P - 44333Park Name: �+/1.. � `Q� �� t2 vl/! t� �� J � �- �' � � � ��
Job Site Address: / � ('� (,� �`��,,,,��,� �` �,L( � �/� E' Zip
Project Valuation: $ �('�('X�, ��7 Applicant Is: ❑ Owner and Occupant ❑ Contractor
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.
�$�� ; � � �� ; ,;
�,�}��tw ��tZ�
For O�ce Use Only
� ��-/v
Permit # G Entered Approved Issued
Updated 1/29/09
SUPPLEMENTAL (NFORMATION SHEET
THIS IS ADDITIONAL INFORMATION REQUIRED BY THE
CCLD FOR APPROVAL OF INSTALLATION PLANS FOR
MANUFACTURED HOME INSTALLATIONS IN COMPLIANCE
WITH THE MANUFACTURERS lNSTALLATlON MANUAL, HUD
CFR 3285 AND MN STATE BUILDING CODE (MSBC).
HOME INSTALLATION BY:
� MN LICENSED MANUFACTURED HOME INSTALLER
0 HOMEOWNER
TYPE OF INSTALLATION
� MANUFACTURED HOME PARK
❑ PRIVATE PROPERTY
SITE
� 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
❑ LIST THE MAX. GAP ALLOWED BETWEEN THE SECTIONS OF THE ,,
STRUCTURE �
❑ FLOOR
❑ CEILING
❑ RIDGE
ACCESSORY STRUCTURES-PER MANUFACTURERS INSTALLATION
MANUAL, MSBC CHAPTER 1350 AND MSBC CHAPTER 1300.
❑ DECKS '
� STAI RS
0 LANDINGS � •
❑ OTHER
G:/BCSNVORD/ms/CCLD Instailation Permit Application PackeUSupport-Anchoring Plans 04-02-09 "
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City of Fridley
6431 University Ave NE
Fridley MN 55432 �
PRINT !N INK or TYPE your responses.
General Information
HOMEOWNERS NAME
� . �-
:...= � .. — /;°>! i r.�..�.f�c i%' ��C='.
�
'004 �.v
NUFACTURED HOME
.."�.
�. �ii '•��.'
r '✓. .
D or STATE LABE!(S)
a
No C�Yes I;�
`
was
Mail
Manufactured Home Installation
Compliance Certification
form to the City within 10 days of completion
COUNTY
,'��� 1 ✓��'�i !�'
c�rY
�:'�?r 'E.
3ER OF HOME DATE OF MANUFF
to July 1, 1972, no label number
� i ^�. . �' �, C �Y r ` K i � /�..� �L..�
Inspection of installation completed? Date
NoOYes❑
Support System Seal Number. Foundation Type; ❑ Ground Block ❑ Frost Depth Piers ❑ Basement q Crawlspaoe w/frost ftg.
� Engineered Slab O Othe� Approval Altema#e Altemate approval number
Soil Bearing Capacity (p.s.f.) Method of verification DRTE OF INS"1'ALLATION
Support System Items of Utility Work: (Enter completed by, if installer state installer, if homeowner state homeowner, if ofher give
name of person, company name, license numbe� if known.)
Sewer:
Tested:
:-- As > : ; � : �
�
_��• . � r ��c,� ,,�
or
Other Items Included in Installation Contract:
�
�
I hereby certify that the Support System on the Manufactured Home listed has been completed in arx;orrfance with the manufacfurers
instructions and the Minnesota State Burlding Code.
MN REGISTRATION NUMBER INSTALLER COMPANY NAME LICENSED/REGISTERED INSTALLERS S)GNATURE:
Anchoring System �`� • '�' `��- r'rj��=���-�';- --r =�
- ----•• ��•u-.nvrr��.1 VRCR J mwtL-rArt��RVDUCT NO. DATE OF INSTALL4TlON
NAM"`
� .�..� � p�,�,,� - -��9��s�'� ��
c rrv�? Ki.__ < �
Soil ,� J J�- ;,�j � , ,
Anchors Ye� Concrete Anchors: pther anchor s stem: Give a
No s Test Probe Tor ue Value inch Ibs. NQ Yes Y i pproval numbers &
/ hereby certify that the Anchoring System on the Manufactured Home listed has been comp/ ted in thaccordance with� the manufacturers
instructions and the Minnesota State Building Code,
MN REGISTRATCON NUMBER INSTALLER COMPANY NAME UCENSED/REG TALLERS SIGNATURE:
MI- ° " '�r :^ --' �
:` i` ::. ,r i—l� f � i d<'�,= ;' �ii'ti�.,:.�-;'i;�s�..
If anchoring of the home completed by others indicate name and addre s of responsible party fo e uired anchoring.
S{NGLE-WIDE SUPPORT PIER PLAN (TYPICAL)
���1
, �
L-. PERIMETER PIER SUPPORT @ OPENINGS
REQUIRED DIMENSIONS C7
--�-�-�-•--- ---•-•-•-�-•-�-�-�-•-�-•-•-•-•-•-�-•-._._._._._._._._._._._._._._. _ Z _._._._._._._.
—� _� � a
� �
� I-BEAM PIER LOCATIONS �
REQUiRED DIMENSiONS _ _ _
. ._._._._._._._._._._._._._._._._._._._•---•-._._._._._._._._•-•-•-•-•-•-• •-�-.-.-."_'"._.
