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PERMIT WORKSHEET 1 page 1 of 2
PERMiT NUMBER, :..... ....
:... �} �• -... ,
�j �,� New Home ❑ Used Home
installer I/'t �" �c Ucense # �?'� /.2,? j,P C
Home installed to the Manufeotureer, installation Manual ❑
Address of home _ ` `,��/ /�'�' `"� Horne is Installed In a000rdanoe with Rule 15-C
being installed
Single wide ❑ Wind Zone li Wind Zone III ❑
Manufacturer „ ,.,__ Length xwidth L �'=°; = . -Double wide ' Installation Deoal n `
NOTE 'If home Is a single tWde M1 out one half of the blocking plan TriplalQuad ❑ Serial
Ithonfe Is triple or quad wide sketch In temslnder 'of home SCANNED
I understand Lateral Arm Systems cannot be used on any home (now or us BY PIER SPACING TABLE FOR USED HOM�s
where the sfdewall ties exceed 5 It 41n: St LU
• installer's in>tfals
Typical pier s�
Show locations of
menlape Walt pl.rswpMna' at end of home var Ruto 18C
;ang "I
capacity
size
(sq 1n)
1rx181
(256)
1811210811V
(342)"
MIMI
(400)
Wx221
(484r
241X241 WxMe
(578)` (676)
100
3
oij6
00 s
8
2 00
8
8
3000
8
88
8
3 00 pat I
a-
a-
8
1"WI PIUM9 uom MIQ 112W-1 pier Spacing WPM
PiER PAD SIZES
I-beam pier pad size
Perimeter pier pad size.
Other pier pad sizes
(required by the mfg.) .
Draw the approximate locations of mardagt
wall openings 4 foot or greater. Use this
symbol to show the piers.
Ust all marriage wall openlrigs greater than 4 foot
and.their pier pad sizes below;
Opening Pier padsize
(�f* v �� n
r A Qr tJ��
POP PA SIZE-8-1
� .vwnv.ly 1
FRAM ETIES LL
within 2' of end of home
spaced at 5' 40 00
■��eaaseefe>ve>•e>•s�e>•s����������s��i!• � i . _
1■■�til•��Ii���■■ti�������ti��tinoMM
EM
I
:PERMIT NUNfBER .. .4` .�:
POCKET PENETROMETER TEST
Thepbcket penetrometer tests are rounded to psi
or check hereto declare 10D0 lb. soll without testing.
X X X
POCKET PENETROMETER TESTING METHOD
1. Test the perimeter of the home at li locations.
2. Take the reading at the depth of the,footer.
N . •
S. Using 600 lb, iperements, take the lowest
reading and round down to that Increment.
X X X
' DRQ E PROBE TEST
The results of the torque probe test is - • 9/— 7 Inch pounds or check
here I you are declaring 5' anohom 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 atlhe sidewall locations. I understand 5 ft
anchors are required at all oenterllne tie points More the torque test
reading is 275 or less and where the rgobile home manufacturer may
requires anchors with 4000 •h*ing capacity.
Installer's initials
ALL TESTS MUST BE PERFO MED BY A LICENSED INSTALLFER
InstailerNamet��� �-•�
Date Tested
' Eleotrl
tbnneot electrical conductors between multi -wide units, but not to the main power
curve. This -Includes the bonding wire between mut-wide units. Pg.
'onnect-all-sewer-drains-to- existing sewer tap or septic tank Pg; -- -
PERMIT WORKSHEET Ipage 2 of 2
Site Preparatlon
Debris and organic material removed
Water drainage: Natural Swale Pad Other
Fastening mul wide units
Floor, Type Fastener. Length: `� Spacing: _
Walls: Type Fastener. Length: 7-77— Spacing: /-
.Roof: Type Fastener. Length: = Spacing: �•�
For. used homes a in. 30 gauge, 8" wide, galvanized metal `strip
will be c entered'over the peak of the -roof and fastened with gale.
roofing nails at 2" on center on both sides of the centerline,
Gasket (wmtheraioellrtg reap MMft0
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 7� .
Installer's initials'
Typegasket `
Installed: � •
Pg. Between Floors Yes
Between Walls Yes
Bottom of ridgebeam Yes c�=�
setherproofing
The bottomboard will be repaired and/or taped Yes Pg.
ations. Y
Siding on units is installed to manufacturer's specifices --�
Fireplace chimney Installed so as not to allow intrusion of rain water, Yes lyz?
see►reneous
Bidding to be installed. Yes, No
Dryer vent installed outside of skirting. Yes ✓WA
Range downflow vent Installed, outside of skirting. Yes TWA
Drain lines supported at 4 fobt Intervals, Yes
Electrical crossovers protected Yes
Other;
er verifies aU Information given with this pe
14 accurate and true based on the
onneot all potable water supply piping to an existing water meter, water tap, or other installer Signature. _��� rt Date �aZy'✓
(depend" water supply sydtems. Pg.