya_Na
G!
[dilLti'i•�3/L!
cam: .-m
irflN3!i��.�Ift��4
ANCHORS
4 1t 5 (t
FRAME TIES
within 2' of end of home -
spaced at 5' 4" oc
OTHER TIES
Number
Sidewall
Longitudinal
Marriage wall
Shearwall
• {'fir iGL r:::t ?i a � ..' t'EHMI I WURKSHEET
PERMIT NUMBER -
POCKET PENETROMETER PENETROMETER TEST
The pocket penetrometer tests are rourideddown-to psf
or check here to declare 1000 lb. 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 tooter.
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/ 0 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 Dpjdinq capacity. - -
Installer's initials
r_4
r�ESTS MUST BE PERFORMED BY A LICENSED INSTALLER
Installe "N: ame
Date Tested AV- 10--?o -c?
:onnect electrical conduct -irk careen multi -wide units, but not to the ,e
ource. This includes the° �ondin ire between mutt -wide units. Pg.
;onnect all sewer drains to an existing sewer tap or septic tank. Pg.
,onnect all potable water supply piping to an existing water meter, water tap, or other
idependent water supply systems. Pg.�� _
.Y
I page 2 of 2
Site Preparation
Debris and organic material removed i
Water drainage: Natural _bGSwale t Pad Other
Fastening multi wide units
Floor: Type Fastener: jLe�#h Spacing:_
Walls: Type Fastener: = _ : Spacing:
Roof: Type Fastener: ength: Spacing:
For used homes a 30 gauge, 8" wide, galvanized metal strip
will be centered r the peak of the roof.. and fastened with gaiv.
roofing nail 2" on center on both sides of the centerline.
Gasket (wmlherpro hnq 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 re
a result of a poorly installed or no gasket being installed. I under c a strip
of tape will not serve as a gasket.
Ins er's i ' 'aIs
Type gasket ailed:
Pg. Between Mobors Yes _
Between Walls Yes
Bottom of ridgebeam Yes
Weatherproofing
The bottomboard will be repaired and/or taped. Yes Pg.
Siding on units is installed to manufacturer's specifications. Yes
Fireplace chimney installed so as not to allow intrusion of rain ater. Yes
Miscellaneous
Skirting to be installed. Yes No
Dryer vent installed outside of skirting. Yes N/A
Range downf low vent installed outside of ski ing.es �N/A
Drain lines supported at 4 foot intervals. Yes ✓✓
Electrical crossovers protected. Yes L✓1-
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
Installer Si
Dati d-3e-0