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AF - 36383From: 6127551554 Page 7/8 Date 10/25l2010 7 28:29 AM FRO('1 : MASTER MOB I LE HOME SERIJ I CE PHONE NlO. : 5127551554 0 c t.. 23 2� 10 �4 : 15PM P7 I'IORI: l,lly Of r�ltli@y Io: JF��755155d Pape; 2/3 Data 4/13/2010 9:p5:54 AM Buildir�g M.F,CHANI�I�L Permit No.:' � i: � j i Inspections ��;SI�.�Nrl'lA.L AYY�,ICA'1'.LQN R���v� $y: r� --� �63-s�z-�soa CITI' 4F F�t.].Di,EY n���' `��" 763-5(1Z-49'77 4�'A?C .. _ �o ll,qTt 1 V ` CY� " Sl7k AullKtSS _,____L i nis ArruC,�n r i5: PROP���'Y o�r�rr�zv TFH.aYr co�vrRacz-oR SIIRMIT A CnPY nP YoURST�TE LlCCNS� WITlI APPLICA710N PERI4IIT TYP� TYPE OF WORK: YOUK t�h�AlL AUURtSSGJ�I�I�pr� �.r� I�S'tTI l� �P - � : ❑OwNe}t CSl".AN'1'ItAC'IC�R NAM � Q� .\ t J ,�uoR�;ss:'-1 � i'V� c�st' ! G I�I srnr�MNu� 55y3d F'lt�Nl:: L'n,�1v9NY NAM1f�' �S � I f� I %�'! l L{� y�C � Cf7NT.�CT PtH50N: a-�Y� s5 C 1TATti UCki��� M/I �T ExP DATb �uoxtss:�� '�ot.�t�' C�rlv� N� cir� L STAT�Nz�P55`i`�`� PHONE�(O�'�I��J".�I�'�'�� }'A?C�IGc�'`7J�5'���J � �(SINCL� NAMILY 17 TWO NAI���Y C FD\Vk1{AUSE �i�rtu' �7 IiEPL,�C'kti1�N7 Q AL�EliA71UAi'1(�MC)uk:L U� t AILtU lJkytKlk�t"lU(V Ut' WVRK 4�Gr5 �i (�iiK � �� .�t�UfYl m +���.5 a�i� sav�n �v s�n.00 r�ii � ix'rt,�ie, exctir�r w H�K� vo•r�a r�xruK�s: �i�ut�n•re •ro•�'ai vutie�M o� x�cH seL�w> PItU�IP� M�l' LUSS C�1,C'S 1'L�R )tA�I�AL J 20U6 ASHHA� HAVp$OUIC. �quipmenr Insmlled Mh'Cr. _ Mqy�L St��TU Ml'G: �SAll1;L: SI'LL'/UTU MNu"; MQll�L. S1Gt/d'CU ,410525.00 F'IRkP�.qCe(ciASlft3.00 • ' QAS AANQtrbYL�NSIO.OQ _AlK TC7 Allt �XCFlA�tGttK S IS '�YIK�'Pt,ACt( WtX7Dl S)S.QO NEVJ CIAS GR1L4 S IQ.00 _tlnIL�:R S?S.RD `��N'�fR N.�C`F:.L,iS (?� �CAg UN1T HTtt SIQ,tI(I _CMIM1vt7 LINtkS�U.� �CiA$UltY�k3lp.bU PCaQLHEATt}1335U0 UUC'7 WORkSIU.UU GA� pIPINf; SIU.c70 �VENTILAT[)K SIS.UU Afu t�or �o���ur�a �,e. ;� 1,5�t� !1 h'uiiib�r c�t ���tcs t�.:5��;pR Nuia�cr v�fi.'�sitca c�;$�3 �f1 �i8iC�:�ut1��3$tf�y` m �i � r _, ..""r'r""".� . . . . . , ... . . . <. . .r<: .'' . . .., . ----'r .. ...., ;�; � �-m�� , k r '. � ; . 3 _.�, s ;. 'y Y� J � y X �} 47 .Y.' ./�^ � r ��i'�< _._.} ..� ......32.. . . . �..2.. „l , f :� srs ;; �; >,' �fi� }: x�k �: � ,i3 S ;> TH1S :S AN APPL!CATIf�k �+C)fiA PL'RM1T-Nl7T V.�LI� VNT1L FRCXLSStD ! hCrc�y appl)� for a building �xrmir ar,d I acknowlalgc. that thr informuti0n BbOvc Ii: Completc and Sccura�c; that th�. N•orl: wii2 ix. in conformancc with thC ordinancCS and CadC� of th� City of 1'ridlcy and with thc MinnC.rots Cot�.�sTr'uGtion Cod�s: that I undcr�tand thi.� is not a fx:rmit but onlv an eppliCStio permit and work i� nof to start without a permit; tii8t thv wOYi: will bc iri aCCOrdanc� with thc xppruvtxi �rlan in thc ca�c li w i h rL�yui rs;vicw und x ruvxl nf ne. SIGNATUR� nF',�PPLtCAN p1L1,yr g��lV1S �QSS2^�' vnTe ��'`� 5�� nPPtiOVnL INaPtC7pRS 31GN.1T �K� DATE �� V ; : 'P <' . SENQsCEr��£PARA : ''f��° . . ,R� �t. I.���LC2'f41t> i . :. , _ :�'g3`t�l� '`:A1�; - , ' �;�4�`y� , �- . `. ,;' Cfty Of Fridley �Buildin� Inspectians Depar�cneni 6a31 Cr�iiversity Avenue �IE, Frldley,l�TN 5543� 763=572-�60� FAX: 763-503-�1977 . ,� �. � Crty o, f ' Fridley : Manufactured Home/ Accessory Installation Permit Application � Park Name: _ � � � � : � , �.?.