P - 83522.�
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City of Fridley
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Manufactured Home/ Accessory Installation
Permit Application
Park Name: �j� 1 i� ���y �� f�' ��
Job Site Address: %yy� �Q-/fE2 ,�V� Al�� Zip
Project Valuation: $_� �(�C� , Ca � Applicant Is: ❑ Owner and Occupant �Contractor
must include material and labor costs
Pro e Owner
Name [";�}�- ,i¢ �j -
Address Unit #
City State Zip
Phone
Contractor
Name � i �Z � �. � 1���i N �' Installer's Name �f ^( i "�Z
Address �'7�(, f.� t,� .� � �
City � f q� T E. �Te w r�.i State �YIl1L Zip ���
Phone `,� Q. License # �y1.� ��,� ��" Email
Pro er Use T e of Structure T e of Work FEES
� Residential �1Principal 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 installation 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.
Permit #�l1 I(� ���
Updated 7/1/10
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Entezed
Print Si nature:
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For Office Use Only
Date ', c�• �j/- / Z
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MANUFACTURED HOME:
Brand Name: ���F�N�"iT��. Model Name: S��u�y�C��.��
Serial Number: '�"6 O Date of Manufacturer: T �c�lo2
Construction Label Numbers:
HUD Code 06/14/76 and newer, State Code 7/O1/72 to 06/14/76, Pre-code prior to 07/O1/72
Roof Load Zone: ? t'� 1�. Heating/Cooling Zone:
INSPECTION:
Installation•
Seals/Certificates# `�"' 13 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 mstructions in a park set or by code adoption or zoning ordinance in a private property
set.)
Foundation Tvue•
Piers below frost depth: 7(�S Crawl space:
Full depth basement (treated wood, concrete block, poured concrete or toher)
Engineered slab on grade (signed approval by Dapia or MN Engineer)
Suaaort Footin�s: Type: C F� N C- �7 eT �- Size: (��� J� C� �►c'v �
Soil Conditions: s�sG� PSF Pier Material: � f?�V ��'Z 2T�-
Pier Snacin�: �_ Feet _`� Inches in center (calculations should be submitted for review prior to inspection.)
Shims: Material Used: ���,p�o'��.�
Size: �/" 7(' 6�'� (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 model numbers) �( oi S�5'�'�' t'h
Soil test Probe Toraue Value inch nounds
Conditions of Issuance
Add Delete
❑ ❑ Consultation
❑ ❑ Final
❑ ❑ Plan Review
❑ ❑ Trench
of Work to be Com
ns
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City of Fridley
6431 University Ave NE * Fridley, MN 55432
Phone 763-572-3604 * Fax 763-502-4977
Updated 7/Ol/2010 ,
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SINGLE-WIDE SUPPORT PIER PLAN (TYPICAL)
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REQUIRED DIMENSIONS (�
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MANUFACTURER INFORMATION
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Maximum End Support (I-Beam) � '
Ground Moisture Control �!� Yes No
Grading to Slope AWAY From Home �.��
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ORIENTATION
SOIL INFORMATION
Classification No. S�N�� �_�'����`�
Soil Bearing Capacity �'�� � �
FOOTING INFORMATION
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MANUFACTURER INFORMATION
Name �v �wTV�t�
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Maximum I-Beam Spacing
Maximum Anchor Spacing
SOIL INFORMATION
Classification No, S�4Noy Gna�
Soil Bearing Capacity �Soo � b
ANCHORING INFORMATION
Ext. Wall Height �'
Roof Pitch 3 %-L.
Height From Ground to o ��
Frame Connection 3
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ANCHORING INFORMATION Cont.
Anchor Manufacturer X t� SyS�N�
Lateral Anchors Req'd YES or NO
Anchor P.N. �1 30'7
Connector P.N. .�'9� 3a °7
Longitudinal Anchors Req'd ES r NO
Anchor P.N. 5�3a"7
Connector P.N. � S�D��
No. Per End I
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* P.N. = Part or Product Number P� S�agl�
G:/BCS/WORD/ms/CCLD Installation Permit Application Packet/Support-Anchoring Plans 04-02-09
FROST DEPTH PIER SECTION VIEW
^"^DBOARD FORMINr �' '�^
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"BELOW"
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SOIL CLASSIFICATION ._S�iNd�� G'�R�{
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FOOTING AREA �`�'�'� SQ. IN.
SOI LS TOTAL LOAD CAPACITY o� "�'� � k'r
-PSI CONCRETE ���`'
G:/BCS/WORD/ms/CCLD Instatiation Permit Appiication PackeUBelow Frost and Frame Pier Section Drawings 04-02-09
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FRAME PIER SECTION VIEW
TOTAL HEIGHT
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FOUNDATION TYPE
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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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