HomeMy WebLinkAboutPERMIT WORKSHEETIt
PERMIT WORKSHEET
PERMIT NUMBER
Installer License It 1 it // .2�
Owner Name &
Address of home
2 4 Ila-
being installed
Manufacturer /'L!J/��� Length x width
NOTE•: if home is a single 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 cannot be used on any horne (new or used)
where the sidewall ties exceed 5 ft 4 in.
Installer's initials >
Typical pier, spacing
o � talcrm
Show locations of Longitudinal and Lateral Systems
innp, tit, (use dark lines to show these locations)
_---.-.- n-••------ L..J-----------. -
rnarnnrfewallpiciswitlrn2•orend of lmmeperRule 5C
Now Home [l
page 1 of 2
Used Home Year ._Model . I In
Home installed to the Manufacturer's Installation Manual
Li
Horne is installed in accordance with Rule 15-C
Single wide ❑ Wind Zone II (( Wind Zone III
C1
Double wide Installation Decal #I a// 6 6
Triple/Quad Ej Serial ft
7-Zd3/56la,6
PIER SPACING TABLE FOR USED HOMES
Load
bearing
Capacity
Footer
siza
(sq in)
16" x 16"
(7.56)
18 1 /2" x 18 112"
--%
20" x 20"
(400)
22" x 22'
(4t14)'
24" X 24"
(57fi)'
26" x 2.6"
(676)
1000 Psf
3'
5'
6'
7'
8'
1500 psf
4' 6"
7'
8'
e
3'
_
2000 Psf
6'
8'
8'
8'
8'
8.
2.500 pst
7' 6"
I
'
8'
3000 psi
3500 psf
' Utterporatra Irons ttute �:,c-� peer spacing taoic
f` PIER PAn EE5 1
1-beam pier pad size
Perimeter pier pad size
Other pier pad sizes / 2N�1.��
(required by the rnfq.)
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.
I�POPULAR PAQ SUT-S
ANCHORS I
Opening Pier pad size
» 0 5ft
_2Z
FRAME TIES
tS �, within 2' of en ��.
spaced a 411
j
TIEL70YVN COMPONENTS -, TIES
Number
Longitudinal Stabilizing Device (LSP, Sidewall
Manufacturer ! _5 ��r� Longitudinal
Longitudinal Stabilizin Device w/ Lat r i Arms Marriage wall
Manufacturer �7iir�/ icy, 5y7= Shearwall
PERMIT WORKSHEET
j page 2 of 2 VV
PERMIT NUMBER
15-CxET PENETtiOMETER TES(
The pocket penetrometer tests are rounded down to psl
or check here to declare 1000 lb. sail 2/ without testing.
X_)C
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. iJsing 500 lb. increments, take the lowest
reading and round down to that increment.
L TOR -UE-PR- O st EST j
The results of the torque probe testis A8q inch pounds or check
here if you are declaring V 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 4capacity.
Installer's initials
ALL TESTS MUST BE PERFORMED BY A LICENSED INSTALLER
Installer Name / �� ✓GL 4y--
Date Tested D y— 2,2 — 24 2, l
Electrical
Connect electrical conductors between multi -wide units, but not to the main 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.
Connect all potable water supply piping to an existing water meter, water tap, or other
independent water supply systems. tag. ___
Site pre r.Ir:rtion
Debris and organic material removed
Water drainage: Natural Swale Pact Other
Floor: Type Fastener: /a9 I_.ength: 8 � Spacing- IL
Walls: Type fastener: /eL p Length: g � � Spacing:
Roof: Type fastener: /11.41a Length: (3 Spacing: 7 2
For used homes a -chin. 30 gauge, 8" wide, galvanized metal strip
will be centered over the peak of the roof and fastened with gaiv,
roofing nails at 2" on center on both sides of the conterline.
Gasket tweainarprootinq requirnmepn
i understand a property 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 beinq installed. I understand a strip
of tape will not serve as a gasket.
Installer's initials e o
Type gasket Installed:
Pg. �w��' Between floors Yes
d Between Walls Yes
Bottom of ridgebeam Yes
Weatherproofing _ ..
Hie bottorriboard will be repaired and/or taped. Yeses Pg.
Siding on units is installed to manufacturer's specificalions. 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 NIA Range downflow vent installed outside of skirting. NIA
Drain tines supported at 4 foot intervals. Yes
Electrical crossovers protected. Yes
Other :
Installer verifies all information given with this permit worlcsheet
is accurate and Vje Faased on the
Installer Signatu • DateO'�
All information on this wor : he us filled out completely to be accept(