%�; v � Job Site Address: %`� `'� .3 �q KF_ �2 5'�" 7V �-- Zip Project Valuation: $ '; `. � = _ � - Applicant Is: ❑ Owner and Occupant :E�Contractor (must include material and labor costs) Pro er Owner Name :�%: .:_ — % �� Address Unit # City State Zip Phone ( ) � Contractor Name �- � ,% %, � Installer's Name ti � =. � -=� : `` ?���__ Address ,� � - _ _ � - V...�. City ��' --_;%--..� J� State r!'f� � Zip S � '�� Phone ( � _ ) �f � - " - - License � � '.:; � � - Email Pro er Use T e of Structure T e of �'ork 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 apply) Single Wide � Double Wide ❑ Additional Yermits 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 1 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. Si�nature of Applicant: Print Si�nature: Date ; � , _. � - � � , �. �_ _ - . � V . F4.� F; -,� ,- :i,�_ ;; —, . Au�roved bv;, , ' Date �.; For Office Use Only � � ' �� REC'D AUG022010 Permit # _ ; y' �i��dA U C(� 2%(� � n Approved —Issued Updated 1/29/09 SUPPLEMENTAL INFORMATION SHEET THIS IS ADDITIONAL INFORMATION REQUIRED BY THE CCLD FOR APPROVAL OF INSTALLATION PLANS FOR MANUFACTURED HOME INSTALLATIONS IN COMPLIANCE WITH THE MANUFACTURERS INSTALLATION MANUAL, HUD CFR 3285 AND MN STATE BUILDING CODE (MSBC). HOME INSTALLATION BY: � MN LIGENSED MANUFACTURED HOME INSTALLER ❑ HOMEOWNER TYPE OF INSTALLATION �- MANUFACTURED HOME PARK ❑ PRIVATE PROPERTY SITE �4, SITE PLAN PROVIDED-INCLUDE BUILDING AND PROPERTY LINE SETBACKS [� SITE DRAINAGE ❑ DESIGNATED FLOOD HAZARD AREA ❑ FIRE SEPARATION REQUIRED YES OR NO: IF YES-EXPLAIN REQUIREMENTS & DETAIL ON SITE PLAN MULTI-SECTION FRAMING TOLERANCES 0 LIST THE MAX. GAP ALLOWED BETWEEN THE SECTIONS OF THE ._ , STRUCTURE ❑ FLOOR 0 CEILING ❑ RIDGE ACCESSORY STRUCTURES-PER MANUFACTURERS INSTALLATION MANUAL, MSBC CHAPTER 1350 AND MSBC CHAPTER 1300. ❑ DECKS � � STAI RS ❑ LANDINGS ❑ OTHER G:/BCS/WORD/ms/CCLD Installation Permit Application Packet/Support-Anchoring Plans 04-02-09 City of Fridley 6431 University Ave NE Fridley MN 55432 PRINT IN INK or TYPE your responses. General Information HOMEOWNERS NAME .�-` � --:�-: :'r��;`,�;;�= , HOME LOCATION/ADDRFS� y y ,�q k F2 S�T ti. � MANUFACTURED HOME BRAND MODEL • . : 1 / � / HUD or STATE LABEL(S) NUMBER (S) (lf home was r Is the home located in a park? Name of Park No OYes p, -- . : C . G' J, _ Building Permit Number: Support System � _ Support System Seal Number: Bearing Capacity (p.s.f. Mail SE Manufactured Home Installation Compliance Certification form to the City within 10 days of completion COUNTY . J J��� J �;-/:.: CITY .� r,� ; �; : ., . . BER OF HOME DATE OF MANUF/ prior to July 1, 1972, no labe/ number i tft _��..✓ Inspection of installation completed? Date of No❑Yes❑ � Foundation Type: ❑ Ground Block ❑ Frost Depth Piers ❑ Basement O Crawlspace w/frost ftg. ❑ Engineered Slab O Other Approval Alternate Altemate approval number: Method of verification DATE OF INSTALLATION L Support System Items of Utility Work: (Entercompleted by, ifinstallerstate installer, ifhomeownerstate homeowner, ifothergive name of person, company name, license number if known.) _, -� . . _ _ _ - -----� Water: Tested: _�' � . � Gas: Tested: �Vlq5t�2 Electrical: (By licensed electrical contractor or homeowner) (Park installatron requires electrical contractoi) Tested: �DV�?nrr�}G�E Other Items Included in Installation Contract: Home Stand/Pad O Lot grading ❑ Skirting G� (Type): Exterior Stairs/Landings F�3 How many? _ Other Items: '� l hereby certify that the Suppori System on the Manufactured Home listed has been completed rn accordance with the manufacturers instructions and the Minnesota State Building Code. MN REGISTRATION NUMBER INSTALLER COMPANY NAME LICENSED/REGISTERED INSTALLERS SIGNATURE: Anchoring System '�" ' � � =- • ; � �%:. -�- _,-- _. Anchor System Seal Number: ANCHOR MANUFACTURER'S . MODEL-PART/PRODUCT NO. DATE OF INSTALLATION NAM � Soil �At� dL�!�,'`28�°� ,�a�d�'� `� .. Anchors Ye� � � �' �� � %• Concrete Anchors: No '� Yes Other anchor system: (Give approval numbers & s Test Probe Tor ue Value inch Ibs. descnbe othera rove anchorin s stem I hereby certify that fhe Anchoring System on the Manufactured Home listed has been completed in accordance with the manufacturers inst�uctions and the Minnesota State Building Code. MN REGISTRATION NUMBER INSTALLER COMPANY NAME LICENSED/REGISTERED INSTALLERS SIGNATURE: MI- `� �' 'F �^ =.� ; -- - --. , . . .. ., ; � . ; i s�;-= r�v-�r:, ;,s-� If anchoring of the home completed by others indicate name and address of responsible party for the required anchoring. i , i i , f I , i I I I I� � I I ` j ; I i ' i i , ' � i � i ' I I,\ � �i '\. \ � \ � � \ . � �1� ' ! / / � '� � � a� �, ; , I �� I � I d v , / \ i i � � 1, � �� �`\, � \ . ` \ �'� �. •� `� _� � , 1 - . o l, � v 1, �1. � , � -}— � \\�, � � � �a �; `\ �� + =,. . �� � ,� � _ �'t'. L'' '�''r' _ � .� � �-� �_ � ��.�� � ;. . �- '' �, -±— c.y ' � �T .. � � �� � � �� ` l.. i � � �.. '.-- .�.: •'• -� MANUFACTURED HOME: Brand Name: p*/ Model Name: Serial Number: Date of Manufacturer: �° �� 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 lioof l.oad Zone: 3 o I b Heating/Cooling Zone: INSPECTION: I nstallation: Seals/Certificates# Anchoring# (Anchoring may be required by Municipal Ordinance park rule for pre code and State Code homes. Anchoring is required for fil'U Code homes.) Instructions Used: Manufacturers x State Chapter 1350 — (Homes constructed after June 14, 1976, requires manufacturer's instructions be used.) Foundation ro State Buildint Code: Q or NO (circle one) (�1ay be required by manufacturer's �nstructions in a park set or by code adoption or zoning ordinance in a private propert� set.) Foundation Tvpe: Piers bclow frost depth:�5 Crawl space: Full depth basement (treatecS wood, concrete block, poured concrete or toher) Engineered slab on grade (sigoed approval by Dapia or MN Engineer) Support FootinQs: Type: CON�Ke'�"C Size: ��" �zo��9 Soil Conditions:__�sb0 __ PSF Pier Material: COn��Qet�- Pier Spacin�: � Feet �i Inches in center (calculations should be submitted for review prior to inspection.) Shims: h'laterial Used: i�AROwooO Sizc: Y" 1� !o �� (minimum 4" x 6" hardwood) (:lothes Dr}'er vented to outside crawlspace or skirted area: YES or NO (circle one) iVlaterial Used: DN � Fresh Air intakes to outside crawlspace or skirted