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a� drs�ss�uf`°home � � � �� � •
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Marlutzaacturer ��� �� Lensytt,.xwis�h` ...�� ���
NOM 'If Dome Isa single w1de fill out one liakf ofthe blockingplan
Yhonrie Is a hVe or quad adds sketch In rewdbder of home
I understand Lateral Atm Systems cannot be used on arty home {new or used)
where the sidewall ties exceed 5 ft 4 in:
— _ lnstailee siriitiats' -
Typical p� spacing -� I -
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PER -Mir WOPMSHEET page I of 2
New Home - ❑ Used Home
Home installed to the Manufacturer's Installation Mantj
Home is installed in a000T&no® with Rule is-C
skm a wide ❑ rnd Ions 1l AWL
ElDouble wide nstalitran Deeal'`�
7rtpteQuadM%Z� �S si' i�G'1�
PIER SPACING TASLE r-oR USED HOMES
lid
4flog—
�t�
Footar 1s-x1s'
(SS)-
iSqb) —
181/2'xi81rX
(,342)_
2W;C2V
�4�_
2Vx22'
(4B4)'
24-X24-
(S75}`
26,
(o of
low Dsts
-
ao a s
-
a
s
25
_
s
oa S
s
B
• (nte>iioleted from hula iSGi plot spadntl tabs .
PLEA PAD s1ZE5
1-bearn pier pad size
Perimeter pier Aad size �"1�1� �.�•
Other pier pad saes _ 172
fragtured by the mfg.) -1
Draw the app a locations of marriage
waft openin " Usa this
11
symbol to sh
am�rnm
List all marriage watt a gas neater ttran 4 foot
andthelr pier pad 1
am{
Opening 3! pad=size
z-Dm
o
POPUWt PrAOs S
Ei CHCRS
F • rn to
Tit 5 f#
oy rn
E T1E5
of hope,
� _ O
da
Lflngli�dJnal Stabl�?.Q �T+1� (L5D) Siciey�
Manufachwa 'i`t►'�tre+ D,1\ Longitudir
Longltud rk-d siabJl.l�zX�rig vice srd Lateral Arias Marrlag® t
Manp(actarer_ �'i`t�tiWi� Sheaiwa$
POCKETENETR0 TES
The pcckef penelrometertests are ro wrt fo psf
k or check here 10 declare 1000 ffi sail��� w�fsotit te&'itsg.
a X X X
POCKET PENETROmmm TESTING METHOD
I. Tedihe perknoter of the home at 6 locations -
2. Take the reatGng at the depth of the feioter.
_ 9. Li�rri9-5DQtb,_iiictetrients, iake_ths.lowest
reading and round down to that increment,
X X X
TOR—OO—EPROBETEST-- -
The results of the torque probe test lSn _' inch pounds or check -
hem 1t you are declaring V anchors vda&ul-test . . A test
showing 275 kmh pounds or less will requira 5 foot anchors:
Note; A state approved lateral am system is being used and 4 fL
=ChOm are allowed atihs sidewall locations I tuiderstand 5 tt
iln xs are required et all centerline tie p0intp where the torque test
reading 1s 275 or -low and where the mobile Rome manufacturer may
requires anchors with -0Ot3Qhi ldtrsg opacity
gY1einstalles'slinitiats
ALL TESTS MUST BE PERFOR En BY A UCaISEn INSTALLER
Installer Name
• DateTasied�;;,, \
Doi
bnnaot electrical conductors between multi -wide
outm This udos the b � -W but not to the main power
1rnF! otKMg wire betweers Inuit -wide watts. I's�
!�1 onned all sewer drains to tsm adsiing sewer lap orseptfc tank Fg:
onnect all notable water supply piping to an w stinn water meter, wafer tap, or other
sdependent water supply sydems. pg.
PERMIT WORKSHEET L page 2 of 2
Site Preparation
Debris and organic matariaioved
Waterdrafnage: Natural V Svale Pad CMer
Fastenfn multi wide units
Floor. Type Fastener.
Walls: Type Fastener. S�aohs
Roof Type Fastener. Length; adh� f14`
For -used housetal o gauge, 8° a, m' p
will be centered bverthe peak of the -roof and fastened with gain.
roofing naffs at 2" on center an both sides of the cWtedme;
I updamt4nd a property lnslalled gasket is a rsqulretrsent of alI newand used
homes and that condenseflop. mold. meldew and budded 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.
• ; iristaller'sinifials �'b
Type gasket Yoofn Installed.
Pg ' Between Floors Yss _ ✓ -
Between Wails Yes
Bottom of tidgebeam Y�
The bottombasrd will be repairedand/orteped. Yes . .
Sid ng on fortis Is installed to manufactumft.speoiftoatlons. Yes
Fireplace chimney installed so as not to allow intrusion of rake
Sidrtina to be installed. Yes V _ No -
Dryer vent installed outside of skitiing. Y� W,
Range downfiow vent kw4ailed'outside of ski -) NIA -
Drdn lines supported at 4 fobt intervals Y
Electrical Crossovers protected. Yes
other; -
IS accurate and true based •on fire