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P - 44214� Park Name: 1� � : � �- � ��> � t� i�,r ;�- : ,- Job Site Address: 7�/ � 9' �,4 �J � p�. 5T- �V .� Zip Project Valuation: $ ��. �� Applicant Is: D 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 insta(lation permit and I acknowledge that the information above is complete and accurate; that -- the work wiil 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. �-- � ; �. ��, �,, . e , � . �, � ° �� .� � r / , �-��.m�� . °��,� �. � , `�� , �. r�' � �'.� � For Off ce Use Only Permit #�� % 1� � Ent�'D A U G 0 2 20�,0� Updated 1/29/09 ��d AU G 0 2 SUPPLEMENTAL INFORMATION SHEET THIS IS ADDlTIONAL 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 (MSBG). HOME INSTALLATION BY: � �I, MN LI�ENSED 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 ❑ 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 " � 0 FLOOR ❑ CEILING 0 RIDGE AC�ESSORY STRUCTURES-PER MANUFACTURERS INSTALLATfON MANUAL, MSBC CHAPTER 1350 AND MSBC CHAPTER 1300. ❑ DECKS • � STAI RS ❑ L.ANDINGS � ❑ OTHER � G:/BCS/WORD/ms/CCLD Instailation Permit Application Packet/Support-Anchoring Plans 04-02-09 ' � City of Frid►ey 6431 University Ave NE Fridley MN 55432 PRINT IN INK or TYPE your responses. General Information HOMEOWNERS NAME �- � . f v�y/ y �!�,- :,. �"i,i C / / � �� JL! �C ✓ HOME LOCATION/ADDRESS � y3 � ,� 6., s t MANUFACTURED HOME B AND MOQEL .t -�: ,. P , ;jl� i'�F;f: � 'v HUD or STATE LABFI /c� w inuRCQ rc� .�s w.._ Is the home located in a No OYes � Mail was Manufactured Home Installation Compliance Certification form to the Ciiy within 10 days of completion COUNTY � , % j`(/°�.ii i=; CITY ��f��. ,� ;; 3ER OF NOM� DATE OF MANUF� prior to JWy 1, 1972, no /a EZ : � :. = � �` � �'`��-ce., Inspedion of installation aompleted? NoOYes❑ requi�ed.) of Support System Seat Number: Foundation Type: ❑ Ground Block ❑ Frost Depth Piers ❑ Basement O Crawlspaoe w/frost ftg. ❑ Engineered Slab O Other Approval �I�ma#e Alternate appmvaYnumber Soil Bearing Capacity (p.s.f.) Method of verification DATE 0F INS7AL{ATION Support System Items of Utility Work: (Enter comp/eted by, if insta//er state installer, if homeowner state homeowner, if other give name of person, company name, license number if known.) Sev�r: „F:_ Tested: —�-- � > : y ;. _ � :� Water. Tested: --,�' ^' �' :�n w ,� � Gas: NI A �jT � 2 Tested: Electrical: (By licensed e/ectrica! contractor or homeowner) (Park installafion requires e/ectrical contractor.) Tested: ��/'A�T�G� Other Items Included in Installation Contract: Other Items: '�- I hereby certify that the Support System on the Manufactured Home listed has been comp/eted in accordance with the manufactwsrs instructions and fhe Minnesota State Building Code. MN REGISTRATION tJUMBER INSTALLER COMPANY NAME LICENSED/REGISTERED INSTALLERS SIGNATURE: MI- Anchoring System '�`� ` j � `��-- :�r?�::�<%.�; _�f.-� Ancho� System Seal Number: ANCHOR MANUFACTURER'S � MODEL-PART/PRODUCT NO. DATE OF INSTALLATION NAM ¢- � If�i��►r� ,�xU ,�a, .. Soil • �� - _ • Anchors Ye� -� � 5^ r� S. Concrete Anchors: r No s Test Probe To ue Value ir�ch Ibs. NQ Yes �her anchor system: (Give approva/ numbers & I hereby ce�fify that the Anchoring System on the Manufactured Home listed has been camplefed in taccondan� wit ��e manufacturers instructions and the Minnesota State Building Code. MN REGISTRATION NUMBER INSTALLER COMPANY NAME LICENSED/REGISTERED INSTALLERS SIGNATURE: MI- ' r` ;� `� � ;� ;�.I� !; J!!!",� ,:�r(iG/!ir.r�:: If anchoring of the home completed by others indicate name and addre s of responsible party for ihe required anchoring. �.�C �---�� 2 � � � � � 0 0 � 3 � � ., ' ; � t ► • �_a r� � �` � �� i � \• . ` � � �4 � a �� .� —r � f . �:� ��.; '� �� . � ...r- � ,� �,� � ^ _`� '� ` �� M , ._ �._ ,�. .:� . �-. � �� .� . ..\, '"� 5 \ v � � . , ; i � .,, ` .,�� ,,, ; � , { / i . � , :. � : � � '. � i � ; � y%�� + / , i � {,.; . � ` ; �� \ � �. � i �y � �� . � � � \� �.1 i t i ; � i , i + � ; I i i i : ! `i � i i �� ' j � i � � � l ; i ; MANUFACTURED HOME: Brand Name: !