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4RkT- NUMBER hSb,�l - 62y��7 . .. ... .... . yr • r1
installer s Ucense # " N 10 A !S �
Address of home 55 'i
being installed 774 a I
Manufacturer Length x width
NOTE., T home Iva single wide fill out one half of the blookIng plan
It home is a i dple or quad wide sketch In remalnder or home
I understand Lateral Arm Systems cannot be used on any home (sed)
where the sldewall ties exceed 5 it 4 in;
Installer's Initials
Typical pier spa cing L�
2 —7 _ 9 roromr
PERltlllT 1r ORKSHEET
New Home . , Used dome []
,
Home installed to the Manufacturer's Inslallatlon
Manual
Home Is installed in accordance with Fluie 15-0
singie wide 09L., Wind Zone Il ®
Wlnd Zone� _t.>.
Double wide [] installation Deoal 0
�_ 7 / tIII
TripleiOuad ' M Serlal g a W
_ - 669�N S 2b 6 bm'119
Pirm SPACING TdBLE FOR USIM HOMES
Load Fboter
bearing size
capadly (sq in)
18' X 16'
(25�
18112• X 181/Z' 20' X20'
(842) (400 )
22' X22!
484
( j'
24' X24'
(676)6
26' X26'
(676)
100D s
8
6
g
00
4 6
6
g
00D51
6
8 8
200
W8
3000
8
8
8
00
1111o1NwrUtw 11VU" nU1W wu-i pier spacing w010.
PiEA PAD SIZES
I-beam pier pad size
Perimeter pier pad size
Other pier pad sizes '
(required by the rnfp.)
Draw the approximate locations of marriage
wail openings 4 loot 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
i — b' �� b
TIEDOwN COMPONENTS
Longltudlnal Stablllaing Device (LSD)
Manufacturer_____Tie Qj2 w�h
Longitudinal Stabiltaing Device w/Lateral Arms
Manuljcfurer
PaO s
iwc>auRs `1
4 it _1.Z15 it
FRAME „r:s . /
within 2' of end of home ✓
spaced at 6' 4" co,
OTHER TIES
sldewall Number
Longitudinal
Marriage wall
Shearwall
P�OC E t r�{eNEi 1�OIV11+"Trri% TEST ;
The ' bcket penstrornetar tests are rounded down to g 150 0 psf
or checlt hereto declare f DOD lb, soil — without test nq.
>C.1400 x�®v X—L1L06
POMET Pl~IVl~rH0METER T ESTINE M 'h1AA
'I. rest the perimeter of the horde at 6 locations.
2. Take the reading at the depth of the jooter.
S, Usinq SOD lb, increments, take the lowest
reading and round down to that increrneriL
ID
TOROu5 PRI R TSs s •t
The results of the torque probe test Is-'- _2j 6 Inch pounds or check
here If you are declaring 6' anchors without testing _ . A test
showing 276 Inch pounds or less wlil require 5 foot anchors,
Note; A state approved lateral arm system Is being used and 4 ii,
.anchors are allowed atihe sidewall locations. I undersland 5 ft
anchors are required at all centerline tie points where the torque test
reading Is 275. or lass and where the rriobile home manufacturer may
requires anchors with 4000 lb !ding capacity.
lnstallees initials
ALL. TESTS MUST EE PERFORMED 13Y A LICENSED INSTALLIER
Installer Name _ ta9_i-,4 h 4 Ca V A) Q S
Date Tested
' Elcatrlcal '
1onneot electrical conductors between muiti-wride units, but not to the main power
ouree. This•ingludes the bonding wire between mull wide units. Pg.
Plumping
;onneet all sewer drains to an existing sewer tap or septic tams. Pg,
onneot all potable water suppiv piping to an existing water meter; water tap, or other
rdependent water supply systems, Pg.
PERMIT WO nKSHEET
Debris and organic material removed Y e S
Water drainage: Natural Swale Pad 2 other,
Floor., 'type Fastener; t,entath: Swing: t� ; � r
Walls: Type Fastener, m� Length: Spacing:
Roof; Type Fastener: length; Spacing:
For -used homes a —min. So gaune, a° wide, galvanized metalslrip�
will be centered bver the peals of the -roof and fastened With galy,
roofing malts at 2" on center on both sides of the centerline.
GestroY Cr r�ultertaM
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 being installed, land a strip
of tapo will not serve as a gasket,
Installer's Initial '
Type gaslcet� Installed:
Pg, Getween Floors Yes
Between Walls Yes
Bottom of ridgebeam Yes
_ wOIIt{70P$hrODn11Q '"'•�"
The bottomboard will be repaired and/or taped. Yes PR,
Siding on units is installed to manufacturerAs specifioattons, Yes___,__%
Fireplace chimney installed so as not to allow Intrusion of rain water, Yes
Skirting to be installed, Yes •� No
Dryer vent installed et a of skirting. Yes! WA
N► A ___ __ __
Range ciownflovv ventt fninstalled'outside of slckrtgng. Y
Dl'aln lines supported at 4 fobs intervals, Yes
Electrical crossovers protected. Yes
Other;
Installer
based 'on the