area: (if reqoired for fireplace or furnace or water heater) ES or tiO (circle one) Anchoring Equipment (If applicable): Anchors Used: (manufacturer's model numbers) Soil test Probe Torque Value Conditions of Issuance Saecific Descri inch pounds Required Ins Add Delete ❑ � Consultation �, � Final ,_; � Plan Review .; J Trench of Work to be Completed City of Fridley 6431 University Ave NE * Fridley, MN 55432 Phone 763-572-3604 * Fax 763-502-4977 l.pdated IR9/2009 ions S INGLE-WIDE SUPPORT PIER PLAN (TYPICAL) �'y ;1 L___ PERIMETER RE R REO o ME sioN�PENINGS � --------------.-.-._.____ _? . _ _ _ �– –�— ~ a � a � � I-BEAM PIER LOCATIONS � - _ _ - - _ _ REQUIREO DIMENSIONS _ _ _ _ _._._._. ._�- � �:% "- MAXIMUM END PIER SPACING ALLOWED � REQUIRED DIMENSION MANUFACTURERINFORMATION Name � a 2 -� ^' Home Size ; S` � ` ;� (p8 ` Maximum I-Beam Spacing 6`� � Door Openings �� s s-� n°. � u�;� I-Beam Loading PLF G �� Maximum End Support (I-Beam) � ' Ground Moisture Contro� �� Yes No Grading to Slope AWAY From Home ,r�; ORIENTATION SOIL INFORMATION Classification No. S��N�� `��`''�' Soil Bearing Capacity �.�'p� FOOTING INFORMATION I-Beam x x � ��. jZ�.,N-� G.lBCS/WORD/mS/CCLD Installation Permit Application Packet/Support-Anchoring Pians oa-02-o9 � � � _�,�,�� -. Z 0 � a U O J Q' O _ U z a _.! Q Z ❑ � H C� Z O J SINGLE-WIDE ANCHORING PLAN (TYPICAL) � � �- S y5`� � w� '- " MAXIMUM END ANCHOR SPACING ALLOWED REQUIRED DIMENSIONS _, -,_ _.�._,_._._._ _ _ _ _ _ _ _ _._._._ _ _,_,_._._._._ _,_._._,_._,_._._._._._._._._._ _._.� _. U � Q ORIENTATION a � � _._._. ._.� ._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._ _. m MAXIMUM INTERMEDIATE ANCHOR SPACING ALLOWED — � REQUIRED DIMENSION � ' "- MAXIMUM END ANCHOR SPACING ALLOWED REQUIRED DIMENSION MANUFACTURER INFORMATION Name �ofZTo�✓ Home Size ) (o X (o$ Maximum I-Beam Spacing Maximum Anchor Spacing SOIL INFORMATION Classification No. S�NnY GRA� Soil Bearing Capacity ,,SOO ( b ANCHORING INFORMATION Ext. Wall Height g' Roof Pitch 3 /i-L Height From Ground to o« Frame Connection 3 . ANCHORING INFORMATION Cont. Anchor Manufacturer SC 1� SySTCV� Lateral Anchors Req'd YES or NO Anchor P.N. Connector P.N. Lonqitudinal Anchors Req'd YES or NO Anchor P.N. Connector P.N. No. Per End * P.N. = Part or Product Number G:/BCS/WORD/ms/CCLD Installation Permit Application Packet/Support-Anchoring Plans 04-02-09 Z 0 � a U O J � O _ U z a J Q Z 0 � H C� Z O J C FRAME PIER SECTION VIEW TOTAL HEIGHT 77 � y. � v-,: = 5 �� ,� -� :s �� FRAME HEIGHT �� HARDWOOD SHIM -----� « 'IER HEIGHT < — ,—�—.,. _ - 'f�._:af� FOUNDATION TYPE `� ;�, b :� c � ; � ;,_i �;` � , . � : — CAP MATERIAL �- . ` � �;fr i ,r„ ♦—BLOCK TYPE G:16CS/WORD/ms/CCLD Installation Permit Application Packe�elow Frost and Frame Pier Section Drawings 04-02-09 0 FROST DEPTH PIER SECTION VIEW ^"ZDBOARD FORMIN�" T""'� �a 1 " DEPTH "BELOW" GRADE SOIL CLASSIFICATION .%�=�'� �� : �= �% -.-°�� � SOIL BEARING CAPACITY ,� � ov PSF FOOTING AREA � �'..5� SQ. IN. SOILS TOTAL LOAD CAPACITY :�S�.a�c' : �. PSI CONCRETE � � v v „ ii ALTERNATE "BELLED" FOOTING �� „ G:/BCS/WORD/ms/CCLD Installation Permit Application PackeUBelow Frost and Frame Pier SeCtion Drawings 04-02-09