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HomeMy WebLinkAboutLA175027 MAWUFACTUR�D HOME PERMIT °�'OeU�On1y �1�5�Z7 APPLICATIdN Aermit NWmber CITY OF LAKEVILLE �l�=-� '' ' BUILDING INSPECTlONS DEPARTMENT Received By 2p195 HOLYflKE AVENIIE `�Z Z� Z� LAKEVILLE,MN S50A�t Date Received q� 952-985-4440 � Q�•� www.lakeviilemn.eov � Fee Tota1 �l REQUIRED FC1R APPLICATION: � C�nplefied Park Manager Approval Fotm � Mant�fac#urer`s approved insCaitation manual Q Separate Eiecalcal Pe�mit GENER,4L lNFORMATIOW ^ HOMEOVNI�IERS NAME OUNiY i �:����� �rt��e �.c��.w� �'S l��kUtc� HOME LOCATIONI'ADpRESS �-n. 1 "1 '?r�r �Cc����� �,�e C..�fi .�' , Lc�rvy/r� , ���� .�3�.�.� �.a.t�e�i tl�. MANtlFACTUREQ HQME BRAND ODEL. ERfAL NUMBER OF HOME ATE OF MANUFAC'1'URE bwtc.i�t Nt�;:Esr,t��j J �5 b�. 1 i�0 7vp NUD or STATE LASEL(S)NllMBER{S)(tfhtrme w8s manufactur�d priar to July�1, 1972,no Jabei numb�rrequired.) Is the home located in a� ame tsF Park p►vo j$Yes ��u�.��� r��,��� Ci���fs SUPPORT SYSTEM � Support Systern Sea! Foundation Type: ❑ Ground � Frost�... � t,.�f r � i��t 4..G�;� �#��t y��.� �^ ❑ En�ineened �] �ther Approvai Alten �,� ;(,_�� � �.�;.� Sai1 Bearing Capaaty Method o#verification =.�tr_._ ��-�_� �.�M — a. .�. lJ��L� _ - '_' ��� SYSTEM ITEMS(Utlilty Wott'1cc): (Entercomp/etedby,ifinstaflersf�te name of person,comDanY name,Jicense nutnber ifknown) ����>� _ ..,..;,,,�. :,,�,,,,� Sewer, �it�2.�.►1e�` !�','+tl�y�lr��1d �"�,r�#V�t:#iw� _ ,� � .�.,.z �:� ...r.�..,-�.�-_.,.� � WBter: �.3.�'t�!t�.l'' J �`t#�41t�t 1 d �°G'►1'���Gf+`� ���. ... -�.._._����,....�.KK���.��,..,,�..�._�._._.�_��.�r..�s�.— Ga�: --.. Elec�ricai:(Bylicensed electrical cor�trac�ort�rhQmeowner)(Parkinstal/a��;� «�- �, - _ -.,�„�: _ — ANCHORiNG SYSTEM --��z�tr,.� �!�'w f�x�„�1 �,�r,�rtu�c;�c.✓�ei l�r:�r�. Anchor S�rstem Seal Mumb�r. CNOR MANUFACTUftER'S NAME ODEL-PART/PRODUC'F NO. T��� ��^�tf''ri �v1 , �`��G � Soil Anchors est Probe Torque Value(iru�Ibs.) �o��#�q��s: r and�or system: ❑N° ❑�'� [] No � Yes INSTAI.LER INFORNIATiON 1 i�ereby cerliffy that the Suppr�rt System and Anchoring,System an fhe Manufa�tu�d Nome listed wiil be comp/eted in acxo�dance wMh tl�e manufacturer's ins6 uctions ar�d the Minnasofa State Berilafin Code. MN REGISTRATIC?N�IUMBER NSTALLER COMPANY PIAME CENSED/REGISTERED INS7AllERSSIGNATURE: MI- �'L I�4�7�, j�;= 1��a yL.lu��G C�i���v'��:.t�t � �,..1 /�=��---�'' If anchoring of the tmme cam�leted by others in�icate name and addre�ss ofi responsible party for th�required anc,horing. OFFICE USE ONLY MANUFACTURED HOME PERMIT APPLICATION USE AND OCCUPANCY: �;`?t^BUILDING CODE Jr�_CONSTRUCTION TYPE -t.