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InstallerLicense#
Address of home j-7Gt.
being installed
PERMIT WORK�sHEET
I page 1 of 2
New Home �sed Home ❑
Home installed to the Manufacturer's Installation Manual
Home is installed in accordance with Rule 15-0
�7 7 7J Single wide ❑ Wind Zone II Wind Zone III
Manufacturer xT ,6 �S`C_i Length x width �i'(Y . �ouble wide rq-`� Installation Decal 4
NOTF_ ' 'It home Is a single wide fill out one half of the blocking plan WrelpleVOuad * ❑ Serial
If home is a triple or quad wide sketch In temalnder of home v v
I understand Lateral Arm Systems cannot be used on any home (new o ig ZIP
Mare the sidewall ties exceed 5 ft 4 in: `r"i' � -
Installet's initials o �.oaci Footer
wring sloe
Typical pier spacing $` %pacity (sq in)
lateral
2' m 1000 S
Sfiow locations of Longitudinal and Lateral System 1 0.0 s
lerpltudlnal (use dark lines to show these locations) ca 000 s
2500 pst
m :.qnnn ne
marriage wall pleri within Y' of and of home
PIER SPACING TABLE FOR USED HOMES
16' x 16' 18 1/2' x is 112 20' x 20' 1 22' x 22• 24' X 24' 26' x 26'
(266) 1 (342) 1 (400) 1 (484)' 1 (576)' 1 (576) '
interpolated from Rule i5C-1 pier spaclrip table.
PIER PAD SIZE$
I-beam pier pad size /,V�[ l�
Perimeter pier pad size C
ea ad sizes / % K2
the mfg.)
�cn5�m
raw the approximate locations of marriage
C �,Ibol o! show thetor pie sreater. Use this
tsc m -c
Co _j >
i i�iage wall openings greater than 4 foot
§n jEgLer pad sizes below.
POPULAR PAD SIZES
Had ize
n.
16 x1
x1
1x1.5
16 x 22.5
1•x-974-
13 1/4 X
X
x 25 717-
17 112x
4x 24
26x26
ANc
,rE__-�V-
ter_ g Pier pad -.size
RS
� X3 -mq MIV
�M� a / 2 �
Oft 5 fi
Z; °D
FRAME TIES
=si,=
ZN�'+ �`?i�
within 2' of end of home
spaced at 5' 4" oc
TIEDOWN COMPONENTS
1 OTHER TIES
Number
L.ongltudlnal Stabjllzlr;gDey,Le (LSD)
Manufacturer ;L LL �i .�� IV-4ib
Longltud/na1
Sidewali
itU'dinal
Stabll#z ng De v wl Lateral Arms
4;
a iaggswau
Manufacturer__ i0 _.,.Shearwall
N
PERMIT NUMBER
... .. �.,
POCKET PENETROMETER TEST
The pbcket penetrometer tests are rounded down 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.footer.
S. 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 isInch 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 w ere the mobile home manufacturer may
requires anchors with 40 ing capacity.
Installer's initials
ALL TESTS MUST7 PERFORIAED BY A Lt ENNSED INSTALLER
Installer Name Gat /Ge G�-1
Date Tested
Electrical
1onnect electrical conductors between multi -wide units, but not to the main power
ource. This•ingludes the bonding wire between mutt -wide units. Pg.
Plumbina
;onnect all sewer drains to an existing sewer tap or septic tank Pg.
onnect all potable water supply piping to an existing water meter, water tap, or other
dependent water supply systems, Pg,
PERMIT WORKSHEET ( Page 2 of 2 1 I
Site Preparation
Debris and organic material removed
Water drainage: Natural Swale Pad Other
Fastening multi wide units
�s
Floor. Type Fastener.ZC- • Length: Spacing: l
Walls: Type Fastener: Length: Spacing:
Roof: Type Fastener. Length: Spacing:
For.used homes a n. 30 gauge, 8" wide, galvanized metal '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 centerline,
Gasket (w=therprooting requ)rcn*nq
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 u erstand a strip
of tape will not serve as a gasket.
Installer's initials
Type gasketInstalled:
Pg. Between Floors Yes v
Between Walls Yes
Bottom of ridgebeam Yes
Weatherproofing
The bottomboard will be repaired and/or taped. Yes . Pq.
Siding on units is installed to manufacturer's specifications. Yes
Fireplace chimney Installed so as not to allow intrusion of rain water. Yes
ecus
Skirting to be installed. Yesy No
Dryer vent installed outside of skirting. Yes _�N/A
Range_downflow vent installed' outside of skirtin N/A
Drain lines supported at 4 foot intervals
Electrical crossovers protected. -`Yes
Other:
Installer verifies all information given with this permit Worksheet
is accurate and true based on the
mannfar_turPr's installation instructions and or Rule 15C-1 & 2
Installer
/�7 e