HomeMy WebLinkAboutPERMIT WORKSHEETPERMIT WORKSHEET
PERMIT NUMBER QQq g-
InF, taller L�sA- License #
Addressofhome
being Installed
I
Manufacturer , ._Af0(_ LengIhxwidh
NOTE.- if home is a single wide fill out one half of the blocking plan
If home is a triple or quad wide sketch in remainder of home
I unders land Laterst(Arm System s cannot be used on any horn a (now r used)
where the sldewall ties exceed 5 It 4 in. Installer's ir :�f
Typical pier spacing
2' 1� ' i�� I 101Wd
[j_ Show locations of Longitudinal and Lateral Systems
D" (use dark lines to show these locations)
'.7
—in
r r r 7 - T - r - r -i-
J- 1 - I - L
41. IL 11
+ J-1-L _L_r�
I . I . .-
L j i L L - L -I-
IL 11
4 - - r
IL + r
.2-, ' " -L -, L
.1 - ?tll - 11 - 11
New Home 1:1
pa el of 2
Used Home
Home Installed to the Manufacturer's Installation Manuel 0
Home is installed in accordance with Rule 15-C
Single wide Wind Zone It ;!g� Wind Zone III
Double wide installation Decal # 1 (10 5 1 L5
Triple/Quad E] Serial # 15 (0 D-D- 130
PIER SPACING TABLE FOR USED HOMES
bearing
capacity
__—Tgpa�
s'�
(Sq , in)
16'. x 1G.'
(256)
---
18 1/2" x 18
1/2" (342)
____7�
2V'x 20"
(400)
22" x 22"
(484)-
24" X 24"
(576)-
26" x 26"
(676)
T_
0
71�
U
�Ps
8,
EmISE
8�_
__T_
_T�
__T�_
__T_
P I _�ERP A D 8 IZ �ES
I-beam pier pad size CA0 Yl�
Perimeter pier pad size IV I
0-k- d 0 0 fe-,
Other pier pad sizes
(required by the mfg.)
Draw the a pproxim ate locations of in arrla�
wall openings 4 foot or greater. Use this
symbol to show the piers,
List all marriage wall openings greater than 4 foo
and [heir pier pad sizes below.
Opening Pier pad size
I POPU gK],�
F ANCHORS
4 ft q
within 2'af en� of home _,I,'
spaced at 5'4," oc
J
TIE)OWNC
Number
Longitudinal 9tabil' i
g Device (LSD)
Sidewall
Manufacturer.
Vo
Longitudinal
Longitudinal Stabilizing Device wl Lateral Arms Marriage wall,
Manufacturer:�.
Shearwail
PERMIT NUMBER
The pocket penetrometer tests are roundad"down to Psf
or check hereto declare 100o Ile. s oil V' withouiT—testing
x — x —
PO IETP NE 'ROMETER TESTING METHOD
T
Te:1
thle
e p:ril.
-ne ter of the home at 6 locations,
2. -Take the reading at the depth of the factor,
3. Using 500 lb. Increments, take the lowest
reading and round down to that Increment.
X_ X_ X_
PERMIT WORKSHEET
The results of the torque probe test is Inch pounds or check
here if you are declarin j83�
_q 5'anChDrS without testing
Showing 275 inch�pouj' _. A test
ids or less will require 5 fact anchors,
Note: A 8 late approved lateral arm system is being used and 4 ft.
anchors are allowed at the sIdewall locations. I understand 5 ft
anchors are required at all centerline tie points where the torque test
reading is 275 or less and where the mobile home manufacturer may
requires anchors with 4POQjIb holding capacity.
_. Lfl Installer's initials
ALLTESTS MUST BE PERFORMED BYA LICENSED INSTALLER
Installer Name J=��
Date Tested
Connect electrical conductors between MUlti-wIde units but not to the main power
Source. This includes the bonding wire between mult-W cle u nits. Pg,
Connectall sewerdrains loan e)dsting sewer tap or septic ank. Pg,_
Car, nectall Potable water supply piping loan e)dsting water meter, water tap. or other
Page 2 of 2
Debris and organic material removed P7P
Water drainage: Natural _ Swale W—Pa—dV/ Oth6r
Floor: Type Fastener: Length: Spacing:
Walls: Type Fes Length:
Roof., Type Fes Spacing: 1�
For used nome-4 Length: Spa in
a a mill. 30 gauge,_� Twide. gaivanized'171etal strip
will be centered over the peak of the roof and fastened with galv.
roofing nails at 2" on center on both sides ofthe centerlIne.
I understand a properly installed gasket is a requirement of all new and used
homes and that condensation, mold, rneldew end bijcl(lpd marr'�'ge Walls are
a result of a poorly Installed or no gasket being installed, I unde'rstand a strip
of tape will not serve as a gasket.
Installer's initials
Type gasket ....... Installed: I
Pg. Between Floors Yes
Between Walls Yes
Bottom of ridgebeam_Y�s —I—
Weatherproofing
The boftomboard will be repaired and/ol, taped. Yes
Sidling on units is installed to manu P6.
facturer's specifications, Yes ;L,�'
Fireplace chimney installed so as "Of to allow intrusion of rain we tarYes iz
UlAscellaneous
Skirting to be Installed, Yes L---N a
Dryer vent ins tailed outs kle of s kirtin ' Yes N/A
Range downflow vent installed Outside of skirt ng. Yes �NIA
Drain lines supported at 4 foot intervals. ye
Electrical crossovers protected. Yes
Other:
nstaller verifies all Information given with this Perim
iS accurate and true based on the
manufacturer's Installation instructions and or Rule
Installer signature