HomeMy WebLinkAboutLA223468-ApplicationsMANUFACTURED 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
Email Address:Phone Number:
OFFICE USE ONLY
MANUFACTURED HOME PERMIT APPLICATION
USE AND OCCUPANCY:
_____
_____
_____
_____
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
MANUFACTURED HOME PARK
MANAGER APPROVAL
CITY OF LAKEVILLE
BUILDING INSPECTIONS DEPARTMENT
20195 HOLYOKE AVENUE
LAKEVILLE, MN 55044
952-985-4440
www.lakevillemn.gov
Office Use Only
___________________
Permit Number
___________________
Received By
___________________
Date Received
REQUIRED FOR APPLICATION:
Park Manager approval form with site plan on reverse.
Manufacturer’s approved installation manual.
Application must be made 24 hours before installation of home and request for inspection.
This form must be completed and signed by the Park Manager. This completed form is required at the time
of application for all building permits.
JOB SITE ADDRESS:
MANUFACTURED HOME PARK:
INSTALLER INFORMATION:
NAME OF OWNER OR CONTRACTOR DOING WORK:
PHONE: _____ CONTR STATE LICENSE #:
STREET ADDRESS: CITY: ZIP:
MANUFACTURED HOME INFORMATION:
MANUFACTURER: YEAR HOME WAS MANUF.:
YEAR OF SEAL: SERIAL #:
DIMENSIONS OF HOME: DIMENSIONS OF LOT:
ARE THERE ANY ROOM ADDITIONS, PORCHES, DECKS OR ACCESSORY BUILDINGS?
YES NO IF YES, STATE TYPE AND SIZE:
I HEREBY AGREE THE INFORMATION ABOVE IS COMPLETE AND ACCURATE. I HAVE PERSONALLY
INSPECTED THE SITE AND THE HOUSE PAD FOR COMPLIANCE WITH ALL CITY ORDINANCES AND THE
MINNESOTA STATE BUILDING CODE.
PARK MANAGER’S SIGNATURE: DATE:
SITE PLAN MUST BE SHOWN ON REVERSE SIDE. INCLUDE ALL ADDITIONS, ACCESSORY BUILDINGS,
DISTANCES FROM LOT LINES, EASEMENTS AND ADJOINING HOMES.
OFFICE USE
APPROVED BY: DATE
COMMENTS
(REVISED 12/28/2017)
16962 Kenrick Ave #8
Connelly Community
RVWP, LLC
MI7533386513736137
6770 Stillwater Blvd N STE 110 Stillwater 55082
Clayton 2017
2017 SOU012005AL
14x52 See Site Plan
4/17/24
DE Email
4-18-2024
Road Offset 1.2 ftRoad Offset 2.5 ftLot 8 Length 52.0 ftL
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Building Inspections Department 20195 Holyoke Ave, Lakeville, MN 55044 Phone #: (952)985-4440 Fax #: (952)985-4499
Notice of Reinstalling of a Used Manufactured Home Above Frost-Line (MN Statute 327.32)
WHICH MAY VOID WARRANTY
It is recommended that the used manufactured home being reinstalled follow the instructions in the manufacturer's installation manual. By signing this notice, the purchaser(s) are acknowledging they have elected to use footings placed above the local frost line in accordance with the Minnesota State Building Code.
The seller has explained the differences between the manufacturer's installation instructions and the installation system selected by the purchaser(s) with respect to possible effects of frost on the manufactured home.
The purchaser(s) acknowledge by signing this notice that there is no manufacturer's original warranty remaining on the home and recognize that any other extended or ancillary warranty could be adversely affected if any applicable warranty stipulates that the home be installed in accordance with the manufacturer's installation manual to remain effective.
After the reinstallation of the manufactured home, it is highly recommended that the purchaser(s) have a licensed manufactured home installer recheck the home's installation for any releveling needs or anchoring system adjustments each freeze-thaw cycle.
The purchaser(s) of the used manufactured home described below that is being reinstalled acknowledge they have read this notice and have been advised to contact the manufacturer of the home and/or the Department of Labor and Industry if they desire additional information before signing this notice. It is the intent of this notice to inform the purchaser(s) that the purchaser(s) elected not to use a frost-protected foundation system for the reinstallation of the manufactured home as originally required by the home's installation manual.
Plain language notice: (Purchaser(s) to initial each item)
- I understand that because this home will be installed with footings placed above the local frost line, this home may be subject to adverse effects from frost heave that may damage this home. Purchaser(s) initials: _________
- I understand that the installation of this home with footings placed above the local frost line could affect my ability to obtain a mortgage or mortgage insurance on this home. Purchaser(s) initials: _________
- I understand that the installation of this home with footings placed above the local frost line could void my warranty on the home if any warranty is still in place on this home. Purchaser(s) initials: _________
Signature of Purchaser(s)
Signature:_____________________________ Date:___________ Print Name:__________________________
Signature:_____________________________ Date:___________ Print Name:__________________________
Location of Home Installation
Address:______________________________ Lot #:__________ Park Name:___________________________
City:_________________________ State:__________ Zip:_____________
Manufactured Home Information
Manufacturer:_______________________________ Model:_______________________ Year:_____________
Serial #___________________________________________
Installer Information (Licensed Installer or Homeowner Responsible for Installation)
Installer Name:_____________________________________ Licensed Installer Homeowner
Signature:________________________________ Date:__________ License #__________________________
RVWP, LLC5/2/24
16962 Kenrick Ave 9 Connelly Community
Lakeville MN 55044
Clayton 2017
SOU012005AL
CMH Fema
Jeff Richtman
5/2/24 MI753338