P - 44284Park Name: !� � � � � �'� � '° %` �:--
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Job Site Address: ��� N L,�J e�`1- � � n ��, � Zip
Project Valuation: $ � i} ��. �% � Applicant Is: D Owner and Occupant �Contractar
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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Permit # ��C�/ �O � � � � � Entered Approved Issued
Updated 1/29l09
SUPPLEMENTAL INFORMATION SHEET
THIS IS 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).
HUME INSTALLATION BY: �
� MN LICENSED MANUFACTURED HOME INSTALLER
❑ HOMEOWNER
TYPE OF INSTALLATION
� MANUFACTURED HOME PARK
[� PRIVATE PROPERTY
SITE
j� 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
❑ LIST THE MAX. GAP ALLOWED BETWEEN THE SECTIONS OF THE
STRUCTURE ��
[� FLOOR
❑ 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 Application Packet/Support-Anchoring Plans 04-02-09 �
City of Fridley
6431 University Ave NE
Fridley MN 55432
PRINT IN INK or TYPE your responses.
General information
HOMEOWNERS NAME
.. , ,r.
i� �` �� - / -r-! � �� f„� r�; �� �
-IOME LOCATION/ADDRESS
73 Wes-t C����� �,�,
�IANUFACTURED HOME BRAND MODEL
r ��=%r � .' ;; � v�'
iUD or STATE LABEL(S) NUMBER (S) (Ifhome was
Is the home located in a paric? Name of Paric
No OYes � �-
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Building Permit Number:
Mail
Manufactured Home installation
Compliance Certification
form to the City within 10 days of completion
COUNTY
.
J 1`(,i � i�ti .r-;
cmr
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prior to JWy 1, 1972, no
j � �'c r2/fi-G ''L
Inspection of installation completed?
No � Yes ❑
Support System Seal Number. Foundation Type: ❑ Ground Blodc ❑ Frost Depth Piers ❑ Basement O Crawlspace w/frost ftg.
Cl Engineered Sfab O Other Approval Alternate Alternate approyal rtumber
Soil Bearing Capacity (p.s.f.) Method of verification
DATE-OF INSTALLATION
Suppprt System items of Utility Work: (Enter completed by, if installe� state installer, if homeowner state homeowne� if other give
name of person, �pmpany name, license number if known.)
Sewer:
^, --' Tested:
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Water;
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C�l1 �15t �-r�
-•--•• �w�• i�r ����r�eo eiectncai contracto� or homeoi
AovAN7�� �
Other Items Included in Instaiiation Contract:
Home Stand/Pad ❑ Lot grading ❑ Skirtina �
requires
a�
How many? �
�
1 hereby certify that the Support System on the Manufactur�sd Home listed has been completed in accordance with the manufacturt�is
insfructions and the Minnesota State Building Code.
MN REGISTRATION NUMBER INSTALLER COMPANY NAME
M�_ LICENSED/REGISTERED INSTAILERS SIGNATl1RE:
Anchorin � ' �
9 System � � • "' ,<�. ;',2� �/;,��; _,�,.•:.
Al1Ch0� Cvc�om ce.�i ��..��--- ' - •-• — - - -- •
NAM� ���w��-rHrc � �NKODUCT NO. DATE OF INSTALLATION
Soil . ��� d�+� ,��►�9, "
Anchors Ye� � �� r� �. Concrete Anchors:
No s Test Probe Tor ue Value inch Ibs. � Yes �her anchor system: (Give approva! numbers 6
l hereby certify thaf the Anchoring System on the Manufactured Home listed has been completed in taccoirlance wit ��e manufactur�rs
instructions and the Minnesota State Building Code.
MN REGISTRATIOM NUMBER INSTALLER COMPANY NAME
' 'r :: .--- LICENSED/REGISTERED INSTALLERS SIGNATURE:
MI- ` y �
If anchoring of the home completed`by others i d cate na� e and addre s of responsible party for the required anchorine
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MANUFACTURED HOME:
Brand Name: Model Name:
Serial Number: Date of Manufacturer: �° � v
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:
installation:
Seals/Certificates# Anchoring#
(Anchoring may be required by Municipal Ordinance park rule for pre code and State Code 6omes. Anchoring is required for
HUll Code homes.)
(nstructions Used: Maaufacturers j� State Chapter 1350
(Homes constructed after June 14,1976, requires manufactarer's ir+strnctions be used.)
