HomeMy WebLinkAboutBLD2025-01062 Remodel - BLD Inspections - 5/7/2026 MASON COUNTY Department of Community Development
COMMUNITY DEVELOPMENT 615 W.Alder St.Bldg 8,Shelton,WA 98584
360-427-9670 ext. 352
Permit Assistance Center,Budding.Planning
www.MasonCountyWA.gov
INSPECTION CARD AND CERTIFICATE OF OCCUPANCY**
To schedule an inspection call or visit
https://masoncountywa.gov/departments/community_development/building/inspections/indox.php
Permit Number BLD2025-01062 Date Issued 10/15/2025 Issued By
Project FULL INTERIOR REMODEL,NO CHANGE IN FOOTPRINT,SOME WINDOWS&DOORS REMOVED, NEW
PLUMBING,INSULATION,FLOORING AND CABINETS
Site Address 8090 E STATE ROUTE 106
Applicant HAGGERTY THOMAS&NORA LYNN
Contractor
Contractor Phone
Primary Code 2021 IBC,IRC,IFC,IEC,IMC,&
UPC Type
Permit Type ADDITION OR REMODEL-
RESIDENTIAL Occupancy
-APPROVED PLANS MUST BE ONSITE FOR ALL INSPECTIONS.
-DO NOT PROCEED BEYOND EACH STAGE OR COVER WORK UNTIL APPROVAL IS GRANTED.
-THIS CARD MUST BE POSTED IN A CONSPICUOUS LOCATION, FRONT OF THE PREMISES IS BEST FOR MAKING ENTRY.
-ALL PERMITS EXPIRE 180 DAYS AFTER THE PERMIT IS ISSUED OR 180 DAYS AFTER DATE OF LAST INSPECTION.
-OWNER/AGENT IS RESPONSIBLE FOR REQUESTING ALL INSPECTIONS THROUGH FINAL INSPECTION.
**THIS STRUCTURE MAY NOT BE USED OR OCCUPIED UNTIL ALL APPROVALS ARE GRANTED.**
PRIOR TO CALLING FOR FINAL INSPECTION,ALL CONDITIONS OF THE PERMIT MUST BE MET
Public Works Access/Driveway Other
Health Septic
Deptartment Well
Planning
Department Site Inspection
Fire Marshall Fire Apparatus Access Fire Sprinkler
Auto Fire Alarm Hood and Duct
Other Final
Building
Department Building Official: Community Services Designee
Concrete Setbacks Slab
Footing Perimeter Point load Footing
Footing Interior Footing Decks/Porches
Foundation Stem Walls Other
Rough-In Groundwork Plumbing Framing L/-2.3_24, 3
Groundwork Mechanical Plumbing I—z. —Z ev —Jr.,
Groundwork Gas Pipe Mechanical 4.
Gas Piping Shear Wall Nailing
Underfloor
Other
Insulation Slab Ceiling z.(7-Z(o
Floor 2-- (7-Z(i 'L Vaulted Ceiling
Walls Vapor Barrier y-Z3-2 (' -y
Other
Wallboard Interior Wall Brace Panels
Nailing Fire Walls
Other
Final Building $--7—ZG ]�
ManufacturedSetbacks Setup
Homdetu
Concrete Foot/Runners Final
Other
e,- . vw l ie iq/23/2(,.
V/ Z-i7-2t. c_ Cale ,4K'
-2G -Z, J� YtbwlP(aLc. �ccrt �cu�oue� J�vy,�
MASON COUNTY INSPECTION RESULTS Pagel
COMMUNITY DEVELOPMENT Department Community
615 W Alder St, Shelton, WA 98584 Development
Permit Assistance Center,Budding,Planning (360)427-9670 ext. 352
Application # BLD2025-01062 Application Type ADDITION OR REMODEL- HAGGERTY THOMAS &
RESIDENTIAL Owner NORA LYNN
Parcel # 322343400030 Site Address 8090 E STATE ROUTE 106 UNION, WA
98592
Inspector Inspection Type Date Status Comments
1-29-26-JQ
1. fire block all vertical bore holes and every 10' horizontal on the interior walls
(Exterior walls are to be completely encapsulated with closed cell spray foam)
2. underfloor-add gussets to posts that are missing positive connection to beams and
positively connect posts to bases that are not secured.
Joshua 3. Please have all documentation for the fireplace on site at insulation inspection
FRAMING INSPECTION 01/29/2026 FAIL
Quarders remove combustible framing around insert and replace with light gauge steel framing
noncombustible for vertical members.
Entire exterior shell and underfloor shell is going to be spray foamed and
encapsulated to full stud, rafter and floor joist depth.
will check at insulation
I
N
1,
INSPECTION RESULTS Pagel
MASON COUNTY Department of Community Development
COMMUNITY DEVELOPMENT 615 W Alder St, Shelton,WA 98584
Permit Assistance Center,Building,Planning (360)427-9670 ext. 352
ADDITION OR REMODEL- Owner
Application# BLD2025-01062 Application Type HAGGERTY THOMAS&
RESIDENTIAL NORA LYNN
Parcel# 322343400030 Site Address 8090 E STATE ROUTE 106 UNION, WA
98592
Inspector Inspection Type Date Status Comments
2-17-26 DEC
PROVIDE INSULATION CERT FOR SPRAY INSULATION PRIOR TO FINAL
INSTALL POST TO FOOTING AND POST TO BEAM CONNECTIONS
1-29-26-JQ
1.fire block all vertical bore holes and every 10' horizontal on the interior walls
(Exterior walls are to be completely encapsulated with closed cell spray foam)
Joshua FRAMING INSPECTION 02/17/2026 FAIL 2. underfloor-add gussets to posts that are missing positive connection to beams and
Quarders positively connect posts to bases that are not secured.
3. please have all documentation for the fireplace on site at insulation inspection
remove combustible framing around insert and replace with light gauge steel framing
noncombustible for vertical members.
Entire exterior shell and underfloor shell is going to be spray foamed and
encapsulated to full stud, rafter and floor joist depth.
will check at insulation
MASON COUNTY INSPECTION RESULTS Pagel
Department of Community Development
0 COMMUNITY DEVELOPMENT 615 W Alder St, Shelton, WA 98584
Permit Assistance Center,8wlding,Planning (360)427-9670 ext. 352
Application# BLD2025-01062 Application Type ADDITION OR REMODEL- Owner HAGGERTY THOMAS &
RESIDENTIAL NORA LYNN
Parcel # 322343400030 Site Address 8090 E STATE ROUTE 106 UNION, WA
98592
Inspector Inspection Type Date Status Comments
2-17-26 DEC
UNSBLE TO COMPLETELY INSPECT FIREPLACE DUE TO DRY WALL STACKED
IN FRONT.
Drew Carlson FIREPLACE INSPECTION 02/17/2026 FAIL FIRE PLACE IS WOOD BURNING INSERT NOT ZERO CLEARANCE.
