NBSIR 73-278 (4 Volumes)

Model Documents for the Evaluation,

Approval, and Inspection of

Manufactured Buildings

VOLUME III - EVALUATION AND APPROVAL DOCUMENTS

CES Project

Office of Building Standards and Codes Services

Center for Building Technology, lAT

National Bureau of Standards

Washington, D. C. 20234

September 1973

Preliminary Report

U.S. DEPARTMENT OF COMMERCE

NATIONAL BUREAU OF STANDARDS

NBSIR 73-278 (4 Volumes)

MODEL DOCUMENTS FOR THE EVALUATION,

APPROVAL, AND INSPECTION OF

MANUFACTURED BUILDINGS

VOLUME III - EVALUATION AND APPROVAL DOCUMENTS

R. D. Dikkers, H. R. Trechsel, P. W. Cooke, H. K. Tejuja, L. P. Zelenka

CES Project

Office of Building Standards and Codes Services Center for Building Technology, lAT

National Bureau of Standards

Washington, D. C. 20234

September 1973

Preliminary Report

This is a preliminary report issued with the express

intent to solicit comments and suggestions. Accordingly,

results and conclusions contained herein are not necessarily

those that will be included in the final report.

U. S. DEPARTMENT OF COMMERCE. Frederick B. Dent. Secretary

NATIONAL BUREAU OF STANDARDS, Richard W. Roberts, Director
PREFACE

In response to requests from the Executive Office of the President and the

National Conference of States on Building Codes and Standards (NCSBCS), the National

Bureau of Standards has undertaken specific research programs to remove or reduce

barriers created by the building regulatory process, so as to Improve productivity

and innovation in building construction. One of these programs is to establish a Coordinated Evaluation System. (CES) by developing, in conjunction with the state

governments, model Informational documentation for use in the building regulatory

process

.

This four-volume report outlines the results of an initial study of documentation

needs, sample forms and checklists pertaining to manufactured buildings and components.

It is a preliminary report Issued with the expressed Intent to solicit comments and

suggestions so that more comprehensive and more generally applicable model documentation can be developed.

A first draft of this report was reviewed during a 2 1/2 day meeting in April,

1973, by a group of consultants composed of representatives of state and local building officials, design professionals, third party evaluation and Inspection agencies,

and industrialized building mianuf acturers . The reviev; m.eeting was organized and

chaired by Mr. John Dunlap , Consulting Engineer of Sacram.ento, California. The other

consultants were:

Joseph Bartell, City of St. Petersburg

Jack Bono, Underwriters Laboratories, Inc. Kern E. Church, State of North Carolina

Jasper Hawkins, Hawkins and Llndsey, Architects

James M. Hicks, State of California

; Glendon R. Mayo, Consulting Engineer

J. Dlllard Powell, Continental Homes

Ed Starostovlc, Product Fabrication Service

Joseph Stein, City of New York

Steve Wilson, National Homes Corporation

The comments of the consultants were m.cst helpful in developing the model documenrs contained in this report, and their valuable assistance is greatly appreciated

and iiex^ewith acknowledged.

11
CONTENTS - V0LUt4E I

Page

1. INTRODUCTION 1

2. COORDINATED EVALUATION SYSTEM (CES) PROJECT 3

3. SCOPE OF CES MODEL INFORMATIONAL DOCUMENTATION k

4. REGULATORY PROCESS FOR MANUFACTURED BUILDINGS AND

BUILDING COMPONENTS 5 4.1. Program Administration 5

a. Initiation of Action 7 4.2. Preparation and Submission 7

a. Building Systems 8

b. Compliance Assurance Program 8

c. Modifications and Variations 8

4.3. Prelimiinary Review ^

4.4. Evaluation 10

4.5. Approval and Disapproval 10

a. Notice of Completed Evaluation 10

b. Stamp of Approval 10

c. Building System.s Approval Report 11

4.6. Fabrication, Inspection, Certification, Transportation

and Handling, and Installation 11

a. Fabrication 11

b. Inspection and Certification 12

c. Transportation and Handling 12

d. Installation 12

4.7. Local Enforcement Activities 13

4.8. Interstate Acceptance (Reciprocity) 14

5. MODEL INFORMATIONAL DOCUMENTS l4

5.1. Use of Documents l4

5.2. Submission 14

a. Building Systems 15

b. Submission Requirements for Manufactured

Building Components 17

c. Compliance Assurance Program 19

d. Modifications of Approved Systems and Variation of

Certified Units 21

ill
J CONTENTS - VOLUME I (Continued)

