P - 44336Park Name:
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Job Site Address: �` p � 3 �p K;-�� ✓L �.2�� � � ,�� 1��,�� � ��p}�I
Project Valuation: $ ��60c.�. e���� Applicant Is: 0 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 witl 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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For Off ce Use Only
Permit # Entered Approved Issued
Updated 1/29/09 �
SUPPLEMENTAL INFORMATION SHEET
THIS lS 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).
HONIE INSTALLAT�ION BY:
� MN LICENSED MANUFACTURED HOME INSTALLER
❑ HOMEOWNER
TYPE OF INSTALLATION
� MANUFACTURED HOME PARK
O PRIVATE PROPERTY
SITE
� SITE PLAN PROVIDED-INCLUDE BUILDING AND PROPERTY LINE
SETBACKS
� SITE DRAINAGE
❑ QESIGNATED FL04D HAZARD AREA
❑ FIRE SEPARATION REQUIRED YES OR NO: IF YES-EXPLAIN
REQUIREMENTS & DETAIL ON SITE PLAN
MULTf-SECTION FRAMING TOLERANCES
❑ LIST THE MAX. GAP ALLOWED BETWEEN THE SECTIONS OF THE _,
STRUCTURE
❑ FLOOR
❑ CEILING
❑ RIDGE
ACCESSORY STRUCTURES-PER MANUFACTURERS (NSTALLATION
MANUAL, MSBC CHAPTER 1350 AND MSBC CHAPTER 1300.
❑ DECKS '
� STAIRS
❑ LANDiNGS � �
❑ OTHER
G:/BCSIWORD/ms/CCLD Installation Permit Application Packet/Support-Anchoring Plans 04-02-09
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MANUFACTURED HOME:
Brand Name: Model Name:
Serial Number: Date of Manufacturer:
Cunstruction Label Numbers:
HUD Code 06/14/76 and newer, State Code 7/O1/72 to 06114/76, Pre-code prior to 07/O1/72
itoof Load Zone: 3 o I b. Heating/Cooling Zone:
INSPECTION:
lnstallation:
Sea ls/Certificates# Anchoring#
(�nchoring may be required by Municipal Ordinance park rule for pre code and State Code�homes. Anchoring is required I'i,r
liUll Code homes.)
lnstructions Used: Manufacturers }�, State Chapter 1350
(Homes constructed after June 14,1976, requires manufacturer's instructions be used.)
Foundation to State Building Code: E or NO (circle one) .
(ivlay be required by manufacturer's �nstructions in a park set or by code adoption or zoning ordinance in a private pro{�erc�
set.)
Foundation Tvpe:
Piers below frost depth: S Crawl space:
Full depth basement (treate wood, concrete block, poured concrete or toher)
Engineered siab on grade (signed approval by Dapia or MN Engineer)
�„ 9
Sua�orTFootings:Type: C�ONGKC'�"e- Size: ! ilo�N
Soil Conditions:��b0 _ PSF Pier Material:_��O n��2e*G.-
Pier Spacine: Feet Inches in center (calcu{ations should be submitted for review prior to inspection.)
Shims: Material Used: h%AROwooO
Sice: Y'` �! b" (minimum 4" x 6" hardwood)
C:lothes Dryer vented to outside crawlspace or skirted area: YES or NO (circle one)
iVlaterial Used: ON �
F resh Air intakes to outside crawlspace or skirted area: (if required for fireplace or furnace or water heater) ES ur \U
. (circle one)
Anchoring Equipment (If applicable):
Anchors Used: (manufacturer's model numbers)
Soil test Probe Torque Value
Conditions of Issuance _ _
Cpdated 1R9/2009
ecific Descri
inch pounds
Required Inspections
Add Delete
❑ 0 Consultation
� 0 Final
�
❑ ❑ Plan Review
�� ❑ Trench
of Work to be Completed
City of Fridley
6431 University Ave NE * Fridley, MN 55432
Phone 7b3-572-3604 * Fax 763-502-4977
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SINGLE-WIDE ANCHORING PLAN
(TYPICAL)
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'- " MAXIMUM END ANCHOR SPACING ALLOWED
1�EQUIRED DIMENSIONS
_._._ _. _ ._._._._._._._._._._._._._._._._._._._._._:_._._._._._,_._._._._._._._._._._._._._._.� -
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m MAXIMUM INTERMEDIATE ANCHOR SPACING ALLOWED
"' r— REQUIRED DIMENSION
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' "- MAXIMUM END ANCHOR SPACING ALLOWED
REGlUIRED DIMENSION
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MANUFACTURER INFORMATION
Name �oR'ib�
Home Size 1(. �C (o$
Maximum I-Beam Spacing
Maximum Anchor Spacing
SOIL INFORMATION
Classification No. SflNoy G�a�
Soil Bearing Capacity 'Soo ( b
ANCHORING INFORMATION
Ext. Wall Height g'
Roof Pitch 3 /!"t._
Height From Ground to
Frame Connection 3 0 "
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ANCHORING INFORMATION Cont.