FLEXIBLE VENTING HAS BEEN INSTALLED AND MUST BE VERIFIED FOR
COMPATIBILITY.
HEARTH DIMENSIONS WILL NEED TO BE VERIFIED.
FIRE BOX/FIRE PLACE WILL NEED TO BE VERIFIED
INSPECTION RESULTS Pagel
W ___________________________________MASON COUNTY Department of Community Development
COMMUNITY DEVELOPMENT 615 W Alder St, Shelton, WA 98584
Permit Assistance Center,Building,Planning (360) 427-9670 ext. 352
ADDITION OR REMODEL- HAGGERTY THOMAS &
Application# BLD2025-01062 Application Type Owner
RESIDENTIAL NORA LYNN
Parcel# 322343400030 Site Address 8090E STATE ROUTE 106 UNION, WA
98592
Inspector Inspection Type Date Status Comments
2-26-26-JQ
POST TO FOOTING POST TO BEAM CONNECTIONS UNDER DWELLING IN
CRAWLSPACE ARE OK THIS DATE ALL GUSSETS ARE INPLACE.
** I SPOKE TO THOMAS HAGGERTY AT LENGTH ABOUT THE FIREPLACE
INSERT- HE IS NOT GOING TO USE THE QUADRA FIRE EXPEDITION II WOOD
FIRED INSERT AND WILL BE REMOVING IT ALONG WITH THE UPPER PORTION
OF DAMAGED BRICK CHIMNEY WHILE LEAVING THE FIREBOX INTACT. HE
WILL OUTSOURCE A ZERO CLEARANCE FIREPLACE INSERT AND HAVE IT
INSTALLED BY A CERTIFIED INSTALLER. THE FLEX CHIMNEY PIPE WILL ALSO
BE REMOVED AND REPLACED WITH TRIPPLE WALL SMOOTH INTERWALL
CHIMNEY PIPE THAT IS APPROVED BY THE MANUFACTURE FOR USE WITH
THE INSERT OF HIS CHOICE.
PLEASE SEE COUNTY HANDOUT AND CHAPTER 10 OF THE 2021 IRC ALONG
WITH THE INSTALLATION MANUAL FOR INSERT OF CHOICE.
Joshua **DO NOT COVER FIREPLACE AREA, ALCOVE, FIREBOX UNTIL INSPECTIONS
Quarders FRAMING INSPECTION 02/26/2026 FAIL FOR THE FIREPLACE HAVE PASSED.
OTHER AREAS ARE OK TO DRYWALL AND FINISH
2-17-26 DEC
PROVIDE INSULATION CERT FOR SPRAY INSULATION PRIOR TO FINAL
INSTALL POST TO FOOTING AND POST TO BEAM CONNECTIONS
1-29-26-JQ
1. fire block all vertical bore holes and every 10' horizontal on the interior walls
(Exterior walls are to be completely encapsulated with closed cell spray foam)
2. underfloor-add gussets to posts that are missing positive connection to beams and
I ..
MASON COUNTY INSPECTION RESULTS Page2
Department of Community Development
COMMUNITY DEVELOPMENT 615 W Alder St, Shelton,WA 98584
Permit Assistance Center;Building,Planning (360)427-9670 ext. 352
positively connect posts to bases that are not secured.
3. please have all documentation for the fireplace on site at insulation inspection
remove combustible framing around insert and replace with light gauge steel framing
noncombustible for vertical members.
Entire exterior shell and underfloor shell is going to be spray foamed and
encapsulated to full stud, rafter and floor joist depth.
will check at insulation
INSPECTION RESULTS Pagel
MASON COUNTY Department of Community Development
COMMUNITY DEVELOPMENT 615 W Alder St, Shelton, WA 98584
Permit Assistance Center,Building,Planning (360) 427-9670 ext. 352
Application# BLD2025-01062 Application Type ADDITION OR REMODEL- HAGGERTY THOMAS &
Owner
RESIDENTIAL NORA LYNN
Parcel# 322343400030 Site Address 8090 E STATE ROUTE 106 UNION, WA
98592
Inspector Inspection Type Date Status Comments
2-26-26-JO
POST TO FOOTING POST TO BEAM CONNECTIONS UNDER DWELLING IN
CRAWLSPACE ARE OK THIS DATE ALL GUSSETS ARE INPLACE.
I SPOKE TO THOMAS HAGGERTY AT LENGTH ABOUT THE FIREPLACE
1 S�� `5 INSERT- HE IS NOT GOING TO USE THE QUADRA FIRE EXPEDITION II WOOD
FIRED INSERT AND WILL BE REMOVING IT ALONG WITH THE UPPER PORTION
OF DAMAGED BRICK CHIMNEY WHILE LEAVING THE FIREBOX INTACT. HE
-- I'L3LZ` �� WILL OUTSOURCE A ZERO CLEARANCE FIREPLACE INSERT AND HAVE IT
INSTALLED BY A CERTIFIED INSTALLER. THE FLEX CHIMNEY PIPE WILL ALSO
BE REMOVED AND REPLACED WITH TRIPPLE WALL SMOOTH INTERWALL
CHIMNEY PIPE THAT IS APPROVED BY THE MANUFACTURE FOR USE WITH
THE INSERT OF HIS CHOICE.
Joshua
FIREPLACE INSPECTION 02/26/2026 FAIL PLEASE SEE COUNTY HANDOUT AND CHAPTER 10 OF THE 2021 IRC ALONG
Quarders
WITH THE INSTALLATION MANUAL FOR INSERT OF CHOICE.
**DO NOT COVER FIREPLACE AREA, ALCOVE, FIREBOX UNTIL INSPECTIONS
FOR THE FIREPLACE HAVE PASSED.
OTHER AREAS ARE OK TO DRYWALL AND FINISH
2-17-26 DEC
UNSBLE TO COMPLETELY INSPECT FIREPLACE DUE TO DRY WALL STACKED
IN FRONT.
FIRE PLACE IS WOOD BURNING INSERT NOT ZERO CLEARANCE.
FLEXIBLE VENTING HAS BEEN INSTALLED AND MUST BE VERIFIED FOR
COMPATIBILITY.
HEARTH DIMENSIONS WILL NEED TO BE VERIFIED.
FIRE BOX/FIRE PLACE WILL NEED TO BE VERIFIED
INSPECTION RESULTS Paget
MASON COUNTY Department of Community Development
0 COMMUNITY DEVELOPMENT 615 W Alder St, Shelton,WA 98584
Permit Assistance Center,Building,Planning (360)427-9670 ext. 352
INSPECTION RESULTS Pagel
MASON COUNTY Department of Community Development
COMMUNITY DEVELOPMENT 615 W Alder St, Shelton, WA 98584
Permit Ass,stance Center,Building,Planning (360)427-9670 ext. 352
Application# BLD2025-01062 Application Type ADDITION OR REMODEL- Owner HAGGERTY THOMAS &
RESIDENTIAL NORA LYNN
Parcel# 322343400030 Site Address 8090 E STATE ROUTE 106 UNION, WA
98592
Inspector Inspection Type Date Status Comments
4-23-26-JQ
{/1 Install gutters and down spouts per R801.3
,2 Install Toe kicks on exterior stair risers.
