HomeMy WebLinkAboutPermit WorksheetPERMIT NUMBER
Installer, �'Q. k. License
i —
Address of home �� t
being installed
Manufacturer Length x width x
NOTE: If home is a single wide fill out one half of tho blocking plan
if home Is a triple or quad wide sketch in remainder of home
I understand Lateral Arm Systems cannot be used on anylhome (new or ed)
where the sidewall ties exceed 5 1t4 in.
Installer's initials
Typical pier spacing
2' 1 lateral
-: iERMIT WORKSHEET
ptigc 1 0.' 21 r
New Home ❑ Used Home
Home installed to the Manufacturees Installation Manual
Home is installed in accordance with Rule 15-0
Single wide [] Wind Zone II (] Wind Zone III L
Double wide PCInstallation Decal # n
Triple/Quad 0 Serial # G �1 ff � ����I A�,Q
PIER SPACING TABLE FOR I ICFn WnRAC:0
Load
Footer
bearing
size
16' x 16'
18 1/2' x 18 1/2-
20- x 20'
22' x 22'
24' X 24'
26' x 26-
capacity
(sq in)
(256)
(342) -
(400)
(484)'
(576)'
(676)
1000 s
3
4
5
8'
1500 s
4 6
6
7
8
2000 s
6
2500 sf
7 6
3000 st
8
g
8
8
8
3500 psi 1
8
g
g
8
' intp-mrant"I f-
Q.J. Irr,_a
..
PIER PAD SIZES
I-beam pier pad size j(1Y2_ Y'2Z4( 2
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.
POPULAR PAD SIZES
I - •
Ir;Y7L1
6
Ifififif+�.rtryz��MK
Uilm
filCL�iL�.1i[:�ta.
A
i�ilf►�!i►�.�IP�wa,
10-
List all marriage wall openings greater than 4 foot MWJAM
and their pier pad sizes below. -
Opening Pier pad size ANCHORS
y"�'i1� 4ft L�5fl
w ous �% i/� Y Z7 Y� FRAME TIES
Im Aft, Aft Mh within 2' of end of home
spaced at 5' 4" oc
CO NT OTHER TIES
Longitudinal S ap!llzg Device S Number
Manufacturer Siciewall
Longitudinal Stabillzinnal
� Device w/ L `rail Arms MarriageLongituds wall
Manufacturer Shearwall
J
'PERMIT NUMBER
POCKET PENETROMETER TEST
The pocket penetrometer tests are rounded wn to psf
or check hereto declare 1000 lb. soil 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 tooter.
3, Using 50015. increments, take the lowest
reading and round down to that increment.
X X X
TORQUE PROBE T
The results of the torque probe test is 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 It,
.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 400 apacity.
installer's initials
ALL TESTS MUST BE PERT RMED BY A LICENSED iNSTALLER
Installer Name \J_Iba 1 ICE t"xA
Date Tested CQ— 1 "t D
Electrical
:bnnect electrical conductors betilsen multi -wide units, but not to the ma' po -
ource. Thls-inoludes the bonding wire between must -wide units. Pg.
onnect all sewer drains to an existing sewer tap or septic to k�~
onnect all potable water supply piping to an axis ' ater meter, water tap, or other
tdependent water supply systems. Pg.
PERMIT WORKSHEET
Site Preparation
Debris and organic material removed _
Water drainage: Natural Swale
page 2 of 2.' I
Other
Floor. Type Fastener. Lengtf It Spacing: � (lt�t� )
Walls: Type Fastener. Length. 'I Spacing:
Roof: Type Fastener, Length: '� Spacing: i
For used homes a mi . 30 gauge, 8" wide, galvanized meta strip
will be centered over the peak of the roof and fastened with gals.
roofing nails at 2" on center on both sides of the centerlinb.
Gasket (wmtherprooting requirement)
1 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 gasket vimm Installed:
Pg. �t, _ Between Floors Yes
YJ triiLj„p�/ Between Walls Yes _
Bottom of ridgebeam Yes
er roonn
he b rd wil ePo
Ynottco
r taped, Yes P_ .
nit ' s tnurer's specifications. Yes
re him Ins ed allow intrusion of rain water, Yes
Skirting to be installed. Yes t/r'No
Dryer vent installed outside of skirting. Yes ✓WA
Range downflow vent installed'outside.of skirting. Yes - WA
Drain lines supported at 4 foot intervals. Y
Electrical crossovers protected. Yes+
Other:
Installer verifies all information given with this permit worksheet
is accurate and true based on the
Installer Signature ! �f'�L� Date�� D_