Certification of Completion for Set-Up Contractors (Print)
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10 Building Permit No _____________________ Owner ____________________________________________ Location _____________________________________________________Township _____________________ Single Wide __________ Double Wide __________ Triple Wide __________ Modular Home On Frame __________ Off Frame __________ Set - Up Contractor Business Name ____________________________________________________________ I , Print Name _____________________________________________ agree and certify as set - up contractor or authorized set - up contractor representative that the above manufactured home modular home has been personally inspected by myself and that this inspection was made after the unit was entirely completed with no outstanding set - up requirements to be meet I also certify the manufacturer’s set - up instructions have been followed and that this unit meets all minimum manufacturers ’ installation set - up requirements as listed but not limited to the items listed below 1 SOIL COMPACTION TEST RESULTS PSF __________ ___________ 2 FOUNDATION PIERS Size , footing projection , layout , & spacing ___________ 3 ANCHOR RODS Number , spacing location , size , depth and anchor plates if needed ___________ 4 TIE DOWN STRAPS Number , tension , connection to frame , connection to anchor rod ___________ 5 MARRIAGE WALL Number of bolts , size , location , spacing ___________ VALID NC MANUFACTURED HOME LICENSE NO _____________________________________ VALID NC GENERAL CONTRACTOR LICENSE NO _____________________________________ __________________________________________ ____________________________________ SIGNATURE DATE THIS SIGNATURE MUST BE SIGNED AND DATED IN FRONT OF A NOTARY PUBLIC Initial Check If Approved STATE OF NORTH CAROLINA COUNTY OF JOHNSTON _______________________________ APPEARED BEFORE ME THIS ________________ DAY OF ________________ YEAR ________________ _____________________________________________ NOTARY PUBLIC Certificate of Completion For Manufactured Mobile Modular Home Set - Up Contractors IMPORTANT NOTE 1 This document does not exempt inspections by Johnston Co Inspection Department and the manufacturer’s installation and set - up instructions are required to be furnished on site for the footing , underside , and final inspection 2 A bond letter furnished by this office must be completed and on file for all modular homes before the underside inspection can be made INACCURATE OR FALSE STATEMENTS AND INFORMATION OR FORGERY OF THIS DOCUMENT COULD RESULT IN THE NOTIFICATION OF THE MANUFACTURED MODULAR HOMES DIVISION OF THE NORTH CAROLINA DEPARTMENT OF INSURANCE FOR INVESTIGATION SEAL Page