P - 44328��.�a ��c. � � ����
Park Name: '��R.�cdt,�- yC ��' �rt t2� c�..
Job Site Address: %� Q( � r 5`� �n,�` � Zip
Project Valuation: $ (��60d, n� 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.
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For O�ce Use Only
Permit # Entered Approved Issued
Updated 1/29/09
SU�'PLEMENTAL tNFORMAT(ON SHEET
THIS IS ADDITIONAL INFORMATlON 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).
HOME INSTALLATION BY:
� MN LICENSED MANUFACTURED HOME INSTALLER
❑ HOMEOWNER
TYPE OF INSTALLATION
� MANUFACTURED HOME PARK
❑ PRIVATE PROPERTY
SITE
� SITE PLAN PROVIDED-INCLUDE BUILDING AND PROPERTY LINE
SETBACKS
I� 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
❑ FLOOR
0 CEILING
❑ RIDGE
ACCESSORY STRUCTURES--PER MANUFACTURERS INSTALLATION
MANUAL, MSBC CHAPTER 1350 AND MSBC CHAPTER 1300.
❑ DECKS •
� STAI RS
❑ LANDINGS �
❑ OTHER �
G:/BCS/WORD/ms/CCLD Installation Permit Appiication PackeUSuppoR-Anchoring Plans 04-02-09 '
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City of Fridley
6431 University ;4ve NE
Fridley MN 55432
PRINT !N INK or 7'YPE your responses.
General Information
HOMEOWNERS NAME
�.
y��° - f,'��'! j j�✓�` ��,�.Ci
HOME LOCATION/ADDRESS
�73 d � W pS�1- C lRG� �£
MANUFACTURED HOME SRAND MODEL
f���ii �` ;�!4,
HUD or STATE LARFi �Ci Ni ineRCQ rc� �rs �,._
�
was
Is the home tocated in a park? Name of Park
No �Yes � �--
���;�,..=
Mail
Manufactured Home Installation
Compliance Certification
form to the City within 10 days of completion
COU NN
�y , ,
,��i,v�.;,,;,
CITY
%Yf� r'� � ,= {'
to July 1, 1972, no
! `��'�!:c� .
Inspection of installation completed? Date of
No�Yes❑
Support System Seal Number. Foundation Type: ❑ Ground Block ❑ Frost Depth Piers ❑ 8asement q Crawlspace w/frost ftg.
❑ Engineered Slab D Other Apprvva! Altema�te Alteri�ate appr�val number
Soil Bearing Capacity (p.s.f.) Method of verification naTF nF �NCT,�� � n-nnti
Support System Items
name of person, company
Sewer:
_;F--
;-- As > : ; •�� � :
Water.
Fy � "j r•���.y
oT u[mry WorK: (Enter completed by, if installer state insta!ler, if homeowner stafe homeowner, if other give
name, license number if known. J
or
Other Items Included in Installation Contract:
Home Stand/Pad ❑ Lot grading ❑ Skirting t�,
Other Items:
I hereby certify that the Suppo�t System on the Manufactured Home Irsted ha
insfructions and the Minnesota Stafe Building Code.
MN REGISTRATION NUMBER INSTALLER COMPANY NAME
MI- ��� , .�--
Anchoring System , `. " ` ?„�` r�,��-�«��;: � �=-
requires electrical contracfor.
How many? �
3en cjomp/eted in accordance wrth the manufacturers
IIGENSED/REGtSTERED tNSi'ALLERS SIGNATURE:
-�---�� ---• •-�•�•���• ��•�� �� ry�r,�v�rru.i utctrc� MUDEL-PART/PRODUCT NO. DATE OFINSTALLATION
NAMi�- ,,.� ,.��� i!�
Soil . 9 i � f�t�i,uJ C' /r�'c Ki . - - - • .- � f�
�`� ' — .� J .i ; � ,
Anchors Ye� ��. ConcreteAnchors: ,s�5��
No s Test Probe To ue Value inch Ibs. �, 9 Yes �her anchor ystem: (Give approval numbers &
l hereby certify that the Anchoring System on fhe Manufactured Home listed has been compl fed in ahccordance wit cthe manufactur�rs
instructi�ns and the Minnesota State Building Code,
MW REGISTRATION IVUMBER INSTALLER COMPANY NAME LICENSED/REGISTE INSTALLERS SIGNATURE:
MI- � ��/'r ;� �"..r�
: .f u,i rJ ; �!�� f ; _/ �L� .��EJ' ✓d°�/f1G.
If anchoring of the home completed by others indicate name and addre s of responsible party for required anchoring.