Page

5.3. Preliminary Review 23

5.4. Evaluation 24

a. Building System 25

b. Compliance Assurance Program 28

5.5- Approval and Disapproval ». • • 30

5.6. Pabrication, Inspection, and Certification 31

5.7. Local Enforcement Agency Activities 33

a. Building Permit Application 33

b. Building Permit 34

c. Local Enforcement Agency Violation Report 34

d. Certificates of Occupancy 34

5.8. Interstate Acceptance (Reciprocity) 36

a. Introduction , 36

b. Prerequisite for Interstate Acceptance 36

c. Process of Interstate Acceptance 37

d. Model Documents 38

6. SUMMARY 40

7. REFERENCES 4l

APPENDIXES 43

iv
CONTENTS - VOLUMES II, III AND IV

Document

Number VOLUME II - SUBMISSION DOCUMENTS Page

S-01 Application for Building System and Compliance

Program Approval 1 S-02 General Submission Requirements 5 S-03 Architectural Submission 9 S-04 Structural Submission 13

S-05 Mechanical Submission 19

S-06 Plumbing Submission 21

S-07 Electrical Submission 23

S-08 Submission Requirements for Building Components 27

S-09 Compliance Assurance Program. 29

S-10 Application for Approval of Minor Modification

to an Approved Building System and/or Compliance

Assurance Program 63

S-11 Application for Approval of Variation to a Certified Manufactured Building or Component 65

VOLUME III - EVALUATION AND APPROVAL DOCUMENTS

E-01 Processing Record 1 E-02 ^ • Preliminary Review Checklist 3 E-03 Submittal Unsuitable for Processing 7 E-04 Evaluation Checklist - Architectural 9 E-05 Evaluation Checklist - Structural 17

E-O6 Evaluation Checklist - Mechanical 21

E-07 Evaluation Checklist - Plumbing 25

E-08 Evaluation Checklist - Electrical 27

E-09 Certification of Products and Test Reports 31

E-10 Evaluation Checklist - Compliance Assurance Manual 33

E-11 Manufacturing Facility Evaluation Report ^3

A-01 Notice of Comipleted Evaluation 49

A-02 Stamps of Approval 51

A-03 Building System Approval Report 55

v
CONTENTS - VOLUMES II, III AND IV (Continued)

Document VOLUME IV - COMPLIANCE ASSURANCE AND LOCAL

Number ENFORCEMENT AGENCY DOCUMENTS Page

C-01 Manufacturer's Data Plate 1 C-02 In-Plant Inspection Checklist 5 C-03 ^ Inspection Report 75

C-Oh •- Noncompliance Tag 77

C-05 " Prohibited Sales Notice 79

C-06 Notification of Suspended Activities t 8l

C-07 Label 83

C-OB . ' Label Control Record 8-5

L-Cl Standard Building Permit Application Form 87

L-02 Manufactured Building Violation Report 89

L-03 Certificate of Occupancy 91

vi
MODEL DOCUMENTS FOR THE EVALUATION, APPROVAL,

AND INSPECTION OF MANUFACTURED BUILDINGS

R. D. Dlkkers, H. R. Trechsel, P. W. Cooke,

K. K. Tejuja, L. P. Zelenka

To assist the states in developing their building regulatory activities

and functions, the Coordinated Evaluation System (CES) Project has defined

and developed model informational documentation pertaining to the functional

areas of data submission, evaluation, approval, compliance assurance, installation data, and owner information.

This is a preliminary report which gives the results of the Investigation

to date, and presents discussions of informational needs and sample model

documents pertaining to manufactured buildings and building components. The

model documentation is based on the Model Rules and Regulations for manufactured

buildings developed by a Department of Commerce sponsored working task group,

and the results of a comprehensive state-of-the-art study of most of the existing

state building regulatory programs. The documentation presented in this report

covers all functional areas except owner information which is not usually subject

to regulation and will be covered by a separate report. Emphasis was placed on developing documentation applicable primarily to one and two family detached

dwellings

.

