HomeMy WebLinkAboutPERMIT WORKSHEETs
A• e
. a
S,L o
Installer license # .xu 1
Address of home
being installed
Manutac(��ar Lennth x width 3(yr.
No?- ' If home is a slrtgle wide fill out one half of the blockhg plan
I home Is a triple or quad wide sketch In remainder of home
f understand Laieral Attu Systems cannot be used on any home (now or used)
wirers the sldewall ties exceed 5 ft 4 in: Ins -tatter's initials �,_
SCANNED
BY
PERMIT WOFRKSKEET N& WMile GO qLYpays Y of 2
New Home • [] Used Home ,
Home installed to the Manufacturers InsWatlon Manual ❑
Home Is installed in accordance with Rule i6-t; ❑
ftle wide ❑ Ind zone 11 Wind zone lil []
Double wide ' installation Decal # '3 Q2 \3�
TrlptefQuad ❑ soda]
PIER SPACING TABLE FOR USED HOMES
load
Ct��
DIY
Footet
8tZ8
I fsa IN
i6'xifa
(256)
18i12'xi8112'
(see)
2Wx2o'
(400)
28'x22'
(484r
2,3'X24'
(576)•
26'x26'
(671
luou
W
s
Oa n5l
4 s
8
log
o
s
IIliC FwuuW 65WM muno 40v a piw Mqlauuw mum.%
PIER PAD SIZES
U S Me
pier pact size \ \`
a
n
Perimeter pier pad size \\
x
Other pier pad sizes S
16 X
frequired by the mfg.)
17x22
Draw the approximate locations of marriage
x
20 x
wall openings 4 toot or greater. Use this
x
symbol to show the piers,
x
List all marriage wall openings greater than 4 toot
x 25
and.thelr pier pad sizes below.
-
Opening Pier pad --size
AN aRs
FRAMWithiETrES
�1--Y, . --
2' and of home
spaced at 5' 4' oc
TIEmm OompoNem
I OTHER TIES
Longitudinal Siab111 g evlce (LSD)
Sidswali
Manufacturer W", h
Longitudinal
Longltudlnal Sta ing evlce ivl ateralArms
Marriage wail
Manufacturer
��i
OCka PE—NETROMETEk TES _
The pocket penstrometertests are round wn to psi
or check here-tb decare IOW Ib. soil V without to _ing.
X X X
POCKET PENETROME Si I ES Na METHOD
I. Test the perimeter of the home at 6 Iocztlons
2 Take the reading at the depth of the tooter:
3, H;in9 Sm lb. increment% take the lowest
reading and round down to that increment.
X X - X
E 3ETEST
The results of the torque probe test Is_ inch potmds orcheck - -
here ft You are declaring S anchors %Moot testing _ . A test -
showing 275 k c b pounds or Jess will require 5 foot anchors:
Note: A state approved lateral arm system Is being used and 4 fL
anchors are allowed at1he sidewatl locations I miderstand 5 fi
anchors are required at all centwilne tla points where the torque test
reading is 275 or lass and wrehethe mobr78 Fiwne manufacturer tray
requires anchors with drhQ 40capagiy-
_:.. st$ilet's triltiats
ALL TESTS MUST BE PERFORMED BY A UCEII&ID INSTAi1FR
Installer Name _
Pate'Tasfed -
:bnned electrical conductors between muld-wide units, bud not to the main power
o=e. TN -hMudes the bmu ffng Wke between muff -wide unars Pg. - �—+—
vnned all sewer drains to kat Odsling sewer tap or septic tank. Pg.
tinned all potable water supply piping to an existing water meter. water tap, or other
;dependent water supply systems• pg.
Page 2 of 2
uit PFopataffOA
Debris and organic material pfhoved _
Water drainage NaUM V Slnrate Pad ptfW
_ Fastenrn� multi w[rie aAtts
Floor. Type fastener.taso
l e�ih: spaoln�
Roof. Type Fhdm Fastener:L�en� Spacing:or
- —
YPe Sly fF y
For -used homegauge, W wide, gal�ranized m
Will be centered bvwthe peak of the -roof and fastened ti4r�fehtagWv-
roofing nails at V on center on both sides of the centarima,
Gasket
I understand a Properly Installed g ldmt Is a requIrement of all new and used
homes and that condensation, mold, maldew and budded marriage waifs are
a result of a pooriv installed or no gasket being Instalierl. I understand a ship
Of tape will not serve as a gaskeL
irisfaller's lixwsa
Type gasket YOOM Installed: /
pB. Between Floors Yes ✓
Between Walls Yes
Bottom of ridgebeam Yes
7Fte bottomboard will be repa7redarWbrteped Yes- Vpg,
Siding on units is ¢hstalted to mandac turet's spec fioations Yes• ;i ,
Fuephwe chimney installed so as not to allow intrusion of rain water. Yes � �iti.
Skating to be•Installed. Yes No
Dryervent i rAalled outside of sidrting. Y s W
Range downffow vent Installed -outside of ski`y NIA
Drain fares supported at 4 fod Worvat.� Y
Eledrkst crossovers protected Yes_
Installer verifies all information given with this permit warkshee
mt
Is accurate and true based oti the
anufacture Ilgffon I stru and of Rule 75C-t 2
tnsiatlerslgneture - - ����� ��