HomeMy WebLinkAboutPERMIT WORKSHEET�.L
-PtRMIT NUMBER
t�iariutacituat`'���-0"1 LeiigiFs'X:�►Ft#h.�'��
Mom— W home Isg wide fill out one half of the blocldag plan
Uirolrla ts� r �e� uad wide sketch b t maInder of house
rZ toC m
f understand Lai catmot be used on airy home (new or used)
where the sldewatl ft 4 its:
- f m ci AnstaMet's
Typical pier:
2, �s
bow
a n
'.id W and t ateiat Systems
PERMIT WORKSHEET page Y of 2
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New Home - [] Used Home f+ca
Home installed to the Manutactum s tnstallatlDn Maw,
Home is instaQed in a000rdanoe with Rote i5->; ��
Single wide ❑ Zone ll Zon 11 ❑
Double wide - fnstallatlon Dacaf
TtipfefOuad ❑ se 4 F�.�M � \ 1��0�� t� ��i
Pim spiam TABLE r-OR U5ID HOMES
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PIM PAD SIZES
I-beam pier pad size 4 `� ],t4
s e _
n
Perimeter pier pad size
BIG
x
Oiherplerpad sizes _ 1�
x
(mi ired by the mfg.)
x
the approximate locations of rnardage
x
x400
❑Draw
wall openings 4 foot or pmater- Use this
x
symbol to show the piers
x
List aU marriage watt openings greater than 4 Toot
x
1 ZUX26a
andtheir pier pad sizes below.
Opmft Pier pad-slze
ANCHORS
%I\, X W
4Tt eft
- FRAME-n
wfthIn 2! of enspared at 6 4'ioc
MEDOWNCOMPOArFJ.i S
OTHERTIES
Longltudlnat sta61,�1ri,Q D�v1ce ILSD)
stdewaR . ----
' Manufacttuer
LcngftudEnai
�
Longlturfibd Shad, zriy vice w1LaferalArms
Marriage
Maro.-Maurer_ N'�1�� d� ifs
$h'ji
.ems ,__•
PENETROMETM TES
The Dom penetrometertests are ro�to Psf
or check here-ib declare t filth lb. soft w3h a testing-
+ X X X
POCKET PaemOMETm mxT] (3 METi-fOD
i. Test the Perimeter of the home at 6 Iocatlons.
2 Take the reading at the depth of the fcioter. -
9. Uring Sw ib• borements, take the lowest
reading and round down to that increment.
X. }( - X
TORIE D ST
The results of the torque probe test !s 3...: a pounds or check,
here if You are declaring s anchors wahoirt'tils 44 - --Atest .
sbowing 275 incur pounds or fees will require 5 foot anchors`
Note. A state approved lateral arm system 1s being used and 4 IL
anchors are allowed atibe sideviall locations: i understand 5 a
• anchms are required at all centerline tie points vrfrere the torque test
reagih,p is 276or tens and where the reobrge home manufacturer may
requlras andtors with do0?t dJ
ALL Ttrs�S MUST 8E P$fFO[�RTEDI3Y A LiL`8�IS7=D It1S7 ALiFii Installer Name - l�
I
"Date Tesfed4�. �
ZnnQot electrical conductors between multi -wider un1L% but not to the main power
ourraa. 7Wurfncludes the bonding wire between tnLd-wide wIftm Pg; - - ,--
ornled all sewer drains to tin odsling sewer tap or septic tank Pg.
onnect all potable water supply plpfn9 to an erosting water meter. wafer tap, or other
3dependent water supply systems. Pg.
PERl17II`I' WORKSHEET
site Fr-- epim—ion
page 2 of 2
Debris and organic materIat rAoved Water dmfnagm NaUnW \/ Slnrate _ Pad Meer '
Fast tnurii w&te ua1Ls
Floor: Type Fastener: Lerrglh: Spaofng: It
Walla: Type Fastener: Length: �n�
Root Type Fastener. Length; facing: �l�
Far_used homes a 3Q gauge. so e, �yanized m;4 strlli
WIII be centered •aver• the peak of the -roof and fastened With scaly.
rooi'mg trails at V on center an both sides of the centetiuue• "
Gnsrcet(rv®p,►e,
1 understtrnd a property installed gasW is a n4uhunent of art new-end.used-- _
-homes and that condensation, mold, meldew and buckled marriage waifs are
a'owlf of a poorly htstatted or no gasket being Installed. 1 understand a strip
Of tape will not serve as a gasket.
,f�rrstallet`s itri3lals"=
Two gasket ' OFo om Installed:
Pg- ' Between Floors Yes ✓
Between Walks Yes
Bottom of tidgebeam Yes
The bonomboard will be mpairedand/orte;md. Yes_
Siding on urtiis Ls installed to taaqutacttrrt�t's-spec�IrTatlons Yes
Fueplace chimney installed so as not to allow intrusion of rain water. Yes � `Uti
Slitting to be instanced. Yes_ No
Dryervent installed ouWa of skirting. s N! .
Range downtiow vent insfalled•outslde of s drOr z
Drain rowsupported at 4 fobt intervals. Y
EQecttical crossovers protected Yes
Other:
Is accUrste and true based on the