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Mobile Home Permit Worksheet
Installer: EDDIE GRUNDEL License # IH1118467
Address of home 10701 S OCEAN DR
being installed
Manufacturer JACOBSEN Length xwidth 21X30/35
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 cannot be used on any home (new or used)
where the sidewall ties exceed 5 ft 4 in.
Installer's initials EG
Typical pier spacing
Eli I lateral
Application Number:
Date:
New Home
❑✓
Used Home ❑
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 # TBD
Triple/Quad
❑
Serial # TBD
Show locations of Longitudinal and Lateral Systems
longitudinal (use dark lines to show these locations)
I
Li
Lj
Li
Li
L-i
Li
Li
Li
Li
--
i---------
- ----------
---- --
Li
Li
-
Li
Li
U
Ll
---------------_'
Li
Li
---
marriage
wall
piers
within 2' of
end
of home per
Rule
15C
PIER SPACING TABLE FOR USED HOMES
H
IZ
Load
bearing
capacity
Fer
size
size
(sq in)
16" x 16"
(256 )
18 1/2" x 18
4
1/2"32 ( )
20" x 20"
400
( )
22" x 22"
(484)
24" X 24"
(576)
26" x 26"
(676)
1000 psf
3'
4
5
7
500 ps
4' 6"
6'
7'
8.8
8'
2000 s
6'
8
8
8
8'
500 s
6
8
8
3000 s
8'
8
8
8'
3500 pst
8'
81
8
8'
x interpoiatea trom rwte i bu-i pier spacing table.
PIER PAD SIZES
I-beam pier pad size 17X22.5
Perimeter pier pad size 16X16
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 size
1-4 17X22.5
2-3, 23X31
Pad Size
Sq In
16 x 16
16 x 18
288
8.5 x 18.5
342
6 x 22.5
360
7 x 22
374
3 4 x 26 4
348
20 x 20
40
17 6x25
44
7 2 x 25 1 2
446
24 x 24
576
26 x 2
67iT
ANCHORS
4ft _V"_5ft_
FRAME TIES
within 2' of end of hc---
spaced at 5' 4" oc _
TIEDOWN COMPONENTS OTHER TIES
Number
Longitudinal Stabilizing Device (LSD) Sidewall
Manufacturer OLIVER Longitudinal
Longitudinal Stabilizing Device w/Lateral Arens Marriage wall
Manufacturer Shearwall
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..X
Mobile Horne Permit Worksheet
POCKET PENETROMETER TEST
The pocket penetrometer tests are rounded down to 1500 psf
or check here to declare .1000 lb. soil without testing.
X 1,500 X 1,500 X 1,500
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 1,500 X 1,500 X 1,500
TORQUE PROBE TEST
The results of the torque probe test is 290 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 holding capacity.
Installer's initials
ALL TESTS MUST BE PERFORMED BY A LICENSED INSTALLER
Installer Name EDDIE GRUNDEL
Date Tested
Electrical
Connect electrical conductors between multi -wide units, but not to the main power
source. This includes the bonding wire between mult-wide units. Pg.
Plumbina
Connect all sewer drains to an existing sewer tap or septic tank. Pg.
Connect all potable water supply piping to an existing water meter, water tap, or other
independent water supply systems. Pg.
Application Number: Date:
Site Preparation
Debris and organic material removed X
Water drainage: Natural Swale Pad X Other
Fastening multi wide units
Floor: Type Fastener: LAG Length: 6" Spacing: 24"
Walls: Type Fastener: LAG Length: 6" Spacing: 24"
Roof: Type Fastener: GALV Length: CONT Spacing: 24"
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.
i Installer's initials
Type gasket FACTORY FOAM
Pg.
Installed:
Between Floors Yes X
Between Walls Yes X
Bottom of ridgebeam Yes X
Weatherproofing
The bottomboard will be repaired and/or taped. Yes X . Pg.
Siding on units is installed to manufacturer's specifications. Yes X
Fireplace chimney installed so as not to allow intrusion of rain water. Yes X
Miscellaneous
Skirting to be installed. Yes X No
Dryer vent installed outside of skirting. Yes X N/A
Range downflow vent installed outside of skirting. Yes X NIA
Drain lines supported at 4 foot intervals. Yes X
Electrical crossovers protected. Yes X
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 Signature
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