Based on the comments received on this preliminary report, the documentation presented herein will be revised and a final report issued.

Key words: Building codes; certification; compliance assurance; evaluation;

industrialized building; inspection; model documents; NCSBCS; standards;

state regulation.

vii

CES DOCUMENT NO. E-01 Page 1 of 1 STATE OF

Norm and AddAeA-i Admlni^tAcutivz Agmcy

PROCESSING RECORD

Name of Manufacturer_

Address

Type of Application: EH New System or Program [U Major Modification

Building System: Appl. No. Date C. A. Program: Appl. No. Date,

DESCRIPTION:

A. Occupancy: CH One and Two Family Detached Dother (Specify)

B. Type of System: Unitized Modular Core Unit Component

[U Architectural D Structural EH Mechanical CH Plumbing ED Electrical

Elfother (Specify)

ACTIONS Building System C.A. Program

REMARKS

Date Hrs Initials Date Hrs Initials

Application Received

Forwarded for Preliminary Review

Preliminary Review Disapproved

Notice of Unsuitability Sent

Preliminary Review Approved

Forwarded for Evaluation

Evaluation Completed

1. Architectural

2. Structural

3. Mechanical

^. Plumbing

5. Electrical

6. Manufacturing Facility

Completed Eval. Notice Sent

Approval Report (B.S.) Completed

Other Actions:

FEE COMPUTATIONS AND RECORD Man-Hrs Rate Total Deposit Reed Date Fee Due Overpayment

Building System Evaluation

C.A. Program Evaluation

Other

Fee Received $ Date Overpaymient Returned $ Date

Building System Approval Report No,

C.A. Program Approval No.

Date

Date

Date Sent

Date Sent

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CES DOCUMENT NO. E-09 Page 1 of 2

CERTIFICATION OF PRODUCTS AND TEST REPORTS

a. Certification

Some form of certification exists today for many building products. The purpose

of such certification is to assure the compliance of the product to some code or standard of safety and performance. The certification programs are either: (1) established and administered by Independent organizations such as Underwriters' Laboratories;

(2) established by a trade association but administered by an independent organization

such as the window certification program of the Architectural Aluminum Manufacturer's

Association, administered by Electrical Testing Laboratories, Inc.; (3) both established and administered by a trade association such as the program sponsored and

administered by the American Plywood Association; or (4) administered and enforced by

a single manufacturer (self-certification). Some certification programs are based on

a single test or evaluation of a prototype, some are based on periodic retestlng or re-evaluation of the product, and some finally are based on tests and on a continuing

surveillance of the manufacturing process to assure not only that the design of the

product complies to a prescribed code or standard, but also that actual production

units meet such code or standard.

From the above discussion it is evident that the degree of confidence that the

evaluator can place in the certification of a specific product depends on the type of

certification process associated \Mith the product. Accordingly, the certification

Information to be submitted to the evaluator for the determilnation of the product's

compliance with a specific code or standard should include the following data:

1. Identification of product

2. Name of agency or organization that has established the certification program.

3. Name of agency or organization that administers the program.

4. Code or standard that forms the technical basis for the certification.

5. Type of evaluation method used (testing, analysis).

6. Number of specimens tested or evaluated.

7. Sampling techniques and identification of person conducting the sampling.

8. Frequency of follow-up tests.

9. Brief description of surveillance activity to assure uniformity of production

quality.

10. Limitations, if any, of the certification.

Although all the above factors can Influence the confidence to be placed in any

particular certification program, it is recognized that some programs have been found

so reliable that they are nationally recognized. In such instances Administrative

Agencies do not normally require the submission of all the above information. It should also be recognized that the certification programs themselves depend largely

on the characteristics of the product, particularly its complexity. Accordingly,

both the evaluation of and the subm.lsslon requirements for certification documents

will depend on the individual product. It would serve both the Administrative Agency

" " 31
CES DOCUMENT NO. E-09 Page 2 of 2

and the manufacturer If the agency would prepare a list of those products and certification programs for which not all the above Information need to be submitted,

b. Test Reports

Tests on products, as used in this context, mean the testing of an individual

product Independent of any certification program. The purpose of such tests is the

demonstration of the performance capabilities of a product related to specific or Implied code or standards requirements. If the method of test is not given in the

code or standard, the evaluation of the test report submission will have to include

a determination of whether or not the test conditions simulate accurately the conditions to which the product will be subjected in service. Only after such a determination Is an evaluation of the product's performance during the test meaningful. Where

test methods are used that are promulgated by nationally accepted consensus standards

organizations, such as ASTM, ANSI, etc., it need in general only be determined that

such method truly applies to the specific product and intended use.

