HomeMy WebLinkAboutPermit WorksheetPERMIT WORKSHEET
PERMIT NUMBER
Installer
Address of home
being installed
Manufacturer Length x width
NOTE. if home is a single wide fill out one half of the blocking plan
If home is a triple or quad wide sketch /n remainder of home
I understand Lateral Arm Systems cannot be used on any home (new or used)
where the sidewali ties exceed 5 ft 4 in.
Installer's initials
Typical pier spacing
lateral
Show locations of Longitudinal and Lateral Systems
117longitudinal (use dark lines to show these locations)
El M
Li
Li L-i
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III
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marriage
wall
Li
piers
within 2' of
Li
end
of home per
Li
Rule
15C
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page 1 of 2
New Home ❑ Used Home
Home installed to the Manufacturer's Installation Manual ❑
Home is installed In accordance with Rule 15-C
�4
Single wide � Wind Zone II ( Wind Zone III ❑
Double wide ❑ Installation Dec 1 #
Triple/Quad ❑ Serial # 6-X.,I I-13CIlam' 0
PIER SPACING TABLE FOR USED HOMES
Load
bearing
capacity
Fooler
size
(sq In)
16" x 16"
(256)
181i2" x 18 1/2"
(342)
20" x 20"
(400)
22" x 22"
(484)`
24" X 24"
(676)''
26" x 26"
(676)
0 Psf
4
8
00 s
of
7
8
000 PS
81
8
8
2500 vsf
7- 6"
8
3000 psf
8
8
3500 Pst8
8
A
J
Interpolated trom Rule 15c-1 pier spacing table.
PIER PAD SIZES .
I-beam pier pad size
1
Perimeter pier pad size
Other pier pad sizes
(required by the mfg.)
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
jLnd their pier pad sizes below.
Opening Pier pad size
® a
POPUEAR PAD S ZES
x
ANCHORS
4ft 5ft
FRAME TIES
within 2' of end of ho rt
spaced at 5' 4" oc
G TIEDOWN COMPONENTS OTHER TIES
Number
Longitudinal-tabiiizin Device (LS �eSidewall
Manufacturer 1-1.D ;V- 1 oM VJnaWZJ� C&itudinal
Longitudinal StabAt-flirg D"e'vice W Lateral 4rins Manage wall
PEAMIT NUMBER
POCKET-139N15TROMETISR TEST
The pocket penetrometer tests are rounded n 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 fboter.
3. Using 500 lb. increments, take the lowest
reading and round down to that Increment.
X
X
TORQUE —PROBE TEST
The results of the torque probe test Is inch pounds or check
here if you are declaring 5' anchors wittiou 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 lie home manufacturer may
requires anchors with 40 g capacity.
Installer's initials
ALL TESTS MUST BE P RFORMED BY A LICENSED INSTALLER
Installer Name
Date Tested
Electrical
Connect electrical conductors between multi -wide units, but not to the mai0 Bawer
source. This includes the bonding wire between mutt -wide units. Pg. V'
PERMIT WORKSHEET
O
Site Preparation
Debris and organic material removed
Water drainage: Natural Swale Pad Other
page 2 of 2
asten ng muld We units
Floor: Type Fastener. Length: Spacing:
Walls: Type Fa er. Length: -r5 aci
Roof. Type Pas gth:Twe
S
For used o ge, a"al a e al stripwill be c e e he s e galy.
roofing nails at 2" on cen r on both sides of the centerline.
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.
nsAall i ials
Type t
Pg. Between Floors Yes
Between Wails 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 water. Yes
Skirting to be installed. Yes V No
Dryer vent installed outside of skirting. Yes N/A
Range downflow vent installed outside of skirt ngYs t�,N/A
Drain lines supported at 4 foot intervals. Y
Electrical crossovers protected. Yes ✓
Other:
Installer verifies all Information given with this permit worksheet
Is accurate auxllfue based on the
Connect all sewer drains to an existing sewer tap or septic tank. Pg. v
Installer Signature
r'nnnanf =n nntahla water st innly oioina to an existing water meter, water tap, or other
Date