HomeMy WebLinkAboutPERMIT WORKSHEET. . . . . . . . . .
Installer II I I I WVY I L.
Address �f home mantA
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stl
Manufacium
NOTE 'thomwlstpolb do 'Og'anchalifhorrie f of the 4roaMnoplan Isa&016rWddesbtu
iftremdndhrof-home
I derstand Laterat ArmsWernis canno - t,be used on arpy home (n
c;w I Installues initials
Typl
P erspa=g.
Show 10catlOns'of Longhuftal and Lateral System
(use dark lines,to show theia,locaillons)
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I . I r--7 -1-1 .
PERNTWO11K-SHEET
Now Horne. Old .IF U-Sed Horne 0 JD a
Horne instalied,to the Manufacturees Installation ManuW
is
Horne 14 Installed In aocordanwi with RtAle. IS-0
Shvip wide ftJ6 Wind Zone if Ov -
Wind Zane;tll
C3.
DoOler wide Installation Decal 4 p
TOPIWOuad Q Serial
I
TABLE FORUSED HOMES
. a .
uraw the aPPrOxImite locitions
of rVHasopenings4 toot crgii�Use this
toWthe pim Ust all marriage Wall OPS01698 greater than 4 foot
andtheir pier pad skouib616W.
Openina Pler.pad-size
ANCHORS
44 -5ft
7
within V of'ond of home
spaced at'S"V'oo
I OTHER TIES
LmqftudtrW 5tabllJ hS DOWO& (LSD)
Manufkdlurer-
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Manufgdurer Am :��:
wall
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The pbcket pene#rometertests are rounded down to fasf '
or check hereto declare i000 ib,-sell .____,_without testing,
• XL
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POCKET i'ENETROM.ETER 7ESTINts MMOD
1: Testthe perimeter of the horhe at t Locations.. .
2 Take. the Ma ding at the depth: of the#ooter.
a Uxing SM lb. lncrements, t 6.the lowest
reading and round. down'to that 1norement.
E. 4B
The results of the torque probe test' inct, pounds or d�edt
here ff you are declaring & anchors ut testJnp _ , A or .
showing 275 inch Rounds or IM-Will requltaZ foot anchont .
Note: A state approved lateral an system is being used and 4'ft.
.anc.�bors are allowed at Mine sidewag lo';Wlorm I uddetstand 5"ft
anchors are req+tlred at al tefte tre polrtts where the torque test.
rea ng" is 27v or Eess the rrtob11e:Fjarn9 manufacturer may
requlras anchors with ,ng,:
Installer's initials,
ALL TESTS" j�T BE PT=AFOR A LICENSED INSTi4Lt.€R
Installer Nance t
Date rested
;onneot etectrtcal cnnduciorsbetween mufti wide unfts, butnot'to the r� power
aurm 7WIhcludes the bonding wire betwee�a mutt -wide units Pg, `V
brineot all. sewer draIns.to an odsting.sewertap orse Vo.tank f%
onnect all potable wafer.supAh►Ffping to Wsting water meter, water
idependent water supply systems, Pg, tap, or other
Debris'and organic material. removed. " t1
Water drainage Natural other,
Fastens rnnl 'uncle sus is
Floor Type Fastertei �,Spac n2
Wails: }� Fasfsriei J-,Lenox,± Q....
Fioofi. 7 e Fastenas
f understand a properly In&atted gasket 1s
homes and that condensatlon, mold, meld
a result of a pootty Installed or no gasket'#
of tape -will not serve es a gasket,
TYpe,gasket._
Pg..
of
n
Floc Yes
Walls Yes..
. ddgebeam Y` es`"'---
weatn
The bottombpaM will be repaired andtor tavecC Yes .
Meui on unitsis installed to rh4riidacturses t o'. Yes_`
Fireplace chimney insWied sa as not to ailcw intrusion of taitf water: Yes
Skirting to beinstalled. Yes
Dryer vent hstailed outside of:sk� No
WARanpedownflowvent:itasteltad'flutslde.ofskirt`in'�es ``N/A
Drain Thies supported at,�4 foot Wervais. �ti�" ..-
Electrical crossovers protected. Yes
Other:
Installer
is'It cczatf based on the