�C--I IRC DWELLING TYPE /2SM i-� ZONING REQUIRED INSPECTIONS: �FOOTI NG --� IE-DOWNS AND BLOCKING �UILDING FINAL(copy of Systems Test Affidavit) PERMIT FEE: PERMITFEE: $ ?��%� � SURCHARGE: $ I � ,;� <�� � TOTAL: $ i� BUILDING INSPECTOR: � 1 r2�����I/1���� DATE: t�ZZ � Z t� COMMENTS: ���tv ��ny��it �I -,r Zv�� /�`r����� �4��1 cG� �(2vi�i��� l;'�.��;��r' �?�ti�� �1+IA��'�►CTUItED Ht3ME PARK osra u�c��� A�AI'��+�E�A�FPRC)YAL �►'�„�,r��. � . CITY OF LAi{EV713.E Raxfvea ey 811It.DING fNS�CTIONS I}EPAATMEN'�' 2U19i Ht�LYOKE Ay'EiM#E LAKEYfi.t.E,Allti SSfl4d -- Date R�ocivtd 95�-9�S�i4�i} urw+w.takealtlrnm.gov REQUIRED FQR APPLICATI�I�I: I'ark Manag�-ap�rc��al form wi�sit�e�rllan 4n reversc, Manufa�urc�r's�pprav+�d i�stallatian�t�rru�l� Applica�ort miust he m�de?.�t hours be�'orc i�talla#ir�n of 6ome and requcst fc►r jnspecti+an. Tl�is form mu�t be cvmpletsd a�rd si�r��by t�te Park Mautag,er. This cvm�t,e#�d,�'ortn ts reqt�ired tit the tinte �',��APiicattan frrr r�l�b�t�cg pr,�rm�#s, JOB�2'I'E AI�Dt�E,SS: C� !�� ��i C_.--�''1��'v f ��-�� MAI+tU�ACT't.tt2�U H�}�PAt�K: l.1 �`,3L7'�� Tt�iSTAI.I,ER iI+P�'fl�IATItJ►N: 2�tAME tJ�OWI�IER flR+C�NTR}1GTl�R U�f3Tl'�G Wiai�tK: '�''`- J'- �4e� �i�r1�v�c.rJK�^ �x�r�: L�, � �3 9 G -�9 r� c��s��.��,acc�aav�E#: �����: ��C., STRE�T AI3�nR.�S�. !J°fl ! ��'� �-���. f C�'t�'; L��i/�i�. t 7�1 rM/ �. ���,eY MANUFA U�ED HHi.� Il'�FO�tMATx4N. MAI�1t.TFAC7'l1R�t:_ �k�tl� 1�lt�.i St��y XF.#lR N+tJM�V�AS MANUF.: �G�G �A�t OF SEt1.I..: SfiR.tAL�#; t331MEIVSlC13��OP H{?IVI�; /tf X� � D1MEN52C1t+d5 OF Libl'. 8'f j X �h� � A�tE TI�iERE ANY ItOOi►tl ADT�ITl�3NS,P1'�RCF�ES.DEC'KS�fR ACC£SSC?RY BUILQINC�S? �'� N�� I�Y�S,S"t"ATE TYP�A�i3 SIZE: I Ji�R��Y AGRREE'1`��IN�R14�r-1TI��1�33C}VE IS�OMFL��'I�ANT,�ACCL1R.�l'�. I H�IVE PE1�S{1h1A1.LY I1�SP�GTED`i'H�Sl'T�A1'�D TH�Ht3�3SE T'A.�?Ft7�t CflA�''I.It�NC�E`�4+ITH ALL CTTY�RLIINAN�FS ANI�THE 1'v�Il�`C�ESt}T1�STATE�UiI.T7ING Ct�DE. I'Alt�i M�tiVAG�R'S SI�N�TtJRE•' � d.,.� � ' ��i?A�'E� r�"`� ��.-� ST`I�,PLAN MUS`P H�S�OW�t)I�t RE'V�RSE 5��, INCI.U]�E ALL AD QN�,ACCE55URY BUII.UINGS, I�15TANC'FS FRt�M LOT L1I+iES,EAS�M�N'!'S A�AL�,�O �i HONSES. +�FF�IICE t}5E APPR{3�33X: DATE Ct�MME3'+tTS (RE111S�I?I�28J2U 17) ,�,� d rl,?'` '� � 1`}\' �� ,�� �� '"\ � �v �� ,�Je�, . � � �,y11,� ��t�� � � , �ir�e"v ,�� � � ���" _ i� � ` � �� � � w �'� �- .y �� � � �' , ��4� `� ,�' � � � � �' � o � � � � � � _,� � � � - �' ---� ��� � ��