Foundation to State BuildinQ Code: Q 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:
Fuli depth basement (treate wood, concrete block, poured concrete or toher)
Engineered slab on grade (signed approval by Dapia or MN Engineer)
ri
Suaaort FootinQS: Type: �ONG�Ct'�'c Size: �g /Iou.�+
Soii Conditions:_��b0 ^ PSF Pier Material: CO n��Q t�'L
Pier Spacine: _� Feet a Inches in center (calculations should be submitted for review prior to inspection.)
Shims: Materiai Used: fiAROwooD
Size: Y'` 1( b" (minimum 4" x 6" hardwood)
C:lothes Dryer vented to outside crawispace or skirted area: YES or NO (circle one)
Material Used: iJON F -
Fresh Air intakes to outside craw►space or skirted area: (if required for fireplace or furnace or water heater)�or NU
(circle one)
Anchoring Equipment (If applicable):
Anchors Used: (manufacturer's model numbers)
Soil test Probe Torpue Value
Conditions of Issuance
t:pdated I/29l2009
Descri
inch ouads
Recluired Ins
Add Delete
� 0 Consuitation
� � Final
_ � � Plan Review
� p Trench
of Work to be Completed
City of Fridley
6431 University Ave NE * Fridley, MN 55432
Phone '763-572-3604 * Fax 763-502-4977
SINGLE-WIDE SUPPORT PIER PLAN (TYPICAL)
1
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L� PERIMETER PIER SUPPORT @ OPENINGS __ I
REQUIRED DIMENSIONS (7 ._.
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� I-BEAM PIER LOCATIONS g
REQUIRED �IMENSIONS _ _._.
._ _"'_' m
,a '� "- MAXIMUM END PIER SPACING ALLOWED _
REC2UIRED I�IMENSION
MANUFACTURERINFORMATION
Name �o���^�
Home Size ; g` �f ' ;� (pg '
�
Maximum I-Beam Spacing �
Door Openings 1 n s s-f- n� � �t� d'r
I-Beam Loading PLF l� �.�
Maximum End Support (I-Beam) � `
Ground Moisture Contro{ �, Yes No
Grading to Slope AWAY From Home ��;
ORIENTATION
SO1L INFORMATION
Ciassification No. S�NAy �<<'jj�f�
Soil Bearing Capacity ,�S'�O (�
FOOTING INFORMATION
I-Beam
�+
x x
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G:/BCSlWORO/ms/CCLD Installation Permit Application PackeUSupport-Anchoring Plans 04-02-09
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SINGLE-WIDE ANCHORING PLAN
(TYPICAL)
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'- " MAXIMUM END ANCHOR SPACING ALLOWED
REQUIRED DIMENSIONS
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� f-- REQUIRED DIMENSION
i
' "- MAXIMUM END ANCHOR SPACING ALLOWED
REQUIRED DIMENSION
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MANUFACTURER INFORMATION ANCHORING INFORMATION Cont.
Name __ �-{oRTo�✓ Anchor Manufacturer SC �,� Sys�yv�
Home Size 1l. �C log Lateral Anchors Rea'd YES or NO
Maximum I-Beam Spacing Anchor P.N.
Maximum Anchor Spacing
SOIL iNFORMATION
Classification No. Sfi�ny Gna�
Soil Bearing Capacity �.SOO ( b
ANCHORING INFORMATION
Ext. Wall Height g'
Roof Pitch 3 /iZ
Height From Ground to
Frame Connection
30`�
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:/BCS/WORD/ms/CCLD Installation Permit Application Packet/Support-Anchoring Plans 04-02-09
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FRAME PIER SECTION VIEW
TOTAL HEIGHT
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CAP MATERIAL
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BLOCK TYPE
< �T s`� 1'�0 � :nr � g "� A �� � m„ +•�-_
FOUNDATION TYPE
G:/BCS/WORD/ms/CCLD Installation Permit Applicatlon Packe�elow Frost and Frame Pier Section Drawings 0402-09
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FROST DEPTH PIER SECTION VIEW
"" ZDBOARD FORMIN�" "' '��
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DEPTH
"BELOW'
GRADE
SOIL CLASSIFICATiON j, :� ��� � �= �=�� ;
SOIL BEARING CAPACITY „�. � �� PSF
FOOTING AREA .� Y,.S` SQ. IN.
SOILS TOTAL LOAD CAPACITY � Se�a� :�•
PSI CONCRETE �� v �'
ALTERNATE
°BELLED"
FOOTING
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G�lBCSMIORD/ms/CCLD Installation Permit ApplicaUon PackeUBelow Frost and Frame Pier Secdon Drawings 04-02-09