HUD-309 HUD Manufactured Home INstallation Certification and Ver

HUD Manufactured Home Installation Certification And Verification Report

U.S. Department of Housing and Urban Development Office of Manufactured Housing Programs

OMB Approval No. 2502 - xxxx Expires xx/xx/xxxx

The Manufactured Housing Installation Program Regulations 24 CFR Chapter XX Part 3286 Sections 111 and 411requires the licensed installer certify that the manufactured home has been installed and inspected in accordance with the regulations. The Manufactured Housing Installation Program Regulations 24 CFR Chapter XX Part 3286 Subpart F requires a qualified inspector verify that the manufactured home has been installed in accordance with the requirements of Part 3286 and Part 3285. The information collected here will ensure that the licensed installers and qualified inspectors inspect the minimum elements for compliance. Public record burden for the collection of information is estimated to average 3.5 hours per response including the time to review instructions, search existing data sources, gathering and maintaining the data needed, and completing and reviewing the collected information. Response to this information is mandatory. This agency may not collect this information, and you are not required to complete this form, unless the form displays a currently valid OMB control number.

Certification Label Number(s) (include all zeros and agency prefix)	Manufacturer’s Serial Number(s) (include all letters and numbers)	Homeowner Information
		(Name)		(Address)
Installer Information		Inspector Information
(HUD License No.)	(Name)	(Name)	(Address)		(Telephone Number)

1. Initial Inspection

Inspection Item	Inspector Verification			Installer Certification
Site location with respect to home design and construction	Pass	Fail	N/A	Pass	Fail	N/A
Consideration of site specific conditions	Pass	Fail	N/A	Pass	Fail	N/A
24 CFR 3285 Subpart C - Site preparation and grading for drainage	Pass	Fail	N/A	Pass	Fail	N/A
24 CFR 3285 Subpart D - Foundation construction	Pass	Fail	N/A	Pass	Fail	N/A
24 CFR 3285 Subpart E - Anchorage	Pass	Fail	N/A	Pass	Fail	N/A
24 CFR 3285 Subpart F - Optional features (Skirting, etc.)	Pass	Fail	N/A	Pass	Fail	N/A
24 CFR 3285 Subpart G - Completion of ductwork, plumbing, and fuel supply systems	Pass	Fail	N/A	Pass	Fail	N/A
24 CFR 3285 Subpart H - Completion of electrical systems	Pass	Fail	N/A	Pass	Fail	N/A
24 CFR 3285 Subpart I - Exterior and interior close-up	Pass	Fail	N/A	Pass	Fail	N/A
Completion of operational checks and adjustments	Pass	Fail	N/A	Pass	Fail	N/A

2. Re-inspection (To be completed and initialed by the inspector)

If the inspector discovers that any item during the Initial Inspection fails to comply with the manufacturer’s installation instructions or with an installation design and instructions that have been certified by a professional engineer or registered architect, the installation must be re-inspected after the installation is corrected.

Describe the work performed following the initial inspection and if the inspection item(s) are in compliance. Attach additional sheet(s) if necessary.

3. Inspector Verification

I hereby certify, in accordance with 24 CFR § 3286.507, that manufactured home identified above has been installed in accordance with the manufacturer’s installation instructions or with an installation design and instructions that have been certified by a professional engineer or registered architect. It is a crime to knowingly make false statements and/or certifications in any matter within the jurisdiction of the United States such as the certification on this or any similar form.  Penalties upon conviction can include a fine and imprisonment.  See 18 U.S. Code Section 1001.

Investigator Signature (Date)

4. Installer Certification

I hereby certify, in accordance with 24 CFR §§ 3286.111 and 3286.411, that manufactured home identified above has been installed in compliance with the manufacturer’s installation instructions or with an installation design and instructions that have been certified by a professional engineer or registered architect as providing a level of protection for residents of the home that equals or exceeds the protection provided by the federal installation standards in 24 CFR 3285. It is a crime to knowingly make false statements and/or certifications in any matter within the jurisdiction of the United States such as the certification on this or any similar form.  Penalties upon conviction can include a fine and imprisonment.  See 18 U.S. Code Section 1001.

I nstaller Signature (Date)

Distribution: Form HUD - 309

Installer

Retailer

Purchaser