P - 44299�
Park Naxne: -- � � � � �- � �� � t? �C� ;�, �_
Job Site Address: _ ����% �e S� C � rt c �£ j� .� 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 instatlation permit and I acknowledge that the information above is comp[ete 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 oniy 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 # YVW 1� � V
Updated 1/29/09
Entered
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REC'D AUG p � 2010
issued
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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
WITH THE MANUFACTURERS INSTALLATION MANUAL, HUD
CFR 3285 AND MN STATE BUILDING CODE (MSBC).
HOME INSTALLATION BY:
� MN LI�ENSED MANUFACTURED HOME INSTALLER
❑ HOMEOWNER
TYPE OF INSTALLATION
� MANUFACTURED HOME PARK
0 PRIVATE PROPERTY
SITE
� SITE PLAN PROVIDED-INCLUDE BUILDING AND PROPERTY LINE
SETBACKS
� SITE DRAINAGE
❑ DESIGNATED FL40D HAZARD AREA
0 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 '
0 FLOOR
0 CEiL(NG
❑ RIDGE
ACCESSORY STRUCTURES-PER MANUFACTURERS INSTALLATION
MANUAL, MSBC CHAPTER 1350 AND MSBC CHAPTER 1300.
❑ DECKS •
,� STAI RS
❑ LANDINGS �
❑ OTHER
G:IBCSNVORD/ms/CCLD installation Permit Application PackeUSupport-Anchoring Plans 04-02-09 �
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� City of Fridley
6431 Uriiversity Ave NE
Fridley MN 55432
PRINT IN INK or TYPE your responses.
General Information
HOMEOWNERS NAME
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HOME LOCATION/ADDRESS
77 ��% �Jlit�y'"� CIYL(,�F
MANUFACTURED HOME BRAND MODEL
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HUD O� STATF 1 ARF� �c� nu u�oce .... ,...
Is the home located in a
No OYes �
Mail
W8S
Manutactured Home Installation
Compliance Certification
form to the City within 10 days of completion
COUNTY
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CITY
?'�,l! i•�'Jr � 'r'
prio� to July 1, l972, no /abe! number
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:' t� c aC j„ :- �' �L°. �' i2/: C�
Inspection of installation completed?
NoOYes❑
of
Support System Sea1 Number. Foundation Type: O Ground Block ❑ Frost Depth Piets ❑ B�asement O Crawlspaoe w/frost f�.
� Engineered Slab D Other Approval Altema#e Alternate app�vai'number,
Soil Bearing Capacity (p.s.f.) Method of verification ne-rc �,� �.���,,, �.�.,...
5upport System Items of Utility Work; (Enfercomplefed by, ifinsta!lerstate installer, ifhomeowne�state homeowner, ifothergive
name of person, company name, license numbe� if known.)
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Gas:
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Electrica�: (gy /�c�ensed electricaf contractor or h�meoi
140v�►�'fi�G E
Other Items Included in Installation Contract:
Home StandlPad ❑ Lot grading ❑ Skirting �
r nereby certifj• that the Support System on the Manufactured Home listed h�
instructions and the Minnesota State Building Code.
MN REGISTRATION NUMBER INSTALI.ER COMPANY NAME
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Anchoring Systerr� ' `� �' =-`�= .-`r2��.l,,;�� _,� -:.
Anchor System Seal Number. ANCHOR MANUFAG7URER'S MO
NAM;r � �� ��l�-a,�
Soil �� - _-
Anchors Ye� �� s l'� 5. Concrete Anchors:
No s Test Probe Tor ue Value inch Ibs. Nq Yes �her ancho� system: (Give approval numbe�s &
I hereby ceRf(y fhat the Anchoring System on the Manufactured Home listed has been comp/e ed in accordan� wit�e manufaetu,�n
instructions and the Minnesota State Building Cpa►e,
MN REGISTRATION NUMBER INSTALLER COMPqNY NAME
MI- ;'' y`� �' ,�%i;"'? y��� ---
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If anchoring of the home completed by others indicate name and addre of n
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been completed m accordance wrth the manufacturers
' LICENSED/REGISTERED lNSTALLEf2S SIGIVATURE:
LICENSED/REGISTERED INSTALLERS SIGNATURE:
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MANUFACTURED HOME:
Brand Name:
Serial Number:
Modei Name:
Date of Manufacturer: � ° i �
Construction Label Numbers:
HUD Code 06/14/76 and newer, State Code 7/O1/72 to 06/14/76, Pre-code prior to 07/Ol/72
Roof Load Zone: 3 0! b. Heating/Cooling Zone:
INSPECTION:
lnstallation•
Seais/Certificates# Anchoring#
(Anchoring may be reqnired by Municipal Ordinance park rule for pre code snd State Code homes. Anchoring is required for
HUll Code homes.)
instructions iJsed: Manufacturers x State Chapter 1350 __
(Homes constructed after June 14,1976, requires manufacturer's instructions be used.)