,a. Caulk the toilet sides and front at the base to the floor.
,.4 Install pipe insulation on HWT supply lines
Joshua BLD-FINAL INSPECTION 04/23/2026 TEMP-OCC
Quarders PLEASE SEND PHOTOS WHEN COMPLETE
The wood burning stove and fireplace has been removed from the permit and will not
be installed
if the customer chooses to install a wood stove in the future they will need to obtain a
permit for the installation of that appliance at that time.
HUNTSMAN Insulation Certificate
BUILDING SOLUTIONS Closed-Cell Spray Polyurethane Foam
This form must be filled out and posted to comply with building code requirements. Meets IRC Chapter 11 Energy
Efficiency Requirements and IECC Chapter 4, Commercial Energy Efficiency Requirements.
The following spray polyurethane foam produc₹(s) has/have been installed.
❑ Icynene HFO 200 2.0-2.4 Ibs/ft3 IAPMO UES ER-0926
❑ Icynene HFO MAX 2.0-2.4 Ibs/ft3 ICC-ES ESR-5496
❑ Heatlok HFO PRO 2.0-2.4 Ibs/ft3 IAPMO UES ER-0565
❑E Heatlok HFO High Lift 2.0-2.4 Ibs/ft3 ICC-ES ESR-4073
❑ Heatlok HFO EZ 2.0 Ibs/ft3 IAPMO UES ER-0871
Consult International Building Code, Chapter 26-Plastic and International Residential Code(IRC) R316 Foam Plastics
for specific requirements.The spray polyurethane foam insulation system(s) has/have been installed in accordance with
manufacturer's processing guidelines to provide a thermal resistance of:
Area Insulated Aged R-Value Thickness**
Vented Attic Floor Area R- At inches
Unvented Attic/Under Roof Deck Insulation R-50 At 6.75 inches
Sloped Ceilings/Cathedral Ceilings R-50 At 6.75 inches
Walls(Location: Perimeter house walls ) R- 22 At 3 inches
Walls(Location: ) R- At inches
Floors (over an unheated crawl space) R-41 At 5.5 inches
Crawl Space Perimeter R- At inches
Basement Walls R- At inches
Other(Location: ) R- At inches
""Nominal thicknesses are representative of field,spray-applied foam material.
Jobsite Address: 8090 E STATE RTE 106UN ION WA 98592 Date of Installation: 2/12/26
Building Contractor.
HBS Contractor: Spray Foam Specific LLC Phone:
Installed By: Arlin
-Post Near Electrical Panel-
:rrte•.P� y1 y� 1 .
Pi
•,fix;'... �`,� � w
.V?
t � ter.
ri
t iwb„cr
rt
•a
F .a
0 Mason County
Mason County - Division of Community Development
615 W.Alder St.
Building 8
Shelton, WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
BLD2025-01062 ADDITION OR REMODEL-
RESIDENTIAL
PROJECT DESCRIPTION: FULL INTERIOR REMODEL, NO CHANGE IN ISSUED: 10/15/2025
FOOTPRINT, SOME WINDOWS & DOORS REMOVED, NEW
PLUMBING, INSULATION, FLOORING AND CABINETS EXPIRES: 04/13/2026
SITE ADDRESS: 8090 E STATE ROUTE 106 UNION
PARCEL: 322343400030
APPLICANT: HAGGERTY THOMAS&NORA LYNN OWNER: HAGGERTY THOMAS&NORA LYNN
1005 APACHE DR 1005 APACHE DR
MOUNT VERNON,WA 98273 MOUNT VERNON,WA 98273
VALUATIONS: FEES: Paid Due
R-3 VB Residential, one- 603.00 $100,924.11 Change in Tenant-Minor EH $140.00 $0.00
and two-family Plan Review
Building Permit Fee $1,093.12 $0.00
Planning Residential Review $275.00 $0.00
Fee
Plumbing Fees $52.00 $0.00
State Fee-Residential $6.50 $0.00
Technology Surcharge $39.37 $0.00
Plumbing Base Fee $30.00 $0.00
Mechanical Base Fee $30.00 $0.00
Plan Check Fee $710.53 $0.00
Mechanical Fees $53.00 $0.00
Residential Energy Code Fee $54.66 $0.00
Total: $100,924.11 Totals : $2,484.18 $0.00
FIXTURES
Qty Mechanical Fixtures Qty Plumbing Fixtures
1.0000 Dryer Vent(s) 1.0000 Number of Hose Bibs
1.0000 Spot Vent Fan(s) 1.0000 Number of Clothes Washers
1.0000 Kitchen Exhaust Hood(s) 1.0000 Number of Dishwashers
Printed by:Anna Schaffran on:10/15/2025 03:33 PM
Page 1 of 6
Mason County
Mason County - Division of Community Development
615 W. Alder St.
N C Building 8
Shelton, WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
ADDITION OR REMODEL- RESIDENTIAL BLD2025-01062
(Oty Mechanical Fixtures Oty Plumbing Fixtures
1.0000 Heat Pump(s) 1.0000 Number of Showers
2.0000 Bathroom Sink
REQUIRED INSPECTIONS
Mechanical Inspection Insulation Inspection
Rough-Plumbing Inspection BLD-Final Inspection
-------------- - - - - - - - - - - - -
Framing Inspection
CONDITIONS
* When parcel development requires direct access to county road(s), a Road Access Permit or Approval must be granted by
the Mason County Department of Public Works. For any construction which is proposed to be located within 25'of a Mason
County road right of way, it is suggested to contact that office to review future planned work which may affect your project.
For more information contact Public Works, at(360)427-9670, ext. 450 or 100 W Public Works Dr. Shelton. The building
permit will not be finaled until the permit holder can show proof that the access permit from Public Works has been finaled
and approved.
OWNER/ BUILDER acknowledges submission of inaccurate information may result in a stop work order or permit
revocation. Acknowledgement of such is by signature below. I declare that I am the owner, owners legal representative, or
contractor. I further declare that I am entitled to receive this permit and to do the work as proposed. I have obtained
permission from all the necessary parties, including any easement holder or parties of interest regarding this project. The
owner or authorized agent represents that the information provided is accurate and grants employees of Mason County
access to the above described property and structure(s)for review and inspection. This permit/application becomes null &
void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of
180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT
APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION UNLESS OTHERWISE APPROVED.
-------------------------------- --------------------------- ---------------------------------------
* All RED stamped approved plans are required to be on-site for inspection purposes. If an inspection is called for and
plans are not available on site, then approval will not be granted. In addition, a re-inspection fee (refer to current fee
schedule, minimum 1 hour)will be charged and must be collected by the Building Department prior to any further inspections
being performed or approvals granted.
