Iowa Manufactured Home Installation Certificate Home Resets
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1IOWA MANUFACTURED HOME
INSTALLATION CERTIFICATE
HOME RESETS
This certificate warrants that this manufactured home has been installed in accordance with the Iowa State
Building Code, including current revisions, and all local ordinances which apply.
INSTALLATION INFORMATION
This portion of the form must be completed prior to setup of the home.
If the home is being installed pursuant to IAC 661-322.11(2) and does not have frost protected footings, the owner and
installer must read and acknowledge by signature the following statement. This option is not available for first time setups.
I understand that by installing this home without frost protected footings that this home may be subject to adverse affects
from frost heave that could potentially damage the home. I also understand that this could void my warranty if any is still in
place on the home.
Note: The following Iowa code sections have requirements that may affect the
installation of homes: sections 414.28 and 335.30
OWNER SIGNATURE: ______________________________________________ DATE: __________
INSTALLER SIGNATURE: __________________________________________ DATE: __________
HOME INFORMATION
VIN #Title: ________________________________ MFRS Serial #:__________________________
Manufacturer Make and Model: _______________________________________________________
Seal Number (HUD):______________________________ Size: ____________________________
Name of Home Owner: ______________________________________________________________
Address of Installation: ________________________________________________________
INSTALLER INFORMATION
Date of Installation: ______________________________
Installer Business Name:_____________________________________________________________
Installer Business Address: ___________________________________________________________
Iowa Installation Seal #:__________________________ Installer Certification #:________________
Name of Retailer: __________________________________________________________________
Name of Manufacturer: _____________________________________________________________
Installer Signature: ________________________________________________________________
SUPPORT SYSTEM AND ANCHORAGE SYSTEM
Please check boxes applicable to the installation of this unit.
□
HUD Model Manufactured Home Installation Standards as published October 19, 2007
□ Manufacturer’s Recommendation
□ Engineered System. IA Licensed Professional Engineer License #_________
□ Subrules IAC 322.11(3) & 322(4) Requirements for support and anchorage systems.
* NOTE This form must be filled out completely and returned to the address below
DISTRIBUTION OF INSTALLATION CERTIFICATE:
Original – Owner’s Copy
Building Code Bureau -Copy
Installer- Copy
Submit to
Building Code Bureau
215 East 7th Street
Des Moines, IA 50319
Revised May 1 2009
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