In recognition of the above, the test report submission requirements should

include the following:

1. Identification of the specimen tested (manufacture, type, model number, source of supply, etc.).

2. A detailed description or drawing of the physical characteristics of the

specimen, including condition (age, repair, etc.).

3. Number of tests and sampling technique used in selection of specimens.

4. Identification of test method used (if a standard test method) or a detailed

description of the test procedure, equipment, and instrumentation used.

5. Tabulation of numerical values associated with test, such loadings, voltage,

etc., and corresponding result readings (e.g. deflections), giving the time scale

involved.

6. Listing or identification of any significant test conditions not indicated

above (such as ambiant air temperature, humidity, etc.).

7. Date of test.

8. Name and address of testing organization or laboratory.

9. Signature of the laboratory's officer or authorized representative (generally

a test engineer in charge who Is a professional engineer), and date of signature.

32
CES DOCUMENT NO. E-10 Page 1 of 9

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CES DOCUMENT NO. E-10 Page 8 of 9

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41

CES DOCUMENT NO. E-11 Page 1 of 6

MANUFACTURING FACILITY EVALUATION REPORT

The Manufacturing Facility Evaluation Report has been developed as a suggested

aid and report format for conducting the inspection survey of the manufacturer's plant

facilities as required by Part IV, Section 4(A) of the Rules and Regulations. The

purpose of this plant inspection by the Evaluation Agency or Administrative Agency

is to determine that the provisions of the compliance assurance manual as submitted

for evaluation are in fact implemented, or can be readily implemented, as soon as actual production starts (after approval of both the building system and the compliance

assurance program). Where a plant is already in operation, the survey or inspection

of the facility may also Include the evaluation of production unit compliance.

Pages 3 and 4 of this document give a suggested checklist to be used in the

plant evaluation. A suggested format to be used by the plant evaluation inspection

team for reporting the results of its evaluation is given on page 2. Page 5 is a suggested evaluation work sheet to be used when evaluating a plant in operation and

where the compliance of units under production is to be Included in the evaluation,

and page 6 gives a suggested format for reporting the results of such unit compliance

inspections. This form is to be used in conjunction with the report form given on page 2.

The Manufacturing Facility Evaluation Report could also be utilized by the

Administrative Agency in the conduct of its monitoring responsibilities of Inspection

Agencies as required by Part IV, Section 4(D) of the Rules and Regulations.

43
CES DOCUMENT NO. E-11 Page 2 of 6

STATE OF

Name, and add/itii AdminiitAot^vz

Agency ok Evaluation Agency

FIANUFACTURING FACILITY EVALUATION REPORT

NAME OF MANUFACTURER

PLANT LOCATION:

APPLICATION NO: BUILDING SYSTEM APPROVAL NO. (IF AVAILABLE)

NAME OF INSPECTION AGENCY:

ADDRESS:

DESCRIPTION OF BUILDING SYSTEM:

PERSONS CONTACTED (NAMES, TITLES, AFFILIATIONS):

EVALUATION TEAM SUMMARY COMMENTS - (SEE FOLLOWING PAGES OF THIS REPORT FOR DETAILS):

RECOMMENDATION: ACCEPTABLE MANUFACTURING FACILITY EVALUATION

UNACCEPTABLE - DISAPPROVE COMPLIANCE ASSURANCE MANUAL

UNACCEPTABLE - DISAPPROVE PLANT

UNACCEPTABLE - DISAPPROVE INSPECTION AGENCY

OTHER RECOMMENDATION:

NAME, SIGNATURE AND DATE OF EVALUATION TEAM MEMBERS:

Page of

44
CES DOCUMENT NO. E-11 Page 3 of 6

FIANUFACTURIN6 FACILITY EVALUATION REPORT

Evaluation worksheet for determining adequacy of compliance assurance program

AREA FOR EVALUATION SATISFACTORY EXPLANATION OF

YES NO ITEMS CHECKED "NO"

Manufacturer's compliance

organization has independence

from production department.

