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PERMIT
Installer
RECEIVED
PERMIT WORKSHEET Fhtf - 3.2021 page 1 of 2
Address of home % V - VINO
being installed.
Manufacturer Length x width tic , J
NOTE: if home is a single wide flit 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 cannot be used on any home (new or
where the sidewali ties exceed 5 ft 4 in.. .
Installer's initials
Typical pier spacing
• ! tale, .
1
Show locations of Longitudinal and Lateral Systems
longitudinal (use dark lines to show these locations)
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-----------------------------------------------------•--------------------------------
...r--
mardage
wall
piers
within 2' of
end
of home per
Rule 15C
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Permitting Department
New Home.
Used Home St. Lnr County
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
Double wide
[]
Installation Decal #
Triple/Quad
❑
Serial # R DLL
101 A
PIER SPACING TABLE FOR USED HOMES
Load
bearing.
capacity
Footer
size
(sq In)
16" x 16"
(256)
181/2" x 18 1/2"
(342)
. 20" X 20"
(400)
22" x 22"
(484)`
24" X 24"
(676)"
26" x 26"
(676)
00 s
3
8
00 s
6
8
D00 sf
6
8
8
8
2500 pSf
7'6"
8
8
8
3000 Pst
8
81
8
3500 pst
8
8
8
interpolatea from Rule 15G-1 pier spacing table.
PIER PAD SIZES r—POPUEAR PAD S ZES
I-beam pier pad size Z.Y 01Z!7, 1 PadSize S In
it 1 x
.Perimeter pier pad size . ( x
Other peer pad sizes -
required by the mfg.)
lDraw 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.
ANCHORS
4ft 5ft
FRAME TIES
within 2' of end of home
spaced at 5 4 oc
TIEDOWN COMPONENTS OTHER TIES
Number
Longitudinal S abi 'zi Device LSD Sidewall
Manufacturer ` ` I/1�Dnglll.idinal `_
�X-.rrinnn .anll
Opening Pier pad size
PERMIT NUMBER
POC ET?MN—ETROMETER TES
The pocket penetrometer tests are rounded down to - psf
or check here to declare 1000 lb. soil without testing,
X
X
ft
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
PERMIT WORKSHEET
TORQ E PROB�rE--T—EST
The results of the torque probe test Is � 2-} ' Inch pounds or check
here if you are declaring 5' anchors without testing . A test,
showing 275 inch pounds or less will require 4 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 4o0� Ing capacit IInstjer's initials
ALL TESTS MUST BE PERF MED BY AUC\ENSED INSTALLER
Installer Name
Date Tested 21
Electrical
Connect electrical conductors between multi -wide units, but not to the ma' ower
source. This includes the bonding wire between molt -wide units. Pg.
page 2 of 2 1
Site Preparation
Debris and organic material removed ,jl�
Water drainage: Natural Swale Pad Other Co 0 c r;Ws1' :
Fastening multi wide units
Floor: Type Fastener: Le gth: -S in
Wails: Type Fastener: MV
Roof. Type Fastener.
For used homes a min. 30 ga e, 8" wide, galvanized metal strip
will be centered over the pea f the roof and fastened with gals.
roofing nails at 2" on center on both sides of the centerline.
• Gasket (wasthermoolina requiremeni)
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.
� . alialler
Type gasket Ile�
Pg. Between Floors Yes
Between Walls Yes
Bottom of ridgebeam Yes
Weatherproofinji
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 water. Yes
Miscellaneous
Skirting to be Installed. Yes_ No
Dryer vent installed outside of skirting. Yes ✓ N/A
Range downfiow vent Installed outside of skirting. Yes N/A
Drain Drain lines supported at 4 foot intervals. Yes J�
Electrical crossovers protected. Yes ✓
Other:
installer verifies all information given with this permit worksheet
Is accurate and true based on the
Connect all sewer drains to an existing sewer tap or septic tank. Pg. _L-40"_
Installer
r,---, , ,,,i .,, fnklo Wnf,-r Qi inniv nininn to an existing water meter, water tap, or other
Date �� 'alp