------------------------
Owner/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance
with Mason County Code 14.28 and 14.17.
* Adopted Washington State Energy Code Compliance has been approved as follows:
Heat Type: Electric or other than electric, Compliance Method: Prescriptive option Marine -4C, Window (Max U-
Factor):0.30, Skylight(Max U-Factor):0.50, Doors (Type/Max U-Factor):0.30 or less, Wall insulation R-20+5ci, Floor
insulation R-30, Ceiling Insulation min. R-60, Vault Insulation R-38, and Slab Insulation R-10.
* REQUIREMENTS FOR ROOF COVERINGS. Roof coverings shall be applied in accordance with the applicable
provisions of the current code and the manufacturer's installation instructions.
A drip edge shall be provided at eaves and gables of shingle roofs.
Printed by:Anna Schaffran on:10/15/2025 03:33 PM
Page 2 of 6
Mason County
Mason County - Division of Community Development
615 W.Alder St.
Building 8
Shelton, WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
ADDITION OR REMODEL- RESIDENTIAL BLD2025-01062
* Installation of heating equipment in a single-family residence shall meet the requirements of the current WSEC R403,
applicable sections of the IRC, and IMC.
Heating equipment shall be sized in accordance to ICC/WSEC, Section R403.7. Heating and design load calculations for the
purpose of sizing HVAC systems are required and shall be calculated in accordance with accepted practice, including
infiltration and ventilation. Design calculations shall be available for inspection during inspection.
Referencing IRC M1601.4, all ducts, air handlers,filter boxes, and building cavities shall be sealed. All joints of duct
systems and seams shall be made substantially air tight by means of tapes, mastics, liquid sealants, gasketing or other
approved closure systems. Closure systems used with rigid fibrous glass ducts shall comply with UL181A and shall be
marked 181A-P for pressure-sensitive tape, 181A-M for mastic or 181 A-H for heat-sensitive tape. Closure systems used
with flexible air ducts and flexible air connectors shall comply with UL1 81 B and shall be marked 181 B-FX for pressure-
sensitive tape or 181 B-M for mastic. Duct connections to flanges of air distribution system equipment or sheet metal fittings
shall be mechanically fastened. Mechanical fasteners for use with flexible nonmetallic air ducts shall comply with UL 181B
and shall be marked 181 B-C. Crimp joints for round metal ducts shall have a contact lap of at least 1-1/2 inches (38 mm)
and shall be mechanically fastened by means of at least three sheet-metal screws or rivets equally spaced around the joint.
Closure systems used to seal metal ductwork shall be installed in accordance with the manufacturer's installation
instructions.
Duct tape is NOT permitted as a sealant on any ducts. When ducts are located in unheated spaces the ducts hall be
insulated to R-8
DUCT TIGHTNESS TESTING shall be conducted by person(s)trained to perform such testing. A signed affidavit
documenting test results in accordance to IECC/WSEC Section R403.3.3 shall be provided to the Mason County Building
Department prior to the final occupancy inspection. Affidavit forms are available on at the WSU-Energy Program website
titles, "Duct Leakage Affidavit"or"Duct Leakage Testing Results (Existing Construction)." Duct tightness testing is not
required if the air handler and all ducts are located within the heated space.
* Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the farthest projection of the
structure. Front setbacks are measured from the front lot line or road easement boundary, whichever is closer.
* Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries,
Contractor Compliance Division. There are potential risks and monetary liabilities to the homeowner for using an
unregistered contractor. Further information can be obtained at 1-800-647-0982. The person signing this condition is either
the homeowner, agent for the owner or a registered contractor according to WA state law.
* CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING
DEPARTMENT AND THE ADOPTED BUILDING CODE.
The construction of the permitted project is subject to inspections by the Mason County Building Department. All
construction must be in conformance with the international codes as amended and adopted by Mason County. Any
corrections, changes or alterations required by a Mason County Building Inspector shall be made prior to requesting
additional inspections.
* The plan review check list and corrections are part of the approved plans and must remain attached. It is the responsibility
of the applicant, owner or contractor to make the required corrections indicated on the plans. Once the plans are marked
"APPROVED",they shall not be changed or altered without authorization from the Building Official. The permit holder is
responsible to retain the complete approved set of plans on site for the duration of the project. Failure to comply and/or
removal of approved documents will result in failure of required building inspections.
* When parcel development requires direct access to state road(s), a Road Access Permit or Approval must be granted and
approved by the Washington State Department of Transportation. For more information contact Washington State
Department of Transportation, at(206)357-2620, ext. 630.
Printed by:Anna Schaffran on:10/15/2025 03:33 PM
Page 3 of 6
Mason County
Mason County - Division of Community Development
615 W. Alder St.
Building 8
Shelton, WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
ADDITION OR REMODEL- RESIDENTIAL BLD2025-01062
* All construction must meet or exceed all local and state ordinances in addition to the International Codes requirements as
adopted and amended by Mason County and the State of Washington. Occupancy is limited to the approved and permitted
classification. Any non-approved change of use or occupancy would result in permit revocation.
------------- --....._.....-----------------------...----••----._....._..------------------- -----------.
* All property lines shall be dearly identified at the time of foundation inspection.
------------------- -------------------------------------------------------------------------------------------.
* All building permits shall have a final inspection performed and approved by Mason County Building Department prior to
permit expiration.The failure to request a final inspection or to obtain approval will be documented in the legal property
records on file with Mason County as being non-compliant with Mason County ordinances and building regulations.
---------------------------------------- ------------------------------------------------
* Concrete used for basement walls,foundation walls,exterior walls, porches,carport slabs, steps exposed to the weather,
garage floor slabs and other vertical concrete work exposed to the weather shall have a minimum compressive strength of
3000 psi (IRC Table R402.2).
----------------------------------•--....---- --.--__........_........--....------------..--------------------
* All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed.The Building
Official may grant one or more extension of 180 days, upon the receipt of a written extension request prior to permit
expiration. Letter must indicate that circumstances beyond the control of the permit holder prevented action from being
taken.
------------------------- - --- --------------------------------------------------- ---•-----•••-•••••-•••-------_.
* Disclaimer: Mason County does not require a survey to obtain a building permit.As a result, site plans may not reflect
accurate data. It is the applicant's responsibility to comply with setback requirements.
-----------------------------------------------------------------------------•-------------------------------
* A minimum of 90 percent of all permanently installed lamps in lighting fixtures shall be high efficacy lamps in accordance
with IECC/WSEC Section R404.1.
* Concrete encased grounding electrodes must be installed and used at each new building or structure that is built upon a
permanent concrete foundation. In Mason County the electrical code is regulated by Washington State Department of Labor
&Industries(L&I).
