HomeMy WebLinkAboutPermit Worksheets 1-20-22PERMIT WORKSHEET
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PERMIT NUMBER
Installer 4 Lei
Installer Mobile Phone
Address of home
being installed
Manufacturer
/� • License #
_TA CD Length xwidth 6e5
NOTE: If home is a single wide rill 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 sidewall ties exceed 5 ft 4 in.
Installer's initials
Typical pier spacing 7
' / i / I lateral
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longitudinal
locations of Longitudinal and Lateral Systems
(use dark lines to show these locations)
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171
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martiage wall piers
within 2' of
end of home per Rule 15C
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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 er Installation Decal # logo> S / % S.S
Triple/Quad ❑ Serial # J_AC F120 39 /,A_
Roof System:--,4/—Typical Hinged 8
PIER SPACING TABLE FOR USED HOMES
Load
bearing
capacity
Footer
(sq siza
16" x 16"
(256)
181/2" x 18
1/2" (342)
20" x 20"
(400)
22" x 22"
(484)`
24" X 24"
(576)•
26" x 26"
(676)
11
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8
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interpoiatea trom Kwe 1bG-1 pier spacing taDle.
PIER PAD SIZES
I-beam pier pad size / -'W7 Z'�
Perimeter pier pad size i I rz Z''
Other pier pad sizes
(required by the mfg.)
1.u.ji 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
Pad ize
Sg In
iti x lb
16 x
18.5 x 18.5
x
13 114 x 26 1
348
20 x 20
400
x 3
1 x 1—Tr6-
1 24 x
6
26 x 25
6 6
ANCHORS
04ft 5ft
FRAME TIES
within 2' of end of home
spaced at 5' 4" oc
OTHER TIES
Number /
Longitudinal Stabilizing Device (LSD) Sidewall ✓
Manufacturer Sk.T_+_j4 Longitudinal
Longitudinal Stabilizing Pevice w/Latefal Arms Marriage wall
Manufacturer �ylipLv_�ra�+�� sy5-yShearwall
Pier pad size
Z 2'
Imo.• �'''�i' � Z''
TIEDOWN COMPONENTS
•
PERMIT WORKSHEET
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PERMIT NUMBER
POCKET PENETROMETER TEST
The pocket penetrometer tests are rounded own to psf
or check here to declare 1000 lb. soll without testing.
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 footer.
3. Using 500 lb. increments, take the lowest
reading and round down to that increment.
X X X
TORQUE PROBE TEST
The results of the torque probe test Is . Z8' 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
(ding capacity.
,R
Installer's initials
ALL TESTS MUST E PERFORMED BY A LICENSED INSTALLER
Installer Name
Date Tested
Electrical
Connect electrical conductors between multi -wide units, but not to the mainpywer
source. This includes the bonding wire between mult-wide units. Pg.
Plumbing
Connect all sewer drains to an existing sewer tap or septic tank. Pg.
Site Preparation
Debris and organic material removed /
Water drainage: Natural Swale Padv Other
Fastening multi wide units
d 0'
Floor; Type Fastener: �p1� Length: 8 Spacing: t
Walls: Type Fastener: Length: g N Spacing: /Z'�
Roof: Type Fastener: Length. Spacing: / Z
For used homes a . 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 centerline.
GaSket (waatherorooflna roaulromeMl
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.
Installer's initials
Type g� �s,ek�t,� Installed:
�
Pg. -' Between Floors Yes 61
Between Walls Yes V
Bottom of ridgebeam Yes
Weatherproofing
The bottomboard will be repaired and/or taped. Yes _ —1 Pg.
Siding on units is installed to manufacturer's specifications. Yes L1—
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 downflow vent installed outside of skirting. Yes .L/ N/A
Drain lines supported at 4 foot intervals. Yeses
Electrical crossovers protected. Yes �k::f
Other:
Installer verifies all information given with this permit worksheet
is accurate and true baseo on the
manufacturer's Installation InstrmctIQWand or Rule 15C-1 & 2
Connect all potable water supply piping to an exdting water meter, water tap, or other Installer Signature ® Date 1D -�Z-7'2/
independent water supply systems. Pg. L/ �- -wor0-'