P - 83524..
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Park Name: r � i !�
City of Fridley
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Manufactured Home/ Accessory Installation
Permit Application
Job Site Address: _'�,� C?"7 __ ,��¢�/y _ Zip
Project Valuation: $ �� �(+�(,� ,� E; Applicant Is: � Owner and Occupant �Contractor
must include material and labor costs
Pro e Owner
Name �';�( � ,�¢ /�1�'/
Address Unit #
City State Zip
Phone
Contractor
Name �2 i"(� c�. �jE;��nJ �' Installer's Name i�f �% �"iZ
Address__�'7�(o t'� tr�� �Z�"
City � j' �}'r' E►ZTO �a► `V State �I/l� Zip ,��,3 $�
Phone `,/ � - License # .� .��a �`�' Email
Pro e Use T e of Structure 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 Z)
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 a�roved pJ,a� in the case of all work which requires review and approval of plans.
Permit #
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Updated 7/1/10
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Entered
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For Office Use Only
Date '
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Date . ' /2
_��� � � � �
Issued
MANUFACTURED HOME:
Brand Name: f}D'JFNT��. Model Name: 5��v�kw�d�
Serial Number: 'f' 6 p Date of Manufacturer: �G/a2
Construction Label Numbers:
HUD Code 06/14/76 and newer, State Code 7/Ol/72 to 06/14/76, Pre-code prior to 07/O1/72
Roof Load Zone: ? p 1�, Heating/Cooling Zone:
INSPECTION:
Installation• �
Seats/Certificates# `j' i3 U 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 k 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 Twe•
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 Footines: Type: C� A! � n e'i" �--- 5ize: ���� ��v�ti�
Soil Conditions: �s(h� PSF Pier MateriaL• C fa �V �. r'Z 2"«-.
Pier Suacine: _� Feet _� Inches in center (calculations should be submitted for review prior to inspection.)
Shims: Material Used: ���,pl,a; a'�n:�
Size: �-/ `� �(' ��' (minimum 4" x 6" hardwood)
Clothes Dryer vented to outside crawlspace or skirted area�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) X � � 5 y 5'��' w►'�
Soil test Probe Torque Value inch aouads
Conditions of Issuance
uired
Add Delete
❑ 0 Consultation
■
■
■
Description of Work to be
❑ Final
❑ Plan Review
❑ Trench
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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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I_- PERIMETER PIER SUPPORT @ OPENINGS
REQUIRED DIMENSIONS C7
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1-BEAM PIER LOCATIONS �
REQUIRED DIMENSIONS _ _ _
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REQUIRED DIMENSION
MANUFACTURER INFORMATION
Name � �� �.=� `d �; ic �-
Home �ize s 5` 'f " � (Dg '
Maximum I-Beam Spacing G`' �
Door Openings �- � 5 S i "`�• `4 � � ��
I-Beam Loading PLF t� �.�
Maximum End Support (I-Beam) � r
Ground Moisture Control�Yes No
Grading to Slope AWAY From Home ��'�
ORIENTATION
SOIL INFORMATION
Classification No. S � ^"
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Soil Bearing Capacity ���, p �,1
FOOTING INFORMATION
I-Beam x x
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SINGLE-WIDE ANCHORING PLAN
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REQUIRED DIMENSIONS
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REQUIRED DIMENSION
MANUF,ACTURER INFORMATION
Name �;� c��-����.
Home Size / berC co> 8' `
Maximum I-Beam Spacing T
Maximum Anchor Spacing
SOIL INFORMATION
Classification No. S�l�ny GnA�-
Soil Bearing Capacity �,5"oa ( b
ANCHORING INFORMATION
Ext. Wall Height �'
Roof Pitch 3 %2
Height From Ground to
Frame Connection 3 ° ��
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ANCHORING INFORMATION Cont.
Anchor Manufacturer SC ( ,� s�t5'{�Vt�
Lateral Anchors Req'd YES or NO
Anchor P.N. .�� � 0°7
Connector P.N. .��' 3G'7
Lonqitudinal Anchors Req'd ES r NO
Anchor P.N. � t 3a'i'
Connector P.N. � S�'��'�
No. Per End �
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G:/BCS/WORD/ms/CCLD Installation Permit Application Packet/Support-Anchoring Plans 04-02-09
FROST DEPTH PIER SECTION VIEW
^ ^' ;DBOARD FORMW� " '��
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"BELOW"
GRADE
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SOIL CLASSIFICATION .�SA� ��$'��
SOIL BEARING CAPACITY ,���'�'_ PSF
FOOTING AREA �`�'� SQ. IN.
SOILS TOTAL LOAD CAPACITY ,0�3��'� �b�
-PSI CONCRETE ���'
ALTERNATE
"BELLED�
FOOTING
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G:/BCS/WORD/ms/CCLD Installation Pertnit Application PackeUBelow Frost and Frame Pier Section Drawings 04-02-09
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FRAME PIER SECTION VIEW
TOTAL HEIGHT
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FRAME HEIGHT
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FOUNDATION TYPE
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CAP MATE IAL
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G:/BCS/WORD/ms/CCLD Installation Permit Application PackeB'�elow Frost and Frame Pier Section Drawings 04-02-09
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