For more information contact L&I for additional information. In Olympia call (360)902-6350 and in Bremerton call(360)415-
4000.
---------------------------------•---_---------...__._..•...• ---•--..---------------------- ------._...._
* Pressure treated wood manufactured after January 1,2004 may contain high concentrations of copper which could quickly
corrode metal fasteners, connectors, and flashing. Install metal connectors approved for contact with the new types of
pressure treated material.
* By definition, propane tanks and heatpumps are structures,which must meet setback conditions. Please check your
"Approved Site Plan"to ensure these structures meet the setback conditions listed.
-------------- ---------------------------------------- -------------------------------------------------------
* All changes to"approved"building plans that effect compliance with the international codes as amended and adopted, or
any other Mason County ordinance or regulation, must be reviewed and approved by Mason County prior to construction.
--•----- ------------------------ -----------------------------------------------------------------------------
* The foundation/footing must be placed on undisturbed,firm-native soil. Proper frost depth, minimum 12 inches, shall be
observed below grade in undisturbed soils.
Printed by:Anna Schaffran on:10/15/2025 03:33 PM
Page 4of6
Mason County
Mason County - Division of Community Development
615 W. Alder St.
Building 8
Shelton, WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
ADDITION OR REMODEL- RESIDENTIAL BLD2025-01062
A permanent certificate, completed by the builder or registered design professional, shall be posted on a wall in the space
where the furnace is located, a utility room,or an approved location inside the building.When located on the electrical panel,
the certificate shall not cover or obstruct the visibility of the circuit directory label, service disconnect label, or other required
labels. The certificate shall list the predominant R-values of insulation installed in or on ceiling/roof, walls, foundation (slab,
basement wall, crawlspace wall and/or floor), and ducts outside the conditioned spaces; U-factors for fenestration; and the
solar heat gain coefficient(SHGC)of fenestration. Where there is more than one value for each component, the certificate
shall list the value covering the largest area.The certificate shall list the type and efficiency of heating, cooling, and service
water heating equipment, duct leakage rates including test conditions as specified in WSEC Chapter 4, and air leakage
results of the blower door test conducted.
Building envelope air leakage control shall be considered acceptable when tested to have an air leakage less than 4 air
changes per hour when tested with a blower door in accordance with WSEC Section R402.4.1.2.
The blower door test results shall be recorded on the permanent certificate required located near the electrical distribution
panel. Air leakage testing is not required for additions less than 500 square feet. Reference WSEC R402.4.1.2.
Compliance certificates are available online at the WSU Energy program website titled, "WSEC 2021 Certificate"and are
available in 1/<or 1/2 sheets.
Carbon monoxide alarms, listed as complying with UL 2075 shall be installed in accordance with manufacturer
specifications and in accordance with IRC Section R315.
Alarms shall be installed outside of each separate sleeping area in the immediate vicinity of the bedrooms and on each level
of the dwelling.
EXISTING DWELLINGS shall be equipped with carbon monoxide alarms when alterations (including addition or alteration of
fuel burning appliances), repairs, or additions requiring a permit occur, or when one or more sleeping rooms are added or
created.
* A Mason County Stormwater Management Worksheet was completed and signed as part of this building permit
application. Design, sizing, placement, inspection and maintenance of stormwater management systems shall be the
responsibility of the owner/agent of the developed parcel. It is the owner/agent/contractor's responsibility to ensure that
Mason County Department of Public Works has approved the stormwater site plan for this parcel prior to the commencement
of any development activities. *NOTE if Stormwater Management option "A"was selected on the Small Parcel Stormwater
Management Application/Worksheet the document entitled"Managing Storm Drainage on Small Lots, The Small Parcel
Stormwater Site Plan" constitutes an approved plan based on the criteria listed on the application/worksheet. If the
development has, or will have, a septic/drainfield system you are responsible for contacting Mason County Division of
Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this, or any other,
parcel. You may also wish to consult with the septic design professional involved with the project. By calling for a final
inspection of the building permit the owner/agent/contractor is acknowledging that all components of the stormwater
management system have been installed as approved on the stormwater site plan. Under the requirements of Mason County
Stormwater Ordinance, either private ditches and drains will meet requirements of the stormwater ordinance or prior
approval will be granted to use an existing utility and drainage easement dedicated for that specific purpose.
* All other necessary permits from Mason County, Washington State, Federal Agencies, and/or other agencies/groups that
are required for this proposed development and construction must be obtained PRIOR TO DEVELOPMENT AND
CONSTRUCTION.
* Retaining walls needed to support a surcharge such as structures, roads, or to support slopes, shall require a separate
building permit and approval prior to construction of the retaining wall.
* All surface water and potential runoff must be controlled on site and shall not adversely affect any adjacent properties nor
increase the velocity flow entering or abutting to any state or county culverting/ditching system or road way.
Printed by:Anna Schaffran on:10/15/2025 03:33 PM
Page 5016
Mason County
Mason County - Division of Community Development
615 W. Alder St.
Building 8
Shelton, WA 98584
360-427-9670 ext 352
www.masoncountywa.gov
ADDITION OR REMODEL- RESIDENTIAL BLD2025-01062
* The use, handling and storage of hazardous materials or flammable and combustible liquids is not allowed without the
approval of the Mason County Fire Marshal.
Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site
plan. Please check your"Approved Site Plan"to ensure these structures are shown and meet the setback conditions listed.
Provisions for surface/subsurface drainage control must be implemented with new construction or development on site and
MUST NOT adversely impact adjacent parcels. Under the requirements of Mason County Stormwater Ordinance, either
private ditches and drains will meet requirements of the stormwater ordinance or prior approval will be granted to use an
existing utility and drainage easement dedicated for that specific purpose. For further information regarding this ordinance
contact the Mason County Public Works Department prior to construction at Ext 450
* Before renovating or remodeling activities in pre-1978 residential buildings or child occupied facilities and to ensure your
compliance with applicable Washington lead regulations, contact the WA State Department of Commerce Lead Paint
Program at; (360) 586-5323 or email lbpinfo@commerce.wa.gov. Visit www.commerce.wa.gov/lead for further information.
* WIND LOADS - Roof coverings shall be designed and tested to withstand the maximum basic wind speed. The basic wind
speed for Mason County is 85 mph with 110 mph gust factor.
-------------- ----------- -----------------
* The international code requires a fire apparatus access road for every facility, building, or portion of a building that is more
than 150'from an approved access road. Roads are required to meet the minimum Mason County Fire Marshal standards
for Fire Apparatus Access Roads up to the point where such roads connect with a county maintained public road or to
another fire apparatus access road which connects to a county maintained public road.
* The stamped approved site plan is required to be on-site for inspection purposes. If an inspection is requested and the
approved site plan is not on site, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule,
minimum 1 hour)will be charged and shall be collected by the Building Department prior to any further inspections being
performed or approvals granted.
