P - 62717Park Name:
Job Site Address:
Zip
Project Valuation: $ 3�CG . . Applicant Is: ❑ Owner and Occupant L�j ontractor
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
✓
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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 1 work which requires review and approval of plans.
, � � � � �� � , � � � ; �� ,' � L�G��, ����i2
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For O�ce Use Only '
� �' � , � ��� � A� � � � �! � � �'�d� � � 1.I � � � I � Issue
Permit # �
Updated 1/29/09
Brand Name• {
Serial Number•
Construction Label Numbers:
AUD Code 06/14/76 and newer, tate Co
Roof Load Zone: � j{;
Model N
Date of 1'
le 7/Ol/72 to 06/14/76, Pre-code prior to 07/O1/'72
Heating/Cooling Zone: '�
Installation:
Seals/Certificates# Anchoring#
(Anchoring may be required by Municipal Ordinance park rute for pre code and State Code homes. Anchoring is required for
HiJD Code homes.)
Instructions Used: Manufacturers i�. State Chapter 1350
(Homes constructed after June 14, 1976, requires manufacturer's instructions be used.)
Foundation to State Buildin¢ Code: YES or NO (circle one)
(May be required by manufacturer's instructions in a park set or by code adoption or zoning ordinance in a private property
set.) �
Foundation Tvae:
Piers below frost depth: Crawl space:
Full depth basement (treated wood, concrete block, poured concrete or toher)
Engineered slab on grade (signed approval by Dapia or MN Engineer)
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Sunport Footings: Type: �'a n cr �� Size:% 7�! �
Soil Conditions: �bG PSF Pier Material: g�d� �
Pier Snacine: � Feet � Inches in center (calculations should be submitted for review prior to inspection.)
Shims: Mate ial Used:�� �,�d��
Size: �'x''y' (minimum 4" x 6" hardwood)
Clothes Dryer vented to outside crawlspace or skirted area: ES NO (circle one)
Material Used: h%i,�. �
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
Soil test Probe Toraue Value
Conditions of Issuance
/�/ �f %1 K +� �i G��t y��
Updated 7/Ol/2010
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inch pounds
Req uired
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❑ Consultation
D Final
❑ Plan Review
❑ Trench '
City of Fridley
6431 University Ave NE * Fridley, MN 55432
Phone 763-572-3604 * Fax 763-502-4977
SINGLE-WIDE �UPPORT PIER PLAN (TYPICAL)
� PERIMETER PIER SUPPORT � OPENINGS
REQUIRED DIMENSIONS �
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REQUIRED DIMENSIONS �
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REQUIRED DIMENSION
MANUFACTURER 1NFORMATtOId
Name ��i,�r�co�t �
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Home Size l� X �c�
Maximum I-Beam Spacing �� �!
Door Openings �
I-Beam Loading PLF l� 3��
Maximum End Support (I-Beam) %'6 j�
Ground Moisture Control�es No
Grading to Slope AWAY From Home_�
ORIENTATION
SOIi. tNFORMATtUN
Classification No. �
Soil Bearing Capacity �ac'tC�
FOOTING INFORMATION
I-Beam � x � x �
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'-�_" MAXIMUM END ANCHOR SPACING ALLOWED
REQUIRED DIMENSIONS
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MANUFACTURER INFORMATION
Name � �rrLrar� �-
Home Size 1� x ?� �
Maximum I-Beam Spacing � 9 �1
Maximum Anchor Spacing �y-•
SOIL INFORMATION
Classification No. �
Soil Bearing Capacity 2�'�
ANCHORING INFORMATION
Ext. Wall Height �'
Roof Pitch '�► /�
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Height From Ground to
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ANCHORING INFORMATION Cont.
Anchor Manufacturer �f� Da�n �'�rc� r
Lateral Anchors Rea'd �r NO �
Anchor P.N. �9��6
Connector P.N. � il�
Lonaitudinal Anchors Req'd YES a�
Anchor P.N. '
Connector P.N.
No. P
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* P.N. = Part or Product Number
G:/BCS/WORD/ms/CCLD Installation Pertnit Application PackeUSupport-Anchoring Plans 04-02-09
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GlBCS/WORDlmslCClp InsfaNalion Peme[ AppF�tion Packet+6dow Frostarid Frame P'ier Sedion Drewings 0402-09
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SUPPLEMENTAL INFORMATION SHEET
THIS IS ADDITIONAL INFORMATION REQUIRED BY THE
CCLD FOR APPROVAL OF INSTALLATION PLANS FOR
MANUFACTURED HOME INSTALLATIONS IN COMPLIANCE
WIT�I THE MANUFACTURERS INSTALLATION MANUAL, HUD
CFR 3285 AND MN STATE BUILDING CODE (IVISBC).
H E INSTALLATION BY:
MN LICENSED MANUFACTURED HOME INSTALLER
❑ HOMEOWNER
TY� OF INSTALLATION
MANUFACTURED HOME PARK
❑ PRIVATE PROPERTY
S1�S1 E PLAN PROVtDED-INCLUDE BUiLD1NG AND PROPERTY LINE
TBACKS
SITE DRAINAGE
❑ DESIGNATED FLOOD HAZARD AREA
❑ FIRE SEPARATION REQUIRED YES OR NO: IF YES-EXPLAIN
REQUIREMENTS & DETAIL ON SITE PLAN
MULTI-SEGTION FRAMING TOLERANCES
❑ LIST THE MAX. GAP ALLOWED BETWEEN THE SECTIONS OF THE
STRUCTURE
� 0 FLOOR
❑ CEILING
❑ RIDGE
ACCESSORY STRUCTURES-PER MANUFACTURERS INSTALLATION
MANUAL, MSBC CHAPTER '(350 AND MSBC CHAP7ER 1300.
❑ DECKS
l� STAI RS
❑ LANDINGS
❑ OTHER
G:/BCSIWORD/ms/CCLD tnsiailation Permit Appfication PackeUSupport-Anchoring Plans 04-02-09