� '� "- MAXIMUM END PIER SPACING ALLOWED m
REQUIRED D4MENSlON _
MANUFACTURER INFORMATtON
Name �-io�.�-'^�
Home Size � :�` � ` � (,og '
Maximum 1-Beam Spacing �
i
Door Openings � P s s-� �y N 4�'�
I-Beam Loading PLF G,.2
Maximum End Support (1-Beam) � r
Ground Moisture Control�Yes No
Grading to Slope AWAY From Home��
ORIENTATION
SOIL INFORMATION
C4assif+cation No. S�NA� Gr�='•��-'�
Soif Bearing Capacity � ,pb� � �j
�
FOOTING fNFORMATION
I-Beam
, x x �
�: (t �
� 1 (ZJ'.,+��X T�le>+ "e> : � -°;
G:/BCS/WORD/ms/CCLD Installation Permit Application PackeVSuppoR-Anehoring Plans 04-02-09
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FROST DEPTH PIER SECTION VtEW
^"2DBOARD FORMINr �' '�'�
y� ,�
DEPTH
"BELOW'
GRADE
SOIL CLASSIFICATION �,�'J.°� �; ?'��< i
SOIL BEARING CAPACITY ;,�, � �� PSF
FOOTING AREA S Y..S" SQ. IN.
SOILS TOTAL LOAD CAPACITY � 5��� :�•
PSI CONCRETE �sv` �'
ALTERNATE
`BELLED"
FOOT(NG
�� „
G:/BCS/WORD/ms/CCLD Installation Pertnit Application PackeUBefow Frost and Frame Pier Sedion Drawings 04-02-09
C
FRAME PiER SECTION VIEW
TOTAL HEIGHT
»
3�
• 6R
� 1-e s5
s�
/o �
77
�G
FRAME HEfGHT
�/ HARDWOOD SHIM
«
�� �PrHCNfi � �. �{i4ROwoo�
CAP MATER{AL
�1ER HEIGHT
f e na e,� 1'"
.----
BLOCK TYPE
�a oy't' �oef�•�+�s cc ►6.c �l�
FOUNDATION TYPE
G:/BCS/WORD/mslCCLD Instaffation Permil Appiication Packe�elow Frost and Frame Pier Section Drawings OM02-09
MANUFACTUPeED HOME:
Brand Name: r/ 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
Roof Load Zone: 3 o I b. Heating/Cooling Zone:
INSPECTTON:
Installation:
Seals/Certificates# Anchoring#
(Anchoring may be required by Municipal Ordinance park rule for pre code and State Code 6omes. Anchoring is required for
HUD Code homes.)
lnstructions Used: Manufacturers x State Chapter t350
(Homes constructed after June 14, 1976, requires manufacturer's instructions be used.)
Foundation to State Buildin� Code: Q or NO (circle one)
(May be required by manufacturer's �nstructions in a park set or by code adoption or zoning ordinance in a private property
set.)
Foundation Tvne:
Piers below frost depth: S Crawl space:
Full depth basement (treate wood, concrete blacic, poured concrete or toher)
Engineered slab on grade (signed approval by Dapia or MN Engineer)
Suaport Footin�s: Type: �ONGKt"Ec Size: � g�� %l0u•v �
Soil Conditions:_,QiSbO _ PSF Pier Material: �b n��Qe*L
Pier Spacine: Feet inches in center (caiculations should be submitted for review prior to inspection.)
Shims: Material Used: /�AROwooD
Size: Y'` !( b u (minimum 4" x 6" hardwood)
Clothes Dryer vented to outside crawlspace or skirted area: YES or NO (circle one)
Material Used: No1� �
Fresh Air intakes to outside crawlspace or skirted area: (if required for fireplace or furnace or water heater)�or NO
(circle one)
Anchoring Equipment (If applicable):
Anchors Used: (manufacturer's model numbers)
Soil test Probe Torque Value _ iach pounds
Conditions of Issuance
uPaacea in9noo9
uired Inspections
Add Delete
❑ 0 Consultation
0 0 Final
❑ ❑ Plan Review
❑ ❑ Trench
of Work to be Com
City of Fridley
6431 University Ave NE * Fridley, MN 55432
Phone 763-572-3604 * Fax 763-502-4977
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SINGLE-WIDE ANCHORING PLAN
(TYPICAL)
X t � s y5-���
'- " MAXIMUM END ANCHOR SPACING ALLOWED
REQUIRED DIMENSIONS
�-�-�- -•Z-.-•-•-•-.-.-.-•-.-.-.-•-.-•-.-.-.-.-.-.-.-.-.-.-.-.-•-.-.-.-•-.-.-.-.-.-.-•-.-.-.-.-.�.-.
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m MAXIMUM INTERMEDIATE ANCHOR SPACING ALLOWED
— I-- REQUIRED DIMENSION
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' "- MAXIMUM END ANCHOR SPACING ALLOWED
REQUIRED DIMENSION
MANUFACTURER INFORMATION
Name �oR"f��✓
Home Size 1 `�C l08
Maximum I-Beam Spacing
Maximum Anchor Spacing
SOIL INFORMATION
Classification No. S�4NOy Grta�
Soil Bearing Capacity ,SDO ( b
ANCHORING INFORMATION
Ext, Wall Height g'
Roof Pitch 3 /�-L
Height From Ground to 3 0"
Frame Connection
►
ANCHORING INFORMATION Cont.
Anchor Manufacturer SC l� Sys'%c W�
Lateral Anchors Rea'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 PackeUSupport-Anchoring Plans 04-02-09
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