* Applicant/Owner assumes all responsibility if On-site Sewage Components are encumbered.
A.) Drainfield/ Reserve requires a 1 Oft setback from all footing/foundations.
B.) Septic tank(s) requires 5ft setback from all footing/foundations.
C.) No foundation/ Perimeter Drains within 30ft, down gradient of Drainfield/Reserve area.
D.) No Cut Bank(s) (greater than 5ft and over 45 degrees)within 50ft, down gradient of Drainfield/ Reserve area.
------------------------------ ------------- ------... ...-----
* NO expansion of footprint.
I hereby certify that I have read and examined this application and know the same to be true and correct.
All provisions of Laws and Ordinances governing this type of work will be complied with whether
specified herein or not. The granting of a permit does not presume to give authority to violate or cancel
the provisions of any other state/local law regulating construction or the performance of construction.
Issued By: S
Contractor or Authorized Agent: Date: k_
Printed by:Anna Schaffran on:10/15/2025 03:33 PM
Page 6 of 6
Total Balance Due: $ 14.i' Permit #: 1�IC��-L75 O OLP
Applicant: 4- - -
Checked Contractor's Regis ation
Who was contacted?: i Date Contacted : Via Phone or Email?: Contacted by:
Other Associated Cases Fee Amount
N _____
I �
TOTAL: $ ' G
MASON COUNTY
COMMUNITY SERVICES
Name _ ftL it#: ��I4 oJ+`? (1 i
�- :
Occupancy Type Square Footage Valuation Amount Total Valuation
(VB) (sq. ft. x valuation)
Residence/Addition/Basement LU' ' $167.37 $ W
Garage/Storage7' _______________ $66.48 $
Unfinished Basement ( __________________ $31.50 $
Deck $17.00 $
Carport/Covered Deck $24.00 $
Other � `L5�67t) C � $
TOTAL VALUATION $ i)) 24 I
Estimated Plan Review Fee: $ I U
y - G Planning Dept. Review Fee[$275, $450, $100]: $
Environmental Health Review Fee: $ Q )
Fire Access & Grade Review Fee [$97.00]: $
ADD - Address Application Fee [$185.00]: $ C,IS 11G
GEO - Geo-technical Review Fee [$300.00]: $ --
ADO - Review Fee[$130.00] $
WAT - WAT Fee: XI I n
Other:
TOTAL DUE WHEN PERMIT IS SUBMITTED: $ I I 5.
The estimated plan review fee is based upon information provided at the time of application and is subject to change. Planning
Department fee is a flat fee which is due when permit is submitted. Building permit fee, mechanical fees,and plumbing permit fees
will be calculated during plan review. The balance of all other fees will be collected when permit is issued.
ESTIMATED BUILDING PERMIT FEES
Building Permit Fee (ICC, Table 1 — Building Valuation Data) $ i
Estimated Mechanical Fees (U.M.C., Table 1-A). $ i / no
Estimated Plumbing Fees (U.P.C. ,Table 1-1)
State Fee: $25 $6.50 $ CO
Technology Surcharge: �.v -� pp
Other: $
iw Estimated Building Permit Fees WHEN PERMIT IS READY for pickup; $ Io,1 Lo
(all fees subject to change w/o notice) GRAND TOTAL
$ 0 ,
Permit No:"iii i6 `o t 6►&t, -�
MASON COUNTY
COMMUNITY DEVELOPMENT
Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: Thomas& Nora Lynn Haggerty NAME: Thomas Haggerty
MAILING ADDRESS:310 E Dalby MAILING ADDRESS: 310 E Dalby Rd#715
CITY: Union STATE: ZIP:98592 CITY: Union STATE:_ ZIP: 98592
PHONE#1: 360-899-6647(Thomas) PHONE: 360-549-8647 CELL: 360-RQ9-6647
PHONE#2: 360-855-5442(NoraLynn) EMAIL: oakhagg@gmaiI.com
EMAIL: oakhagg@gmail.com L&I REG# N/A EXP._!!
PRIMARY CONTACT: OWNER CONTRACTOR❑ OTHER 0
NAME EMAIL oakhaag@gmail.com
MAILING ADDRESS CITY Union STATE WA ZIP 98592
PHONE 360-899-6647 CELL 360-599-6647
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 32234-34-00030 ZONING 19-Residential-Vac./ abin
LEGAL DESCRIPTION(Abbreviated) TR 3 OF G.L.3&T.L.EX 3A S 53/232 FIRE DISTRICT Mason Ctv.#6
SITE ADDRESS ROAD E State Route 106 CITY Union WA 98592
DIRECTIONS TO SITE ADDRESS Go East on Highway 106 from Dalby road past Alderbrook Inn approximately 1 mile
The house is on the right-hand"hill side"of Highway 106.The house is white with green trim.
IS THE PROJECT WITHIN 300 FT OF SLOPES)GREATER THAN 14%: YES O NO❑ SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all thatappl)):
SALTWATER 0 LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW 0 ADDITION 0 ALTERATION 0 REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garmge,Commemia/Bldg,Ew.) Residential
IS USE: PRIMARY 0 SEASONAL❑ NUMBER OF BEDROOMS 1 NUMBER OF BATHROOMS 1
HEATED STRUCTURE? YES({f1roleBldg)0 YES(Pan[s]ofBldg)❑ NO❑
DESCRIBE WORK Gut interior,replace plumbing,electrical,add insulation everywhere,flooring and kitchen cabinet
SQUARE FOOTAGE:(preposeeq (*)No EXPANSION of floor plan.Only alterations to existing floor plan.
I ST FLOOR1�G) ,sq.ft. 2ND FLOOR N/A sq.ft. 3RD FLOOR N/A sq.ft. BASEMENT N/A sq.ft.
DECK N/A sq.ft. COVERED DECK N/A sq.ft. STORAGE N/A sq.ft. OTHER N/A sq.ft.
GARAGE N/A sq.ft. Attached❑ Detached❑ CARPORT N/A sq.ft. Attached❑ Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE N/A MODEL N/A YEAR N/A LENGTH N/A
WIDTH N/A BEDROOMS N/A BATHS N/A SERIAL NUMBER N/A
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER 0 / NEW❑ EXISTING H
PLUMBING IN STRUCTURE? YES B NO❑ Ifyes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NC� EXISTING SQ.FT.
