Manufactured Home Installation Plan Review Application - Minnesota Department Of Labor And Industry
Download a blank fillable Manufactured Home Installation Plan Review Application - Minnesota Department Of Labor And Industry in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Manufactured Home Installation Plan Review Application - Minnesota Department Of Labor And Industry with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1DLI-Construction Codes and Licensing Division
443 Lafayette Road North
Saint Paul, MN 55155-4341
Submit by Email
Print Form
Office Use Only
Type the following information or place check marks in the appropriate boxes, then print the form.
Application Approval Number
Used Home
New Home
Single Section Home
Multi Sectional Home
___________________
Received By
Date of Manufacture as recorded on the home's Data Plate:
___________________
On Private Property
In a Manufactured Home Park
The home will be installed:
Date Received
___________________
Proposed Start Date:
Completion Date:
Foundation Type:
Frost Piers
Basement
Monolithic Slab
Ground Set
Crawl space
Resident Name:
Site Address:
Phone #:
Cell #:
Describe the work to be performed under this application :_______________________________________________________________
Installer:
Home Owner
Identify person responsible for the installation
MN Licensed Installer
Installer's Name:
Installer License #:
Phone #:
Address:
City:
Anchoring
Above Installer is responsible for:
Foundation
Support System
Electrical
Plumbing
Gas/Mech
Electrical Work:
MN Licensed Electrical Contractor
Home Owner
Identify the person responsible for the Electrical
Work. NOTE: Any electrical work performed in a manufactured home
MN License #:
park requires a MN electrical license.
Address :
Elec Contractor Name:
City:
Office Phone:
Cell #:
Plumbing Work
Home Owner
Plumber
Installer
: Identify the person responsible for the plumbing work.
Office Phone:
Plumbing Installer:
Address:
City:
MN License #:
Mechanical Work:
Identify the person responsible for the Mechanical Work.
Mechanical Contractor
Home Owner
Mechanical Contractor:
Address :
Office Phone:
Cell #:
City:
I hereby apply for installation approval and I acknowledge that: the plan review submittals and the information above is correct,
complete, and accurate; the work performed will be in conformance with the manufactured home's installation instructions,
Minnesota Building Codes, Minnesota Rules Chapter 1350, and/or 24 CFR Part 3285 and 3286. I understand this application is
not a permit and work is not to start without a Department approval, and that all work will be in accordance with the approved plan.
NAME OF APPLICANT ( PLEASE PRINT)
_________________________________________________________
APPLICANT'S SIGNATURE: ____________________________________________ DATE: _______________
G/BCS/Word/MS/Installation/Plan Review/Manufactured Home Installation Plan Review Application
(Revised 05/07/2010)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Cc0195 - Residential Building Contractor Residential Remodeler Contractor Business License Renewal -minnesota Department Of Labor And Industry
Legal
Form U11 - Unemployment Insurance Employer Registration - Montana Department Of Labor And Industry
Legal
Form Erd - 987 - Application Form For Certification By The Subsequent Injury Fund Form - State Of Montana, Department Of Labor And Industry
Legal
Form Erd-985 - Application Form For Certification By The Subsequent Injury Fund - Montana Department Of Labor And Industry
Legal
Related Categories
Parent category: Legal