P - 83523�
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City of Fridley
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Manufactured Home/ Accessory Installation
Permit Application
Park Name: �'"' � l 1'a ��
Job Site Address: +%�/�{ �¢i«/L Ve �j/�� Zip
Project Valuation: $ �,� ��p .� E: Applicant Is: ❑ Owner and Occupant �Contractor
must include material and labor costs
Pro e Owner
Name_�,�}( � ,�} �'j
Address Unit #
City State Zip
Phone
Contractor
Name i2�T�� ��. 1j�,�fN� Installer'sName i�NI r'T�2k'
Address �'7;�(0 �'.j t� � ,� �"
City (� A� T' E�2Te w=V State � Zip ,�"�
Phone ' / Q. License # .� ��,� �'�' Email
Pro er Use T e of 5tructure T e of Work FEES
❑ Residential ❑ Principal Bldg � New Bldg Permit Fee: 100.00
❑ Commercial ❑ Accessory Bldg ❑ Existing Bldg State Surcharge: 5.00
❑ Industrial ❑ Repair / Replace
❑ Institutional Other TOTAL DUE: 105.00
❑ Public
T es of Homes s(check all that a ly)
Single Wide� Double Wide ❑
Additional Permits Are Required For Electrical, Plumbing (sewer & water), and Mechanical (gas)
REQUIRED ITEMS TO BE SUBMITTED WITH APPLICATION:
Accurate Site plan: Note Setbacks
Soils report: a minimum of 2 engineered soil bearing capacity tests
Manufacturer's anchoring specifications Home and Site specific
Check if items are included
I hereby apply for a manufactured home instatlation permit and I acknowledge that the information above is complete and accurate; that
the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I
understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of all work which requires review and approval of plans.
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Permit # �� �� J�� �� Entered
Updated 7/1/10
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For Office Use Only
Approved
Date � G` � Z
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Issued
MANUFACTURED HOME:
Brand Name: �}j)�FN7'U�� Model Name: ,$'/N�+/t�..�o�'
Serial Number: �'1" 6 p Date of Manufacturer: �t>>�
Construction Label Numbers:
HUD Code 06/14/76 and newer, State Code 7/O1/72 to 06/14/76, Pre-code prior to 07/Ol/72
Roof Load Zone: ?-p 1 b,� Heating/Cooling Zone: �
INSPECTION:
Installation:
Seals/Certificates# ''fi � p Anchoring#
(Anchoring may be required by Municipal Ordinance park rule for pre code and State Code homes. Anchoring is required for
HUD Code homes.)
Instructions Used: Manufacturers "� State Chapter 1350
(Homes constructed after June 14,1976, requires manufacturer's instructions be used.)
Foundation to State Buildin� Cod YES or NO (circle one)
(May be required by manufacturer's n tructions in a park set or by code adoption or zoning ordinance in a private property
set.)
Foundation Twe•
Piers below frost depth: �tC'.� Crawl space:
Full depth basement (treated wood, concrete block, poured concrete or toher)
Engineered slab on grade (signed approval by Dapia or MN Eagineer)
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Suanort Footin�s: Type: C F.� �lJ C..2 c'� �- Size: ��� � t�°.l�v
Soil Conditions: ,�� Sd �' PSF Pier Material: C t> �V C� ✓z �2"��--
Pier Snacin�: _� Feet _� Inches in center (cakulations should be submitted for review prior to inspection.)
Shims: Material Used: �,¢�,p�o'�c��
Size: �-% �' 7(' (� �� (minimum 4" x 6" hardwood)
Clothes Dryer vented to outside crawlspace or skirted area ES r NO (circle one)
Material Used:
Fresh Air intakes to outside crawlspace or skirted area: (if required for fireplace or furnace or water heater) YES or NO
(circle one)
Anchoring Equipment (If applicable):
Anchors Used: (manufacturer's modei numbers) X( � S� 5�'c M'�
Soil test Probe Torque Value inch pounds
Conditions of Issuance
Add Delete
❑ ❑ Consultation
❑ ❑ Final
❑ ❑ Plan Review
❑ ❑ Trench
of Work to be
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skr2fi. 9,�� �- er��+zt�
City of Fridley
6431 University Ave NE * Fridley, MN 55432
Phone 763-572-3604 * Fax 763-502-4977
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SINGLE-WIDE SUPPORT PIER PLAN (TYPICAL)
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L— PERIMETER PIER SUPPORT @ OPENINGS
REQUIRED DIMENSIONS (�
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I-BEAM PIER LOCATIONS �
REQUIRED DIMENSIONS _ _
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REQUIRED DIMENSION
MANUFACTURER INFORMATION
Name 4 � �= `� i; %c IF�
Home �ize s �` �{ ° ,� (pg `
Maximum I-Beam Spacing � �
Door Openings ��'s s�- n-- � ��'`�
I-Beam Loading PLF (� ��2
Maximum End Support (I-Beam) � Y
Ground Moisture Control ;�� Yes No
Grading to Slope AWAY From Home ���
ORIENTATION
SOIL INFORMATION
Ciassification No. S���y �j?'�J�-`�
Soil Bearing Capacity ,���, p �j
FOOTING INFORMATION
I-Beam x x
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G:/BCS/WORD/ms/CCLD Installation Permit Application PackeUSuppoR-Anchoring Plans 04-02-09
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REQUIRED DIMENSIONS
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REQUIRED DIMENSION
MANUF,ACTURER INFORMATION
Name �p J c�'� t� �2 �.
Home Size �/ 6vrC �o► S� `
Maximum I-Beam Spacing �
Maximum Anchar Spacing
SOIL INFORMATION
Classificatian No. .S�1wby ��A��
Soil Bearing Capacity �$'DO ( b
ANCHORING INFORMATION
Ext. Wall Height �'
Roof Pitch 3 ��Z.
Height From Ground to p ��
Frame Connection 3
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ANCHORING INFORMATION Cont.
Anchor Manufacturer SC [ � SyS�W�
Lateral Anchors Req'd YES or NO
Anchor P.N. Sr 30°7
Connector P.N. .�"'S� 3� �7
Lonqitudinal Anchors Req'd ES r NO
Anchor P.N. �7�34�
Connector P.N. � �����C°
No. Per End y
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* P N. = Part or Product Number P� s Ya��'
G:/BCS/WORD/ms/CCLD Installation Permit Application Packet/Support-Anchoring Plans 04-02-09
FROST DEPTH PIER SECTION VIEW
^"';DBOARD FORMIN�
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DEPTH
"BELOW'
GRADE
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SOIL CLASSIFICATION .S���y G���=�
SOIL BEARING CAPACITY �.��'�'_ PSF
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FOUTING AREA �`��' SQ. IN.
SOILS TOTAL LOAD CAPACITY o� ��� ��'r
PSI CONCRETE ���"'
ALTERNATE
�BELLED"
FOOTING
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G:/BCS/WORD/mslCCLD Installation Permit Application PackeUBelow Frost and Frame Pier Sedion Drawings 04-02-09
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FRAME PIER SECTION VIEW
TOTAL HEIGHT
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FRAME HEIGHT
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�� HARDWOOD SHIM
'IER HEIGHT
FOUNDATION TYPE
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CAP MATE IAL
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G:/BCS/WORD/ms/CCLD Installation Permit Application Packe$'�elow Frost and Frame Pier Section Drawings 04-02-09
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