EXISTING BEDROOMS 1 PROPOSED BEDROOMS 0 TOTAL BEDROOMS 1
OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by
signature below.I declare that I am the owner and 1 further declare that I am entitled to receive this permit and to do the work as proposed.I have
obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project. The owner or legal
representative,represents that the information provided Is accurate and grants employees of Mason County access to the above described property
and structure(s)for review and inspection. This permit/application becomes null&void if work or authorized construction is not commenced within 180
days or if construction work is suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
x Au ust 29 2025
Signature of OWN us si ned t OWN Date
DEPARTMENTAL REVIEW APPRO ED DATE ENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
Permit No: Vt 2t b O&2_
MASON COUNTY
r' COMMUNITY DEVELOPMENT
Permit Assistance Center, Building,Planning
PLUMBING & MECHANICAL PERMIT APPLICATION
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: Thomas& Nora Lynn Haggerty NAME: Thomas Haggerty
MAILING ADDRESS: 310E Dalby Rd#715 MAILING ADDRESS: 310 E Dalby Rd#715
CITY: STATE: WA ZIP: 98592 CITY: Union STATE: WA ZIP: 98592
15f PHONE: 360-899-6647(Thomas) PHONE: 360-899-6647 CELL: 360-899-6647
2"d PHONE: 360-855-5442(Nora Lynn) EMAIL : oakhagg@gmail.com
EMAIL: oakhagg@gmail.com L&I REG# N/A
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number): 32234-34-00030 Zoning: i4 - Residential-Vac./ abin
LEGAL DESCRIPTION(Abbreviated): TR 3 OF G.L. 3&T.L. EX 3A S 53/232
SITE ADDRESS: 8090 E State Route 106 CITY: Union WA 98592
DIRECTIONS TO SITE ADDRESS:
Go East on Highway 106 from Dalby road past Alderbrook Inn approximately 1 mile.
The house is on the right-hand"hill side"of Highway 106.The house is white with green trim.
TYPE OF JOB:
NEW I I ADD=AL'I ]REPAIR= =
OTHER USE OF BUILDING Full-time residential
LOCATION OF FIXTURES/UNITS—1sT FLOOR 2ND FLOOR=BASEMENT=GARAGED OTHER=
PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANICAL UNITS
Type of Fixture No.of Fixtures Fees Fuel Type:Electric1LPGlJNatural Gas=Ductless=
Toilets 1 (existing) Type of Unit No.of Units Fees
Bathroom Sink 2 (1 new) Furnace
Bath Tubs 0 Heat Pump 1 (new)
Showers 1 (existing) Spot Vent Fan 1 (new)
Water Heater 1 (existing) Propane Tank
Clothes Washer 1 (new) Gas Outlets
Kitchen Sinks 1 (existing) Wood/Gas/Pellet Stove
Dishwasher 1 (new) Kitchen Exhaust Hood 1 (new)
Hose bibs Dryer Vent 1 (new)
Other Outdoor Shower/Hose bib 1 (new) Solar Panel
Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
OWNER acknowledge submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is
by signature below. I declare that I am the owner,owners legal representative,or contractor.I further declare that I am entitled to receive this
permit and to do the work as proposed.I have obtained permission from all the necessary parties,including any easement holder or parties of
interest regarding this project.The owner or authorized agent represents that the information provided is accurate and grants employees of
Mason County access to the above described property and structure(s)for review and inspection.This permit/application becomes null&void
if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF
OF CONTINUATION OFTHIS PERMIT IS BY MEANS OF INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS
WILL INVALIDATE THE APPLICATION.
x August 29, 2025
Signature r Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
Rev:1/27/2016 JBN
r + Permit No: i yI+F�
MASON COUNTY
COMMUNITY DEVELOPMENT SEP 092025
Permit Assistance Center Building,Planning
BUILDING PERMIT APPLICATIONEu etreet
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: Thomas&Nora Lynn Haggerty NAME: Thomas Haggerty
MAILING ADDRESS:310 E Dalby Rd#715 MAILING ADDRESS: 310 E Dalby Rd#715
CITY: Union STATE:] ZIP:98592 CITY: Union STATE: WA ZIP: 98592_
PHONE#1: 360-899-6647 (Thomas) PHONE: 36p-Rqq-6647 CELL: 360-894 .47
PHONE#2: 360-855-5442(NoraLynn) EMAIL: oakhagg@gmail.com
EMAIL: oakhagg@gmail.com L&I REG# N/A EXP._/
PRIMARY CONTACT: OWNERW CONTRACTOR❑ OTHER❑
NAME Thomas Haggerty EMAIL oakhagg@gmail.com
MAILING ADDRESS CITY Union STATE WA ZIP 98592
PHONE 360-899-6647 CELL 360-899-6647
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 32234-34-00030 ZONING 19-Residential-Vac./ abin
LEGAL DESCRIPTION(Abbreviated) TR 3 OF G.L.3&Ti.EX 3A S 53/232 FIRE DISTRICT Mason Cty.#6
SITE ADDRESS 8090E State Route 1O6 CITY Union,WA 98592
DIRECTIONS TO SITE ADDRESS Go East on Highway 1O6 from Dalby road past Alderbrook Inn approximately 1 mile
The house is on the right-hand"hill side"of Highway 1O6.The house is white with green trim.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO❑ SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all thatapp1i1:
SALTWATER 0 LAKE❑ RIVER/CREEK❑ POND❑ WETLAND 0 SEASONAL RUNOFF❑ STREAM[3
TYPE OF WORK: NEW❑ ADDITION 0 ALTERATION 0 REPAIR I] OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg.Etc) Residential
IS USE: PRIMARY la SEASONAL❑ NUMBER OF BEDROOMS 1 NUMBER OF BATHROOMS 1
HEATED STRUCTURE? YES(Whole Bldg)0 YES(Pan[s]of Bldg)❑ NO❑
DESCRIBE WORK Gut interior,replace plumbing,electrical,add insulation everywhere,flooring and kitchen cabinet
SQUARE FOOTAGE:(praposed) (*)No EXPANSION of floor plan.Only alterations to existing floor plan.
1ST FLOOR1QO sq.IL 2ND FLOOR N/A sq.ft. 3RD FLOOR N/A sq.ft. BASEMENT N/A sq.ft.
DECK N/A sq.ft. COVERED DECK N/A sq.ft. STORAGE N/A sq.ft. OTHER N/A sq.ft.
GARAGE N/A sq.ft. Attached❑ Detached 0 CARPORT N/A sq.ft. Attached 0 Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE N/A MODEL N/A YEAR N/A LENGTH N/A
WIDTH N/A BEDROOMS N/A BATHS N/A SERIAL NUMBER N/A
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER 0 / NEW❑ EXISTING 0
PLUMBING IN STRUCTURE? YES 0 NO❑ Ifyes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NC EXISTING SQ.FT.
