HomeMy WebLinkAboutLA193299 PERMIT 877 MACBETHMANUFACTURED HOME PERMIT
APPLICATION
CITY OF LAKEVILLE
BUILDING INSPECTIONS DEPARTMENT
20195 HOLYOKE AVENUE
LAKEVILLE, MN 55044
952-985-4440
Office Use Only
___________________
Permit Number
___________________
Received By
___________________
Date Received
___________________
Fee Total
REQUIRED FOR APPLICATION:
Completed Park Manager Approval Form Manufacturer’s approved installation manual Separate Electrical Permit
GENERAL INFORMATION
HOMEOWNERS NAME COUNTY
HOME LOCATION/ADDRESS CITY
MANUFACTURED HOME BRAND MODEL SERIAL NUMBER OF HOME DATE OF MANUFACTURE
HUD or STATE LABEL(S) NUMBER (S) (If home was manufactured prior to July 1, 1972, no label number required.)
Is the home located in a park?
No Yes
Name of Park
SUPPORT SYSTEM
Support System Seal
Number:
Foundation Type:
Engineered
Slab
Ground
ock
Frost Dep h
Piers
Basemen
t
Crawlspace w/frost
ftg.
Soil Bearing Capacity
(p.s.f.)
Other Approval Alternate
Method of verification
SYSTEM ITEMS (Utility Work): (Enter completed by, if installer state installer, if homeowner state homeowner, if other give
name of person, company name, license number if known.)
Sewer:
Water:
Gas:
Electrical: (By licensed electrical contractor or homeowner) (Park installation requires electrical contractor.)
ANCHORING SYSTEM
Anchor System Seal Number:ANCHOR MANUFACTURER’S NAME MODEL-PART/PRODUCT NO.
Soil Anchors
No Yes
Test Probe Torque Value (inch lbs.)Concrete Anchors:
No Yes
Other anchor system:
INSTALLER INFORMATION
I hereby certify that the Support System and Anchoring System on the Manufactured Home listed will be completed in accordance
with the manufacturer’s instructions and the Minnesota State Building Code.
MN REGISTRATION NUMBER
MI-
INSTALLER COMPANY NAME LICENSED/REGISTERED INSTALLERS SIGNATURE:
pthpth
www.lakevillemn.gov
Submit to: permits@lakevillemn.gov
OFFICE USE ONLY
MANUFACTURED HOME PERMIT APPLICATION
USE AND OCCUPANCY:
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_____
_____
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REQUIRED INSPECTIONS:
FOOTING
TIE-DOWNS AND BLOCKING
BUILDING FINAL (copy of Systems Test Affidavit)
PERMIT FEE:
PERMIT FEE: $____________________
SURCHARGE: $____________________
TOTAL: $____________________
BUILDING INSPECTOR: __________________________ DATE:__________________________
COMMENTS:
BUILDING CODE
CONSTRUCTION TYPE
IRC DWELLING TYPE
ZONING