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Manufactured Home Svstems Test Affidavit
This form must be completed in its entirety and be submitted at the Building Final inspection for the installation of a
manufactured home. All tests must be completed and signed off on this form. A certificate of occupancy will not be
issued until this completed form is received.
SYSTEMS TEST VERIFICATtON
'� Description Date Passed Signature of Tester
Drain Line: Pursuant to CFR 3280.612(b) Date: �
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Print Name of Tester and Company: ' �
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WBte� L111@: Pursuant to CFR 3280.612(a) Date: � �
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Print Name of Tester and Company: � ` �1 j � /.i�
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FIXtUI'@ T@St: Pursuant to CFR 3280.612(c) Date: Z � � �--�
Print Name of Tester and Company: ..� " �,.� ` � � ' � e�� ��
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GaS T@St: Pursuant to CFR 3280.705 and IFGC 406.4 Date: ���j ' Z,�i' �
Print Name of Tester and Company: � ,�' � � 5 �
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Electrical Operational: Pursuant to cFR 32s5.7o2 Date� � ,,2f> ���
Print Name of Tester and Company:��,�.,L ���� ��Cu✓' �.�
Electrical Polarity: Pursuant to CFR 3285.702 Date: �_a _ ��
Print Name of Tester and Company: ��-�����i.� �n,(,�,��,r,��-� ��,C
Electrical Continuity: Pursuant to CFR 3285.702 Date: �---�- � �-� - -
Print Name of Tester and Company:�'��� ���j� ����,,, „-,� �,�
S1110ke Alat'1'Yt T@St: Pursuant to CFR 3280.208 Date: ��,�� �
Print Name of Tester and Company: � - ����y �/�/
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I certify the above systems testing has been completed and was found to be in compliance with the provisions iden' ed for each
systems test:
Siqnature: Date:
§ 3285.604 Plumbing Tests and inspection. x • .>
(a)Water system. All water piping in the water distribution system shall be tested by subjecting the syst�m
to air or water at 100 psi for 15 minutes without loss of pressure. (water h�ater disconnected)
(b) Drainage and vent system and plumbing fixtures. The waste and vent system shall be tested by one
of the three following alternate methods for evidence or indication of leakag�e:
a)Water test: before plumbing fixtures are connected, all the openings into the piping must be plugged and
the entire piping system subjected to a static water test for 15 minutes by filling it with water to the top of
the highest vent opening with no evidence of leaking.
b)Air test: after all fixtures have been installed, the traps filled with water, and the remaining openings
securely plugged, the entire system must be subjected to a 2-inch (manometer)water column air test.
c) Flood level test: the entire system must be filled with water to the rim of the water closet bowl (tub and
shower drains must be plugged), the test must be sustained for 15-minutes without evidence of leaks. The
system must then be unplugged and emptied. The waste piping above the water closet bowl must then be
tested to show no evidence of leakage when the high fixtures are filled with water and emptied
simultaneously to obtain the maximum flow to drain piping.
§ 3285.605 Gas piping systems. �
After the appliances are connected, the piping system must be pressurized to not less than 10 inches or
more than 14 inches water column (6 to 8 ounces per square inch)and the appliance connections tested for
leakage with soapy water or bubble solution. The system must be isolated from the air pressure source and
maintain this pressure for not less than ten minutes without showing any drop in pressure.
I�GC 406.4(Required on main line from the gas meter to the connection to the trailer gas piping system)
406.4.1 Test Pressure. ...not less than 25 psig. Where the test pressure exceeds 125 psig, the test
pressure shall not exceed a value that produces a hoop stress in the piping greater than 50 percent of the
specified minimum yield strength of the pipe.
406.4.2 Test Duration. ....When testing a system in a single-family dwelling, the test duration shall be
permitted to be reduced to 10 minutes...
406.4.3 Test Gauges. ....Test pressure shall be within the middle 50 percent of the test gauge pressure
range.
§ 3285.702 Electrical Testing
1. Continuity test to ensure metallic parts are effectively bonded,
2. Operational tests of all devices and utilization equipment(except water heaters, electric
ranges/furnaces/dishwashers/clothes dryers &washers, and portable appliances)to demonstrate that they
are connected and in working order,
3. For electrical equipment installed or completed during installation of the home, electrical polarity checks
must be completed.
§ 3280.208 Smoke alarm requirements.
Testing and maintenance.
(1) Each required smoke alarm installed at the factory must be operationally tested in accordance with
the alarm manufacturer's instructions. A smoke alarm that does not function as designed during the test
and is not fixed so that it functions properly in the next retest must be replaced.
Tests must be completed by:
• Licensed plumbing contractor of record for the project. (Plumbing Tests)
• Minnesota-bonded mechanical contractor. (Gas Supply Tests)
• Licensed electrical contractor of record for the project. (Electrical Tests)
• Minnesota-licensed manufactured home installer of record, if the installer has been approved by CCLD
as capable of completing the on-site for each of the systems. (All Tests Approved to PerForm)
• Manufacturer's IPIA agent. (All Tests)