EXISTING BEDROOMS 1 PROPOSED BEDROOMS 0 TOTAL BEDROOMS 1
OWNER acknowledges that submission of inaccurate information may result in a stop work order or pemut revocation.Acknowledgement of such is by
signature below.I declare that I am the owner and I further declare that I am entitled to receive this permit and to do the work as proposed.I have
obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project. The owner or legal
representative,represents that the information provided is accurate and grants employees of Mason County access to the above described property
and stnx ture(s)for review and inspection. This permit/application becomes null&void if work or authorized construction is not commenced within 180
days or if construction work is suspended fora period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
x August 29 2025
Signature of OWN us Si ned t OWN Date
DEPARTMENTAL REVIEW APPRO ED DATE ENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
PermitNoTPJk1orb �J -d 1 d`L
MASON COUNTY
COMMUNITY DEVELOPMENT
Permit Assistance Center, Building,Planning
PLUMBING & MECHANICAL PERMIT APPLICATION
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: Thomas &Nora Lynn Haggerty NAME: Thomas Haggerty
MAILING ADDRESS: 310 E Dalby Rd#715 MAILING ADDRESS: 310 E Dalby Rd#715
CITY: STATE: WA ZIP: 98592 CITY: Union STATE: WA ZIP: 98592
1S`PHONE: 360-899-6647 (Thomas) PHONE: 360-899-6647 CELL: 360-899-6647
2'd PHONE: 360-855-5442 (Nora Lynn) EMAIL : oakhagg@gmail.com
EMAIL: oakhagg@gmail.com L&I REG# N/A EXP•N/A//_-_
Thomas Nora
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number): 32234-34-00030 Zoning: 19 - Residential-Vac./Cabin
LEGAL DESCRIPTION(Abbreviated): TR 3 OF G.L. 3&T.L. EX 3A S 53/232
SITE ADDRESS: 8090 E State Route 106 CITY: Union WA 98592
DIRECTIONS TO SITE ADDRESS:
Go East on Highway 106 from Dalby road past Alderbrook Inn approximately 1 mile.
The house is on the right-hand"hill side"of Highway 106.The house is white with green trim.
TYPE OF JOB:
NEW ADD AL1II REPAIR=OTHER=
II = USE OF BUILDING Full-time residential
LOCATION OF FIXTURES/UNITS-1 ST FLOOR[j ]2 FLOOR=BASEMENT=GARAGED OTHER
PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANICAL UNITS
Type of Fixture No.of Fixtures Fees Fuel Type:Electric ]LPGI Natural Ga. Ductless0
Toilets 1 (existing) Type of Unit No.of Units Fees
Bathroom Sink 2 (1 new) Furnace
Bath Tubs 0 Heat Pump 1(new)
Showers 1 (existing) Spot Vent Fan 1(new)
Water Heater 1 (existing) Propane Tank
Clothes Washer 1 (new) Gas Outlets
Kitchen Sinks 1 (existing) Wood/Gas/Pellet Stove
Dishwasher 1 (new) Kitchen Exhaust Hood 1 (new).
Hose bibs Dryer Vent 1(new)
Other Outdoor Shower/Hose bib 1 (new) Solar Panel
Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
OWNER acknowledge submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is
by signature below.I declare that I am the owner,owners legal representative,or contractor.I further declare that I am entitled to receive this
permit and to do the work as proposed. I have obtained permission from all the necessary parties,including any easement holder or parties of
interest regarding this project.The owner or authorized agent represents that the information provided is accurate and grants employees of
Mason County access to the above described property and structure(s)for review and inspection.This permitlapplication becomes null&void
if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF
OF CONTINUATION OFTHIS PERMIT IS BY MEANS OF INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS
WILL INVALIDATE THE APPLICATION.
August 29, 2025
Signature r Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
Rev:1/27/2016 JBN
WAT C?'1
MASON COUNTY 415N.6a Street
Shelton,WA 98584
Shelton:360-475-4467
Public Health & Human Services ,Ext.400
Belfair:360-275-4467,Ext.400
Application for Determination of Water Adequacy
Instructions
1. Complete Part 1. No determination can be made until Part 1 is fully completed.
2. Complete only the portion of Part 2 applying to the type of water connection utilized.
3. Submit completed application with any required attachments for review.
4. An approved building site plan must accompany this application.
Part 1: Applicant) Parcel Identification 4
Name on Applicant: ►I lol Date: 7- 2L"Z5
Mailing Address31O E 1 �1L bir k1l. '71 hone: 3(MQ•1691. L (, '41
Parcel Number: j4— 11,1 am u>- -- ig3s7 •
Type of Water System Reason for Application �c
Public/Community W er System(2 or more ❑ Building permit 4d 2 5 "6 .)L,,connections) 2 VA9-t ❑ Division of land:
❑ Individual water source (one lonnection), #of Parcels? SPL
❑ Well ❑ Boundary line adjustment
❑ Spring/surface water
❑ Other(explain) ❑ Other(explain)
❑ Replacement r Remodel (p ase indicate name
If you have more than one residence connected of water system pplicable—no l
to this well, check the Public/Community Water signature required) O� pr-i
System box. t'
Part 2: Water Connection Information
Complete the section appropriate for the type of water connection being evaluated:
Public Water System
le
Name of Water System: i )
Water Facility Inventory (WFI) Number: fl()tic (write"none"for two-party)
❑ I am the manager of this water system. The water system has been approved for services. There
are presently connection(s) in use. This will be the connection.
❑ I am the manager of this system.This connection will be to upgrade or change the use of an existing
connection on this system (i.e.: recreational to full time). Please indicate on the following line the nature of
this change:
This water system is able and willing to provide water to this (these) connection(s)without exceeding the
limits of the water system or any limits set by state and local regulation.
Print Name of Water System Manager Phone
Signature of Water System Manager Date
This form may be scanned and available for public view at www.masoncountywa.gov
J:\EH Forms\Drinking Water Revised 05/08/2024 Pagel of 2
Group B Water Systems
❑ Satisfactory bacteriological test within last year(attach to application).
Individual Water Well
❑ Water well report(attached to application). Depth ft.
❑ Well capacity Test(attached to application) gpm gpd.
The well driller often performs well capacity tests at the time the well is constructed. Results from
these tests are noted on the water well report. Results from these tests will be accepted. If the water
well report cannot be located by the applicant or if the water well report does not have a capacity test,
a well capacity test, which provides stabilization of draw-down and recovery data, must be performed
by a licensed contractor.
❑ Satisfactory bacteriological test within last year(attach to application).
Individual Spring/Surface Water
❑ WDOE permit(attach to application)
❑ Method of disinfection
❑ I have reason to believe that this water source can provide at least 800 gallons per day; and/or
provides water at a rate of 2 gallons per minute based on the following observations.
Author of Statement Date
Relationship to Applicant
e •
Part 3: Mason County Community Services Evaluation (staff use only)
❑ Satisfactory Determination:
This determination does not address adequacy of the distribution system, guarantee an adequate supply of
water indefinitely in the future,or guarantee compliance with all applicable WDOE water resource regulations.
Recommended approval indicates requirements of Sanitary Code,Title 6, Chapter 6.68.040-Determination of
Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply. Chapter
36.70A RCW.
E Unsatisfactory Determination:
Applicant's water supply does not appear adequate to meet the needs of its intended use for the following
reason(s).
Reviewer's Signatures:
Environ. Health: Date
This form may be scanned and available for public view at www.masoncountywa.gov
Page 2 of 2