HomeMy WebLinkAboutPERMIT WORKSHEETF'ERM17' NUMBER � `:r'..".��`:�, . "�.���.�.-�.•-_-•'
Installers �� 2.���j`' License#
Address of home
being installed
Manufacturer �%?,���-o �`7r Length xwidth
NOTE 'It home Is a single wide fill out one half of the blocking plan
If home is a triple or quad wide sketch In temalnder of home
I understand Lateral Arm Systems cannot be used on any home (new or used)
Mare the sidewall ties exceed 5 it 4 im
Installer's initials
Tvniral nior on-1 n - _
7
PERMIT WORKSHEET
L page 1 of 2 I
New Home ❑ Used Home ®/
Home installed to the Manufacturer's Installation Manual ❑
Home is Installed in accordance with Rule 15-0
Single wide ❑ Wind Zone II tE�V+rind Zone ill ❑
Double wide Installation Decal = 5;; ?
Triple/Quad ❑ Serial 7 , ; � , �oZ a4rz >87
PIER SPACING TABLE FOR USED HOMES
Load
bearing
capacity
F 1z er
size
(sq In)
16' x 16'
(256)
181/2' x i 8 1/2'
(342)
20' x 2D'
(40D)
22' x 22•
(484)•
24' X 24'
(576)`
26' x 26'
(676) "
1000 IDst
1 3
1 Ds
4 6
6
B
000 pst
6
81
8
_
8
2 00 pet
76-7—
'3000 ps
8 "
B
g
�3 00- s —
8 •
8
lnwupuldlou 110M mule fat+-7 pier spacing =18.
PIER PAD SIZES
I-beam pier pad size 12 "Y 92 10,
Perimeter pier pad size 7! t 2 °r
Other pier pad sizes 12 X ;o - `
(required by the mfg.)
4
FMDraw 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 Pier pad=size
1,7 ri X ;? !/
`%"X ;);z r
TIEDOWN COMPONENTS
Longltudlnal Stabif(Izing Device (LSD)
Manufacturer !/nv¢s
Longitudinal Stab111zing Device wlLateral Arni s
Manufacturer--- -#WrF, Txig M_70n
POPULAR PAD SIZES
!
�0
l���i'i�.ie�
• � �
irilY.i't►.t.�/P.��'''L�
0 V "-
ANCHORS
4 it .5 it
FRAME TIES
within 2' of end of home
spaced at 5'4" oc J'
OTHER TIES
Number
._
Sidewali
Longitudinal
Marriage wall
Sh eaiwail
.f
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.footsr.
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 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 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 40 Uolding capacity.
Installers initials
ALL TESTS MUST BE PERFORMED BY A LICENSED INSTALLER
Installer Name )`co � 04 �/ 7
Date Tested
Electrical
lbnngct electrical conductors between multi -wide units, but not to the main power
ource. This -includes the bonding wire between must -wide units. Pg.
Plumbing
onneot 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
idependent water supply systems. Pg.
PERMIT WORKSHEET i page 2 of 2 I
Site Preparation
Debris and organic material removed /L b
Water drainage: Natural _LG'Swafe Pad Other
Fastening multi wide units
Type Fastener
f Length: rr Spacing:
r. r. �_ -
Walls: Type Fastener. -s' Length: Spacing: 8
Roof: Type Fastener: S Length: 9 Spacing: fs
For.used homes a in. 30 gauge, 8" wide, galvanized metal strip
will be centered bvsr the peak of the roof and fastened with gals.
roofing nails at 2" on center on both sides of the centerline.
Gasket (w—therpi=11ng requlremtmti
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 Y , 2
Type gasket �� Installed: L�
Pg. Between Floors Yes
Between Walls Yes
-- Bottom of ridgebsam Yes ___&_ _�
Weatherproofing
The bottomboard will be repaired and/or taped. Yesy�Pg.
Siding on units is installed to manufacturer's specifications. Yes L
Fireplace chimney installed so as not to allow intrusion of rain water. 122.2
Mlsaallaneous
Skirting to be installed. Yes V No .
Dryer vent installed outside of skirting. Yes WA
Range downflow vent installed outside of skirting. Ye_ WA�
Drain fines supported at 4 foot intervals. Yes
Electrical crossovers protected. Yes
Other:
installer verifies all information given with this permit Worksheet
is accurate and true based 'on the
Installer Signature
and or Hu
Date ��