Compliance control personnel

are adequately trained and

qualified

Checklists for a "uniform system

of audits" are maintained by

mfgr. or Inspection Agency.

Compliance records are maintained by manufacturer

and Inspection Agency.

Building system and compliance assurance manual changes are adequately controlled.

"Working drawings", if used,

are adequately controlled.

A unit identification or serial

numbering system Is utilized.

Certification labels are adequately controlled by Inspection Agency and/or manufacturer.

Receiving Inspection checklists

are utilized.

Storage and handling of materials

is adequate.

Rejected raw materials are Identified and dispositioned

Corrective action is implemented

and documented, as necessary.

Evaluation by: Date

Page of
CES DOCUMENT NO. E-11 Page 4 of 6

NANUFACTURING FACILITY EVALUATION REPORT

Compliance assurance program evaluation worksheet - continued.

AREA FOR EVALUATION SATISFACTORY EXPLANATION OF

YES NO TTFMS CFFCKFr) "NO"

Control of testing and Inspection

equipment, if any, is adequate.

Manufacturer frequency of

Inspection is satisfactory.

Inspection Agency frequency of

inspection Is satisfactory.

Plant or factory layout of

stations is satisfactory for

all Inspections.

In-plant inspection checklists

are utilized at each station in

the production sequence.

In-plant inspection checklists

adequately list all essential

characteristics of inspection.

Code compliance workmanship

standards are satisfactory.

Noncompllant construction - identified and corrected.

Compliant units properly labeled

and records of labels maintained.

Certified units properly handled

and stored prior to shipment.

Compliance assurance manual

being followed by manufacturer.

Compliance assurance manual

being followed by

Inspection Agency.

Evaluation by: Date: Page of

46
CES DOCUMENT NO. E-11 Page 5 of 6

MANUFACTURING FACII ITY FVAIIJATIQN RFPORT

Evaluation worksheet for production unit compliance inspections by station

STATION NO. AND NAMEo I o — TEM*

COMPLIANCE

OF

COMPLIANCE

OF

REMARKS - include

unit serial numbers,

v/here appropriate

S

PM

E

SPM

E

S

PM

E

PM

E

FM

• E

SPM

E

SPM

E

SPM

E

SPM

E

* S - structural; P - Plumbing; M - Mechanical; E - Electrical

Use additional evaluation worksheets for remainder of stations

Evaluation by: Date: Page

47
CES DOCUMENT NO. E-11 Page 6 of 6

MANUFACTURING FACILITY EVALUATION RFPQRT

Summary findings for production unit compliance inspections by station. Describe

any building system noncompliances and code violations from Production Station Evaluation Worksheets.

STRUCTURAL ELEMENTS:

FIRE PROTECTION CONSIDERATIONS:

PLUMBING SYSTEM:

MECHANICAL SYSTEM:

ELECTRICAL SYSTEM:

Use additional sheets as necessary

Evaluated by:

48

Date

Page of
CES DOCUMENT NO. A-01 Page 1 of 2

NOTICE OF COMPLETED EVALUATION

The purpose of the Notice of Completed Evaluation Is: (1) the notification of

the manufacturer of the action taken by the Evaluation Agency; (2) the statement of

additional fees due to the agency or refunds due to the manufacturer (In case the sum

of the deposit collected was greater than the total of fees required); and (3) If the

application Is disapproved, the transmittal of the reasons for such disapproval, that

Is, a list of deficiencies found.

Based on the above purposes, the following Information should be contained In the

Notice of Completed Evaluation:

1. Name and address of manufacturer;

2. Application number (s);

3. Results of evaluation (approved, disapproved);

4. Fees due by manufacturer to the Administrative or Evaluation Agency; or refund due the manufacturer;

5. In case of disapproval, a list of deficiencies found. A copy of the Evaluation Checklists (CES Documents No. E-04 to E-08 and E-10) may be used for this purpose.