Foundetion to State Buildine Code: � 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.)
F'oundation Tvr►e:
Piers bclow frost depth: S Crawl space:
Fuli depth basement (treate wood, concrete block, poured coacrete or toher)
Engineered slab on grade (signed approval by Dapia or MN Engineer)
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Suauort FootinQS: Type: CoN��t"'�'c. Size: /� %loun+
Soil Conditions:___,��b0 _ PSF Pier Material: �Oti►�Qe-rG.
Pier SuacinS: � Feet a Inches in center (caMulations shouid be submitted for review prior to inspection.)
Shims: Material llsed: f�AROwoo,p
Size: Y" �( b N (minimum 4" x 6" hardwood)
Clothes Dryer vented to outside crawlspace or skirted area: YES or NO (circle one}
Material Used: NON F
Fresh Air intakes to outside crawlspace or skirted area: (if required for tireplace or furnace or water heater)�or NO
(circle orte)
Anchoring Equipment (If applicable):
Anchors Used: (manufacturer's modet numbers)
Soil test Probe Toraue Value
Conditions of Issuance
l:pdated iR9/2009
S
uired
Add Deiete
❑ 0 Consultation
❑ ❑ Final
� � Plan Review
C D Trench
of Woric to be Corn
City of Fridley
6431 University Ave NE * Fridley, MN 55432
Phone 763-572-3604 * Fax 763-502-4977
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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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RE4UIRED DIMENSIONS _ _
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a '?% "- MAXIMUM ENO PIER SPACING ALLOWED
REQUIRED DIMENSION
MANUFACTURER INFORMATION
Name i'!o �--��
Home Size :5` `t ` � (ag '
Maximum I-Beam Spacing �S �
Door Openings L P s s-f n=+ ti 4�S '�
I-Beam Loading PLF G a�
Maximum End Support (!-Beam) � '
Ground Moisture Control�Yes No
Grading to Slope AWAY From Home ��r�;
ORIENTATION
SOIL INFORMATION
Classification No. S�NAy �j�-��'��^
Soil Bearing Capacity �tSc�Q j�
FOOTING INFORMATION
I-Beam x x
�: 7 (� �. �
�% � f \ J 'J N •.X. � �.0 j + `�° ' ' � '
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G:lBCSM/ORO/msICCLD Installation Pe�it Application PackeUSupport-Anchoring Plans 04-02-09
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(TYPICAL)
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REQUIRED DIMENSIONS
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m MAXIMUM INTERMEDIATE ANCHOR SPACING ALLOWED
(-- REQUiRED DIMENSION
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REQUIRED DIMENSION
MANUFACTURER INFORMATION
Name _ �-{p�-o�/
Home Size 1(, � (og
Maximum I-Beam Spacing
Maximum Anchor Spacing
SOIL INFORMATION
Classification No. S�4Nny GnA�
Soil Bearing Capacity ,SOO t b
ANCHORING INFORMATION
Ext. Wall Height __ g'
Roof Pitch 3 %-L.
Height From Ground to
30��
Frame Connection
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ANCHORING INFORMATION Cont.
Anchor Manufacturer SC ( .,Z Sys�yv�
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/CCID Installation Permit Application PackeUSupport-Anchoring Plans 04-02-09
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T4TAL HEIGHT
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CAP MATERIAL
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G:/BCSMIORD/ms/CCLD Installation Permit qpplicaUon Packe elow Frost and Frame Pier Section Drawings 04-02-09
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""'tDBOARD FORMINr T' ."'"
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"BELOW'
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SOIL CLASSIFICATION .5�� �� �� � �x-w°�� i
SOIL BEARING CAPACITY ;,�. � �� PSF
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FOOTING AREA � �'.S` SQ. tN.
SOILS TOTAL LOAD CAPACITY � aGw�c :.:?•
PSI CONCRETE �� � �'
ALTERNATE
"BELLED"
FOOTING
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G:/BCSMJORDIms/CCLD Installation Permit Application PadceUBelow Frost and Frame Pier Sedion Drewings 04-02-09