Anchor Manufacturer SC 1.� s�s� w�
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:fBCSNVORD/ms/CCLD Installation Permit Application Packet/Support-Anchoring Plans 04-02-09
. . , �
FRAME PIER SECTION VIEW
TOTAL HEIGHT
77
36
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FRAME HEIGHT
�/ HARDWOOD SHIM
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�IER HEIGHT
� f PH'ICNt oVL rf1¢�dWooc7L-
CAP MATERIAL
r G Yh. e rv 1'�
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BLOCK TYPE
�/loy't" �osf�n.�s CcN�c�J�
FOUNDATION TYPE
G:/BCS/WORD/ms/CCLD Instailation Permit Application PackeB'f3elow Frost and Frame Pier Section Drawings 04-02-09
FROST DEPTH PIER SECTION VIEW
^"4DBOARD FORMINr �. .�r
;�� »
DEPTH
"BELOW"
GRADE
0
SOIL CLASSIfICATION �%"`'r� �%'•''"`"� �
SOIL BEARING CAPACITY ;,� � ��_ PSF
FOOTING AREA 3 Y..3! SQ. IN.
SOILS TOTAL LOAD CAPACITY ���j�' �' ��
PSI CONCRETE ��v�
ALTERNATE
"BELLED"
FOOTING
�� „
G:/BCS/WORD/ms/CCLD Installation Pertnit Application PackeVBelow Frost and Frame Pier Section Drawings 04-02-09
6
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SINGLE-WIDE SUPPORT PIER PLAN (TYPICAL)
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L— PERIMETER PIER SUPPORT @ OPENINGS
REQUIRED OIMENSIONS C7
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REQUIRED DIMENSIONS _
._ _._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._. •_�-•-�- -•- -�-
a '� "- MAXIMUM END PIER SPACING ALLOWED m
REQU{RED DIMENSION
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MANUFACTURER INFORMATION
Name �`�' o � � ��
Home Size ; g` y ` ,� (pg '
,
Maxirnum I-Beam Spacing S �
Door Openings L P s s-f- +�� •v 4 8'°
I-Beam Loading PLF G ��
Maximum End Support (I-Beam) � '
Ground Moisture Control�Yes No
Grading to Slope AWAY From Home y��
ORIENTATION
SOIL INFORMATION
Classification No. S.�N� y �<<'� a�-��
Soil Bearing Capacity � �b� � ;;
�
FOOTING INFORMATION
I-Beam x x
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oi 1 �Z'J'J N .X. "Cilo >j ". .
G;/BCS/WORD/ms/CC�D Installation Permit Application PackeUSupport-Anchoring Plans 04-02-09
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� City of Fridley ,
6431 University Ave NE
Fridley MN 55432
PRINT IN INK or TYPE your responses.
General Information
HOMEOWNERS NAME
� • - - �'' '� ! %� :�,�'` �`' �� �
HOME LOCATION/ADDRESS
MANUFACTURED FiOME BR
.:=-�'- ^. — , �"
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HUD or STATE LABEL(S) NU
Is the home located in a park?
No �Yes �
Bwlding Permit Number:
vL. C��cc��
!D MODEL
home was
of Pa[k
' < : G' �, :-
Mail
Manufactured Home Installation
Compliance Certification �
form to the City within 10 days of completion
COUNTY
. -� �`'r� :' s; ,
CITY
�
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3ER OF HOME DATE OF MANUFACTU
prior to July 1, 1972, no labe/ number required. J
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Inspection of installation completed? Date
No0Yes0
Support System
Support Systern Seal Number. Foundation Type: ❑ Ground Block ❑ Frost Depth Piers ❑ Basement O Crawlspace w/frost ftg.
O Engineered Slab � Other Approval Altema#e Aitemate approvaf number.
Soil Bearing Capacity (p.s.f.) Method of verification pATE OF INSTALLATION
Support System Items of Utility Work: (Enter completed by, if installer state installer, if homeowner state homeowner, rf other give
name of person, company name, license number if known.)
Sewer.
_•---
Tested:
—:-- �>. _ _ :
-Y r'� �T � � v
Gas: .
licensed
or homeowner) (Park
Other Items Included in Installation Contract:
Home Stand/Pad p Lot oradina ❑ Sk�rt��„ ia
requires
/NV �
Tested:
ested:
contractor ) ► Tested:
How many? �
�
1 hereby certify that the Support System on the Manufactured Home listed has been complefed in accordance with the manufacturers
instructions and the Minnesota State Building Code.
MN REGISTftATION NUMBER INSTALLER COMPANY NAME LfCENSED/REGISTERED INSTALLERS SIGNATURE:
Anchoring System '�"' : ` ;�- ���J.�fci��; � �:.
Anchor System Seal Number. ANCHOR MANUFACTURER'S I MODEL-PART/PRODUCT NO. DATE OF INSTALLATION
NAM �- „�
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soil < J �� , r .- �
Anchors Ye5 �>• Concrete Anchors: pther anchor s stem: Give a
No s Test Probe Tor ue Value inch Ibs. � Yes Y ( pproval numbers &
I hereby certify that the Anchonng System on fhe Manufactured Homs lisfed has been comple ed in eccorclance with the manufacturers
inst�uctions and the Minnesota Sfate Building Code.
MN REGISTRATION NUMBER INSTALLER COMPANY NAME LICENSED/REG1S ALLERS SIGNATURE:
. , . .. �
MI- . :' � :% ; —r; ! �i>--�-- - ;� . !/
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If anchoring of the home completed by others indicate name and addre s of responsible party for the uired anchoring.