6. In case of approval, a statement that after receipt of the additional fee due

(if any), a copy of the approved (stamped) documents will be returned to the manu- facturer (together with an approval report if application was for a building systems

approval )

Page 2 of this document shows a sample form for the "Notice of Completed

Evaluation"

49
STATE OF

CES DOCUMENT NO. A-01 Page 2 of 2

Wowie and kddAUi, oi kdm,uiUtAative. Agency

Nairn o(i Uanaf^acXuAZA Date

RE: NOTICE OP COMPLETED EVALUATION

Building System - Appl. No.

^- LDcA. Program - Appl. No.

Dear Sir : ,

• -

CH Evaluation of your submission for the above appllcatlon(s) has been completed.

This office will issue approval documents upon remittance of evaluation fees

payable to ^ ^

[H Evaluation of your submission for the above application ( s ) has been completed.

Your application is disapproved for the following reasons:

Attachments

O Evaluation Checklists

Documents Returned d plans dspecs CH calculations CUtest data HHc.A. Manual

i I other

Fee Due $

Refund $

Sincerely

,

Signature of Agency Official

Name and Title

50
CES DOCUMENT NO. A-02 Page 1 of 3

STAMPS OP APPROVAL

According to the Rules and Regulations [Part IV, Section 2], the approval of

building systems and compliance assurance programs is to be signified by a stamp of

approval on each sheet of the submission, "or by other effective means of identification". In Part V, Section 1(A)(7) a space of 3 inches by 4 inches is required on all

drawings of a building submission application, and a 3 by 4 inch stamp is used for

signifying approval on such drawings. This is in conformance with current practice

in many states, and provides sufficient space for the information required on the

stamp. Although a similar space is not mandatory on compliance assurance program

submissions, the same stamp should be used on the first page or on the cover of the

compliance assurance manual, as well as on specifications which may be submitted v/lth a building system. However, the single pages of a compliance assurance manual or of

a set of specifications can not conveniently be stamped with a 3 inch by 4 inch stamp.

Accordingly, an "other means of identification" of such pages should be used which is

smaller and need not contain all the information required on the larger approval

stamp. Accordingly, it is suggested that a smaller and simpler stamp be used for such

pages. The contents of both stamps are discussed in this document.

Contents of Stamp of Approval

A 2-7/8 inch by 3-7/8 inch stamp of approval should be used. Such stamp should

contain as a minimum the following information:

1. Identification of State

2. Identification of Administrative Agency or of Evaluation Agency (if different

from the former).

3. A statement that the plans and/or compliance assurance manual have been

approved pursuant to the applicable legislation (identify enabling legislation and

regulations )

4. A statement that this approval does not authorize any deviation or omissions

from valid state or local laws.

5. A statement that the approval of either a building system or a compliance

assurance program alone does not authorize the certification of units built according

to such system or manual, but that approval for both must be obtained.

6. Approval number.

7. Space for signature of authorized person (Including title) and the approval

date

In some states additional information is given on the approval stamp, such as design loads, occupancy class, etc. However, if such information is contained in the

Building System Approval Report (CES Document No. A-03) it appears that it need not

be repeated on each stamp.

51

/
CES DOCUMENT NO. A-02 Page 2 of 3

Contents of Alternate Stamp

For identifying typewritten pages, such as in a compliance assurance manual. It

is suggested that an alternate stamp be used. Such stamp should not be used singly,

but only In conjunction with an approval stamp as described above.

The content of such an alternate stamp should be as simple as possible while

still performing the function of "identifying" the pages. Accordingly, It is suggested that only the following items be shown.

1. Identification of state;

2. Identification of approving agency;

3. Approval number.

It is suggested that such stamp be not greater than 3/^ inch by 2 inch so that

It can be placed conveniently on the margin of typewritten pages.

On Page 3 of this document samples for both the Approval Stamp and for the

Alternate Stamp are shown.

52
CES DOCUMENT NO. A-02 Page 3 of 3

3 7/8 inch

STATE OF

Name, od AdrriiivCitAcutivz Agzncy

on. EvaZujJution Agency

This DBuilding System

Compliance Assurance Manual

has been evaluated and is hereby approved

pursuant to f Idewti^y enabling ^

leg-ulcution and

_ ^eguZationi

This approval does not authorize any deviation or omissions from state or local law.

Approval for both a building system and comi- pllance assurance manual must be obtained prior

to unit certification.

