HomeMy WebLinkAboutPermit WorksheetPERMIT VVORKSI-IEET
PERMIT NUMBER
Installer ��,r� 'S_ l��od1� d License It
Ownerof h &
Addresss of home
being installed
Manufacturer ZZ&L//2 Length x width
NOTE: if home is a simile wide fill out one half of the blocking plat
if home is a triple or quad wide sketch in remainder of home
I understand Lateral Arm Systems carinot be used on any home (new or used)
where the sidewall ties exceed 5 ft 4 in.
Installer's initials
Typical piierr spacing
J i
_y
Show locations of Longitudinal and Lateral Systems
Innpoudma! (use dark lines to show these locations)
y � i L1 I—_._L_j -L_j --
f -U'------
1
t1[—mmir-riipri walll piers wi-th-i'n T ofof en—njd of home per Rule 15C
New Home ❑
page 1 of 2
Used Home LJ Year Model
I-fome installed to the Manufacturer's Installation Manual []
Home is installed in accordance with Rule 15-C 201-
Single wide ❑ Wind Zone it /r Wind Zone III [j
Double wide Er Installation Decal 1€
Triple/Quad ❑ Serial it 7Z
?z 6r! Z<530
PIER SPACING TABLE FOR USED HOMES
Load
bearing
capacity
rooter
sizt:
(sq in)
16" x 1G"
(256)
18 1!2" x 18 112"
(342)
20" x 20"
(400)
22" x 22"
(4II4)`
24" X 24"
(576)'
26" X.. 2.G"
(676)
1000 psf
a
6'
6'
7'
8' —
150U psf
4' 6"
6'
7'
8'
t3
8'
2000 psf
6'
S.
8'
8'
2500 psf
7' 6'
a,
3000 psf
8'
$'
3500 psi
8'
Ilrlulpulalm IfVlll "Ulu 'IJV-I pler spaLillu lam
PIER PAD 8tZ -S
I-beam pier prod size / f
Perimeter pier pad size
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
oft
... OMPONCNTS
�� TIGOOWId C
beut
CO Longitudinal Stabilizin- Device (LSD
C1E : .
°w �. a r, �+X 1t. Manufacturer fys��iyt�
,� ,, n 7 nciitudina Stabrlizinry Device w/ Lateral Arm:
Lo
u . �'� 19
Manufacturer
ZVILE
a
PERMIT WORD SHEET
(POPULAR PAD SIZES
ANCHORS 7
Oft5 ft
FRAME TIES
within 2' of end of home
spaced at 5' 4" oc
OTHER TIES ,
Number
Sidewall
Longitudinal
Marriage wall
Shearwall
I page 2 of 2 --
PERMIT NUMBER
��OC1rET PEtd9TROMETF_i '1•EST
The pocket penetrometer tests are rounds own to psi
or check here to declare 1000 lb. sail without testing.
X X__
X
POCi4ET 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 Ib. increments, take the lowest
reading and round down to that increment.
X X
FOR05 RROE ETE5T
The results of the torque probe test is 2S F 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 Ah�ing capacity.
installer's initials
ALL TESTS MUST BE PERFORMED BY A LICENSED INSTALLER
Installer Name
Date Tested
Electrical
Connect electrical conductors between multi -wide units, but not to the m power
source. This includes the bonding wire between mutt -wide units, Pg.
Plumbing_
Connect all sewer drains to an existing sewer tap or septic tank. Pg. J
Connect all potable water supply piping to an existing water meter, water tap, or other
independent water supply systems. 1'g. /
Site Prell iration_�
Debris and organic material removed
Waler drainage: Natui al Swale fact Other
FasUmitxr multi wide units
Floor: Type Fastener: Lo:!5� Length: 46 >> Spacinq- / 2—
Walls: Type F-astenerZM_� Length: 8oi Spacing: J Z �J
Roof: Type Fastener: to� Length: 6 Spacing: ) Z
For used homes a pxi'n. 30 gauge, 8" wide, galvanized metal strip
will he centered over the peak of the roof and fastened with gaiv.
roofing nails at 2" on center on both sides of the ccnterine.
Gasitot Iwealbcrproolrnry rcryulramanll �_
I understand a properly installed gasket is a requirement of all new and used
homes and that condensation, rnold, 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. p
Installer's initials /1
Type gasket Installed:
Between Floors Yes
Between Walls Yes
Bottom of ridgebeam Yes -�
Weatherproofing
Hie bottorriboard will be repaired and/or taped. Yes fig.
Siding on units is installed to manufacturer's specifications. Yes
Fireplace chimney installed so as not to allow intrusion of rain water. Yes .�
Miscellaneous y
Skirting to be installed. Yeses No
Dryer vent installed outside of skirting. Yes N/A
Range downflow, vent installed outside of skirting. Yes / N/A
Drain lines supported at 4 foot intervals. Ye$
Electrical crossovers protected. Yes
Other:
Installer verifies all information giver, with this permit worksheet
is accurate and ue based on the
installer Signature Dated
All information on this wo lee be filled out completely to he accept(