✓ 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: INSPECTION: I nstallation: Seals/Certificates# Anchoring# (Anchoring may be required by Municipal Ordinance park rule for pre code and State Code 6omes. Anchoring is required for IiUll Code homes.) (nstructions Used: Manufacturers x State Chapter 1350 (Homes constructed after June 14,1976, requires manufacturer's instructions be used.) �'oundation to State BuildinQ Code: Q or NO (circle one) (May be required by manufacturer's instructions in a park set or by codc adoption or zoning ordinance in a private properq� set.) Foundation Tvoe: Piers below frost depth:_1iGS Crawi space: Full depth basement (lreateb wood, concrete block, poured concrete or toher) Engineered slab on grade (signed approval by Dapia or MN Engineer) / �' �i Sunaort �ootings: Type: C�ON��t"'�'�_ Size: �ou•v Soil Conditions:��b0 _ PSF Pier Material: ON�Qe"r� Pier Spacins: _� Feet Zi tnches in cenier (calculations should be submitted for review prior to inspection.) Shims: Material Used: ,�iAROwoo,p Size: Y" 1( b a (minimum 4" x 6" hardwood) C:lothes Dryer vented to outside crawlspace or skirted area: YES or NO (circte one) Material Used: "101� � Fresh Air intakes to outside crawlspace or skirted area: (if required for frepi8ce or furaace or water heateP)�or NO (circle one) Anchoring Equipment (If applicable): Anchors Used: (manufacturer's model numbers) Soil test Probe Torque Value ____ Conditions of Issuance Descri uired In Add Delete ❑ � Consultation ❑ G Final � 0 Plan Review ❑ �7 Trench of Work to be Com City of Fridley 6431 University Ave NE * Fridley, MN 55432 Phone 763-572-3604 * Fax 7b3-502-4977 C:pdated 1/29/2009 SINGLE-WIDE SUPPORT PIER PLAN (TYP�CAL) �,�;1 � PERIMETER PIER SUPPORT @ OPENINGS REQUIRED OIMENSIONS (7 , _ . _ . _ _ _ _ _._,_,___,_._._._.-•-•-•-•-•-•-•-•-." " " _ Z _. . • � o,� � a � a � � � I-BEAM PIER LOCATIONS � - _ _ _ REQUIRED DIMENSIONS _._,_._. •- -""' m a �'% "- MAXIMUM END PIER SPACING ALLOWED REQUIRED DIMENSION MANUFACTURER INFORMATION Name �02 � �^i Home Size ; �` �f � ;� (a$ ` � Maximum I-Beam Spacing S Door Openings �� 5 5�' "`` ti 4��n I-Beam Loading PLF � d.� Maximum End Support (I-Beam) � ' Ground Moisture Control \� Yes No Grading to Slope AWAY From Home �r�; ORIENTATION SOIL INFORMAT{ON Classification No. S�N�� <<j�"-�� Soi! Bearing Capacity ;��c�� (� FOOTING (NFORMATION I-Beam �ti x X iZ!J ��J N � � � > j i . . ' . G:lBCS/WORD/ms/CCID Installation Permit Application PackeVSupport-Anchoring Pla�s 04-02-09 Z 0 � Q U O J � � x U Z a J Z 0 � F t9 Z O J SINGLE-WIDE ANCHORING PLAN (TYPICAL) X t a s y5-�� ' " MAXIMUM END ANCHOR SPACING ALLOWED REQUIRED DIMENS�ONS .-. �.- .Z •-.-.---._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._.�._. _ ( U � a ORIENTA710N ( � ._._._. ._.�.._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._. m MAXIMUM INTERMEDIATE ANCHOR SPACING ALLOWED � r— REQUIRED DIMENSION � ' "- MAXlMUM END ANCHOR SPACING ALLOWED REQUIRED DIMENSION MANUFACTURER INFORMATION Name t-ioRTa�✓ Home Size J(, X tog Maximum I-Beam Spacing Maximum Anchor Spacing SOIL INFORMATION Classification No. Sfl�ny GnA� Soil Bearing Capacity ..�SOO ( b ANCHORING INFORMATION Ext. Watl Height �' Roof Pitch 3 /�Z Height From Ground to 3 Q« Frame Connection � ANCHORING INFORMATION Cont. Anchar Manufacturer SC ( .� Sysi�'rW� Lateral Anchors Rea'd YES or NO Anchor P.N. Connector P.N. Lonqitudinal Anchors Rea'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 � Q U O J � 0 _ U Z a J Q Z ❑ � H C7 Z O J 0 FRAME PIER SECTION VIEW TOTAL HEIGHT i� 'Z �. � �� I �=.: �s �� °:; ,� .� � �� FRAME HEIGHT r,�-� HARDWOOD SHIM 'IER HEIGHT « � �+�,�y��i' � y� �"�'/�.�'.�9�jvtfa�:i— .Lw .CAP MATERIAL .; - �� '� a f- BLOCK TYPE r ;' r2 o J`� �"�s�': fv s} 5 :'� VEaC aA.F�_ FOUNDATION TYPE G:/BCS/WORD/mslCCLO Installation Pertnit Applicatlon Padce�elow Frost and Frame Pier SecGon Drawings 0402-09 a � FROST DEPTH PIER SECTION VIEW "" ZDBOARD FORMINr' �' ""' y� » DEPTH "BELOVV" GRADE SOIL CLASSIFICATION J�� _�� SOIL BEARING CAPACITY ;,� 5 t�� PSF FOQTING AREA � YS" SQ. IN. SOILS TOTAL LOAD CAPACITY � SG�T t�. PSI CONCRETE y� �' �' ALTERNATE °BELLED° FOOTING �, � „ G:/BCS/WORD/ms/CCLD Installation Permit Application PadceUBelow Frost and Frame Pier Secdon Drawings 04-02-09