SINGLE-WIDE SUPPORT PIER PLAN (TYPICAL)
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, «
L_. PERIMETER PIER SUPPORT @ OPENINGS
REQUIRED DIMENSIONS C7
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _,_,_._._._,_._._._._._._._._._._._._ - Z -•---•-•-•-•-
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� 1-BEAM PiER LOCATIONS �
REQUIRED DIMENSIONS _ _ _
. ._._._._._._._. ._._._._._._._._._._._._._._._._._._._._._._._._._._ _ •-�-•-•-�-•-�- -
a '� "- MAXIMUM END PIER SPACING ALLOWED m
REQWRED DIMENSION
MANUFACTURER INFORMATION
Name �d�'��^�_ —
Home Size } 5` Y ` �, (�g '
Maximum I-Beam Spacing �
r
Door Openings 1 P s s-!- �=� � 4�'A
I-Beam Loading PLF � ��
Maximum End Support (I-Beam) � '
Ground Moisture Contro{ �. Yes No
Grading to Slape AWAY From Home ��,
ORIENTATION
SOIL INFORMATION
,
Classification No. S�Np� ����'�'��
Soil Bearing Capacity �,�bQ � �
�
FOOTING INFORMATION
I-Beam x x
r. ,. � �
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G:/BCS/WORD/ms/CCID Installation Permit Application PackeVSupport-Anchoring Plans 04-02-09
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FROST DEPTH PIER SECTION VIEW
^"^.DBOARD FORMINr' T.."~
DEPTH
"BELOVI!'
�� „ GRADE
SOIL CLASSIFICATION � � ����` � �'��`- �
SOIL BEARING CAPACITY ;,� � ��_ PSF
FOOTING AREA 3 Y.S" SQ. IN.
SOlLS TOTAL LOAD CAPACITY � S���e :.��
PSI CONCRETE �� v' `' .
�� „
G:16CS/WORD/ms/CCLD Installation Permit Application PadceVBelow Frost and Frame Pier Section Drawings 04-02-09
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FRAME PIER SECTION VIEW
TOTAL HEIGHT
77
3�
' b R
� � 55
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77
FRAME HEIGHT
�� HARDWOOD SHIM
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•``` �P 1M c N� o� (T /42 (% W o o J�
CAP MATERIAL
'IER HEIGHT
�-
�' e ►'�. e•� fi
BLOCK TYPE
�RO'S� �06fIN� S CC.�N�
FOUNDATIQN TYPE
G:/BCSJWORD/ms/CCLD Instailation Permit Appiication Packe�elow Frost and Frame Pier Section Drawings 04-02-09
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MANUFACTU�2ED 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:
INSPECTION:
lnstallation:
Seals/Certificates# Anchoring#
(Anchoring may be required by Municipal Ordinance park rule for pre code and State Code homes. Anchoring is required for
H U D Code homes.)
lnstructions Used: Manuf�cturers x State Chapter 1350
(Homes constructed after June 14,1976, requires manufacturer's instructions be used.)
Foundation to State Buildine Code: � 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 Tvae:
Piers below frost depth:_�CS Crawl space:
Fu!! depth basement (treate wood, concrete block, poured concrete or toher)
Engineered slab on grade (signed approval by Dapia or MN Engineer)
ii n
Suaaort Footines: Type: �O NGKt "f'c _ Size: �� /lo un+ J'
Soii Conditions:��b0 _ PSF Pier Material: �O n� �Q e�'L
Pier SpacinS: Feet Inches in center (calculations should be submitted for review prior to inspection.)
.
Shims: Material Used: f�AROwoo,D
Size: Y�' !( b N (minimum 4" x 6" hardwood)
Ciothes Dryer vented to outside crawlspace or skirted area: YES or NO (circle one)
Material Used: Nof� F
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
Conditions of Issuance
Updated 1/29/2009
inch
uired
Add Delete
❑ ❑ Consultation
❑ � Final
o o Plan Review
❑ p Trench
of Work to be Com
City of Fridley
6431 University Ave NE * Fridley, MN 55432
Phone 763-572-3604 * Fax 763-502-4977
ons
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SINGLE-WIDE ANCHORING PLAN
(TYPICAL)
X t� S ys� � w�
' " MAXIMUM END ANCHOR SPACING ALLOWED
REQUIRED DIMENSIONS
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m MAXIMUM INTERMEDIATE ANCHOR SPACING ALLOWED
� �-- REQUtRED DIMENSION
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' "- MAXIMUM END ANCHOR SPACING ALLOWED
REQUIRED DIMENSION
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MANUFACTURER INFORMATION ANCHORING INFORMATION Cont.
Name i-{oR'%�✓ Anchor Manufacturer yC (� Sys'{�W\
Home Size (, (o Lateral Anchors Rea'd YES or NO
Maximum I-Beam Spacing Anchor P.N.
Maximum Anchor Spacing
SOIL INFORMATION
Classification No. si9+�ny GnA�
Soil Bearing Capacity _ �SOO ( b
ANCHORING INFORMATION
Ext. Wall Height g'
Roof Pitch 3 ��2
Height From Ground to o ��
Frame Connection 3
Connector P.N.
Longitudinal Anchors Req'd YES or NO
Anchor P.N.
Connector P.N.
No. Per End
* P.N. = Part or Product Number
G:/BCS/WORDlms/CCLD Installation Permit Application PackeUSupport-Anchoring Plans 04-02-09
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