HomeMy WebLinkAboutPermit WorksheetPERMIT WORKSHEET
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page 1 of 2
PERMIT NUMBER
Installer i 1('� � License # 1 XA - l bZ j 14 8
New Home
Used Home []
Home installed to the Manufacturer's Installation Manual
,( Lt
Address of home ips N QC�tQS ��d
Home is installed
in accordance with Rule 15-C
El
being installed'
���Y15Q�1
Single wide
Wind Zone II Ej Wind Zone III
Manufacturer r.0 bSc�n Length xwidth 9 24
Double wide
Installation' Decal #
NOTE: if home is a single wide fill out one half of the blocking plan
Triple/Quad
Serial #
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 used)
where the sidewall ties exceed 5 It 4. in.
Installer's initials
Typical pier spacing�
7 1 , liners
2'
Show locations of Longitudinal and Lateral Systems
to loiludirs (use dark lines to show these locations)
1 1
r-r-r-,- 1- J.-
.-i-r -1--,--�-1-r;-�1 --,--,-;-t-p-r-r�-,--,-;-t-r-,--r-I-n- ;-r-1
L-L-I_J-J,_1-L-L _L _I_J_J-1+1..�LJ_J_1_L-L
1 1 1 j 1 , I 1 1 1 1. I . •�j�+�,Jy �)'I�. Ir\ , �1 ,� 1 1 I 1 I 1 I 1
-y_1_L--E•`1'��;•♦"�(_{.-L-i
1 1 1 I1 1 1 1 / / I 1 1 • . 1
,
I 1 , 1 1 , I 1 1 1 1 1 1
l`�-r-r-rr-r -1--rc ,-F-r'r-I--1-'1-T-r `r�-r -1-�-1-T-•r-r-1
1 0 I ',, 1 I 1 1 I 1 I 1 1 1 I 1- 1 1 1 1 I 1
r -1--+--1_1-7-r_�_r _I- �_ �_7_j_Y'_� -�- ��--��iTi p-'1 1 1 r-r-,-1--1-1-T-r r -r -,
1_! _L_I_ -J-J- _! -L-%_J A.-L_! -! -I_!_ �_L_L_L_L-I_J
I 1 1 1 1 1 1 1 1 1 1 1 I I 1 1 1 I 1 1 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 1-
L_I_J_y_J_.-L_L_I-J-�-,_L_M-L
1 1 1 1 1
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PIER SPACINGTABLE FOR USED HOMES
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interpolated From Rule 15C'1 pier spacing table.
PIER PAD SIZE
eam pier pad size .911 CO cLJ
r pier pad size -SLWr-;� 1!
ther rpad sizes - 1` 4k'lu-
(re iced byihe mfg.)
Draw the approximate locations of marria
wall openings 4 foot or greater. Use this
symbol to show the piers.
List all marriage wall openings greater than 4 fool
and their pier pad sizes below.
_ --a_ rANCHORS
Oft 5ft
POP LAR PAD
Opening
Ci oj111
Pier pad size
10
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• 1 0
itLtli[ 3'i�.i.�e1i, [.yam
01&W44'8+3I IrkWj
:�
I�.z:'r:►.i:�
.
FRAM E TItS
within 2' of end of ho / —
spaced at 5' 4" oc
OTHER TIPS
Number
Longitudinal Stabilizing Device (LSD) - Sidewall /
Manufacturer DZ:4— 116 i 7?r-h Longitudinal
Longitudinal Stabilizing evice w Lateral Arms Marriage wall
Manufacturer //0/ f�OL,/ rE�l� Shearwall ��
sjAp _ tjAJo91r
A -g
rW
TI®OWN COMPOM34TS
PERMIT WORKSHEET
page 2 of 2
PERMIT NUMBER
The pocket penetrometer tests are rounded down to I psf
orcheck here to declare 1000 lb'. soil without testing.
x x rT 0WC_--' Qx `S4R
POCKET PENETROMETER TESTING IVIEfHOD
1. Test the perimeter of the home at locations.
2. Take the reading atthe depth- of the looter,.
3.. Using 500 lb, increments„take, the .lowest
reading and round down to that increment.
x x X
TORQUEPROBETEST
The results of the torque, probe testis 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: Astate 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 d�
.reading is 275 or less and where the mobile home manufacturer may
requires anchors wi h 40 Iding'capacity.
Installer's initials
ALL TESTS MUST B PERFORMED BYA LICENSED INSTALLER
Installer Name
Date Tested _02 7 -- 1 3
Bectricall
Connect electrical conductors between multi -wide units, but not to the maid in power
source. This includes the bonding wire between mutt -wide units. Pg.,
Plum bing
Connect all sewer drains loan e�dstingsewer tap or septic tank. Pg.
Connect all potable water supply piping to an a)dsflng water meter, water tap, grottier
Site Preparation
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Debris and organic material removed
Water.drainage: Natural Swale Pad ✓ Other
Fastening multi wide units
i
Floor: Type Fastener: Length: �_�� Spacing: /G
Walls: Type Fastener: Length: Spacing:
�q —
Root. Type Fastener: gth: • Spacing: D s� S
For used, homes a min. 30 gauge, 8" wide, galvanized metal strip
will be.centered over the peak of the roof and fastened with galv..
roofing.riails at2" on center on both sides of the centerline.
Gasket (weatherproof Ing" roq ulrenwhi)
I understand a properly installed gasket is a requirement of all new and used
homes' andthat condensation, mold, meldew and buckled marri:ag'e walls ace
a resultofa poorty installed or no gasketbeing installed. I understand'a strip
of tape,will not serve as a gasket_ l
Installer's initials
Type gasket 4011 Installed:
Pg. Between Floors Yes
Between Walls Yes
Bottom of ridgebeam Yes
ttomboard"will be repaired and/or taped. Yes _�. Pg. `jam
on units is installed to manufacturer's specifications. Yes
M chimney installed so as not to allow intrusion -of rain water. Yes
Sk cnstalted. Yes No,
Dryer tinstalled outside of skirting. Yes . NIA
Range. downflow vent installed outside ofski " g es 7N/A
Drain lines supported at4 footintervalS. Y
Electrical crossovers protected. Yes.
Other:
Installer verifies all information
Is accurate
Installer Signature
this permit worksheet
Qn the
SC-1 & 2
Date