Approval No.

[S-ignatuAe, TWLe, Vate]

2 7/8 inch

Approval Stamp for signifying approval of drawings and

front page of typed or printed documents.

2 inch

STATE OF

[

Nome oi AppfLOv-Lng agency APPROVAL NO.

3/4 inch

Alternate Approval Stamp for signifying

approval of typed or printed pages.

53

CES DOCUMENT NO. A-03 Page 1 of 3

BUILDING SYSTEM APPROVAL REPORT

The main purposes of the building system approval report are: (1) to notify the

manufacturer of the approval of his submission, and (2) Indicate the conditions of

such approval, particularly a limitation Imposed on the use of the building system.

In addition, the report serves to transmit such information to the local enforcement

agency in whose jurisdiction the manufactured building or building component is to be

installed, or to other states in which the manufacturer applies for approval based on reciprocity.

The approval report should contain the following information:

I. Type of Approval : This indicates whether a new system is being approved

or a modification, and gives all pertinent approval and application

numbers, dates, etc.

II. Identification : In this section the manufacturer, the location of his

plant, and any Inspection Agency and/or architect/engineer Involved in

the design are identified.

III. Documents Submitted : All documents which formed the basis for the approval

are to be listed.

IV. Description of Manufactured Building or Component : This section gives

pertinent information regarding the approved building or component,

including items such as type of occupancy, type of construction, principal construction materials and design parameters (loads and temperatures).

V. Details of Construction : This is a brief description of all major

construction systems which form part of the building or component.

VI. Applicable Codes or Standards : The codes and standards used as a basis

for the technical evaluation are to be noted in this section.

VII. Installation Instructions : A discussion or list of critical items or provisions that must be observed in the preparation for and installation

of certified units on the site.

VIII. Limitations of Approval : Any use limitations of the approved building

system, other than those inherent in the Information given in IV above,

should be clearly stated.

In addition, the name, title, and signature of the person preparing the approval

report and of the agency official also must appear on the document.

A sample approval form is given on the following two pages.

55
CES DOCUMENT NO. A-03 Page 2 of 3 STATE OF ^^Se 1

Namz and Add/ieAi oi$

BUILDING SYSTEM APPROVAL REPORT

TYPE OF APPROVAL New System Modification APPROVAL REPORT NO. Date of Approval Expiration Date

Previous Approval Nos :LllBullding System CUc.A. Program^

Building System Application No. Date

II. IDENTIFICATION

Name of Manufacturer

Address

Location of Manufacturing Plant

Name of Inspection Agency

Address

Name of Reg. Architect/Prof. Engineer Reg. No. Address State

III. DOCUMENTS SUBMITTED Plans Dspecs CIlTest DataDshop Dwgs . Dc .A.Manual Dsample

Calculations (Type) Other (Specify)

EH Other State or Agency Approvals/Listings

IV. DESCRIPTION OF MANUFACTURED BUILDING OR COMPONENT

A. Occupancy: EH One and Two Family Detached EH Other (Specify)

B. Type of Construction (classification)

C. Type of System: Unitized Modular Core Unit Component

Architectural Structural Mechanical Plumbing Q Electrical

other (Specify)

D. Principal Construction Material: Wood concrete Steel Masonry

other (Specify)

E. Energy Source: Heating Cooling

F. Design Parameters: Live Load Wind Load Snow Load Seismic Load_

G. Design Temperatures: Summer Winter

V. DETAILS OF CONSTRUCTION

Structure

Walls and Partitions:

Floor - Celling:

Roof - Celling:

56
CES DOCUMENT NO. A-03 Page 3 of 3 BUILDING SYSTEM APPROVAL REPORT (continued) Page 2 DETAILS OF CONSTRUCTION (continued)

Mechanical:

Electrical

Plumbing

Other

VI. APPLICABLE CODES OR STANDARDS

VII. INSTALLATION INSTRUCTIONS

VIII. LIMITATIONS OF APPROVAL (IF ANY)

This is a Building System approval only. For manufactured buildings and/or building

components to be certified, an approved concurrent C.A. Program is also required.

Prepared by (Name) Signature Date

Signature of Agency Official Date

Name and Title

(Space for Stamp or Seal)

57