HomeMy WebLinkAboutComBldgPermitApplication CITY OF
_TWINFM,18 City of Twin Falls
r 9 Building Department
324 Hansen Street East Phone:208-735-7238
P.O. Box 1907 Fax:208-736-2256
'0<ss�avr�N�Qw Twin Falls, ID 83303-1907 www.tfid.org
Commercial Building Permit Application
Type of Permit Requested Date Received:
❑Commercial Site Plan-Buildable Lot Land Use:
❑New Complete Building ❑Multi-Family(3 or more units) Number of Units 50
El Shell Building-No Interior walls(no occupancy) ❑Addition Sq.Ft. 32,562
El Shell Building-with interior walls(no occupancy) BRemodel Total Cubic Feet 260,496 **
❑Tenant Improvement in Shell Building BOther Replacing 7 Boilers (**Fire District Only")
PROJECT INFORMATION
Project Address: 277 Maurice St.N.;Twin Falls,ID 83301 Subdivision:
Business/Tenant using space: Twin Falls Housing Authority-Duvall Courts Lot/Block:
Phone:(208) 733-5765 Parcel#:
PROPERTY OWNER INFORMATION CONTRACTOR INFORMATION
Name: Twin Falls Housing Authority Business Name: To Be Determined
Address: 200 Elm St. N. Address:
City,State,Zip: Twin Falls ID 83301 City,State,Zip:
Phone: 208 733-5765 Phone:
Fax: 208 733-5878 Fax:
Email: -lean ne.tra en twinfallshousin Email:
State Registration#
&Expiration Date:
ARCHITECT INFORMATION ENGINEER INFORMATION
Business Name: None Business Name: McClure Engineering, Inc.
Contact Name: Contact Name: David Bastow
Address: Address: 507 Main Av. W.
City, State,Zip: City,State,Zip: Twin Falls, ID 83301
Phone: Phone: 208 734-9015
Fax: Fax: (208) 734-9016
Email: Email: dbastow@mcclure-engineering.com
ADDITIONAL CONTACTS:Proiect Manager, etc
Business Name: Twin Falls Housing Authority Business Name:
Contact Name: -Marty Ginder Contact Name:
Address: 200 Elm St. N. Address:
City,State,Zip: Twin Falls, ID 83301 City,State,Zip:
Phone: 208 731-4258 Phone:
Fax: (208) 733-5878 Fax:
Email: marty.ginder@twinfallshousing.c Email:
1. Project D seription: \
2. Project Value: C��T4lV�A AG--u.al w,'11 �e_ 1.��Gil�
beds a.v e- re co of veW 4 cogAm- -i- a u. &rd eA)
A. Project Value is used to calculate fees for the building permit. Project Value is the total value of the construction work
for which the permit is issued,includinp_overhead and profit as well as finish work,painting,roofing,electrical,
plumbing,heating,air conditioning,elevators,fire extinguishing systems,other permanent equipment,and owner
supplied items. Project value excludes the value of the land.
I certify that the value&scope of work provided above are the most accurate available at this time:
Print Name Signature Date
3. Planning&Zoning Information A//a
A. Land Use Zone: E. Warranty Deed
B. Site Drainage Area with Calcs F. Flood Plain
C. Landscaping Area G. Water Tap Size
D. Parking Spaces H. Sewer
Tap Size
4. Building Information IV, CND 4 e-W UIA
a
A. Proposed Use AA o e ( Wia r E.Tenant Improvement Area:
B. Occupancy Groups: Q ®e,( F.Total Existing Building Area:
C. Construction Type: G. Actual New Building Area:
D. Building Height: H. Number of Stories:
5. Fire Information A//A Cil/o P?Piw X a
***Attach a site-specific letter from the engineering department or other public water provider stating fire flow at hydrants.
Include static pressure if fire sprinklers are to be installed.***
A. Fire Flow:
B. Static Pressure:
C. Is there a fire alarm system? _Yes _No _Partial
D. Is the building fully fire sprinkled?
If yes,will the sprinklers be used for:
Allowable Area Increase? _Yes_No
Story Increase? _Yes No
Fire-resistive Substitution? Yes No
If partially sprinklered,where?
E. Are there any classified areas? _Yes _XNo(if yes,please show on plans and explain classification)
(This mostly has to do with electrical wiring)
***NOTICE***
All permits expire 180 days from the date of their issuance or the date of the last inspection. Expired permits will require
reactivation at such time that the responsible party decides to complete the project. Reactivation fees will be required on all
permits. Furthermore,any application that has not been issued or picked up after 180 days will become null and void.
Commercial projects review with all the required submittals are not expected to exceed 2-3 weeks for the initial review,but
could take longer depending on needed revisions or current workload.Please let the Building Department know if there are
any unusual time constraints and we will work with you to move your project forward as quickly as possible. Please keep in
mind that any missing information from the below checklist will cause delays in the processing of the permit application.
Commercial/Non-Residential/Multi-Family Plan Review Checklist
Notice to applicants: This checklist is designed to provide the basic information needed to allow the various agencies with
the City to complete a plan review of the proposed project. The basic requirements outlined below may not be all inclusive.
General Requirements for all plan submittals (to be FOR CONSTRUCTION):
1. Electronic Plans: Plans saved (actual size pages will be printed) as PDF&combined together. We prefer
plans to be saved directly from CAD (instead of scanned) so the file is"intelligent". Locked Digital signatures OK
just don't lock the entire file.
2. Paper Plans: 1 complete sets of stamped plans&an electronic set(signature can be a scanned/copy or
digital)
** Electronic plans submitted via thumb drive, email or ftp site (contact Building Dept office 208-735-7238 to have ftp
site set up) **
CONSTRUCTION PLANS (NEW Construction, Additions& Remodels)
***(DESIGN PROFESSIONAL TO GO THROUGH LIST AND CHECK OFF THAT ALL REQUIREMENTS HAVE BEEN PROVIDED
ON PLANS.) ''`**MISSING ITEMS BELOW WILL DELAY ISSUANCE OF THE BUILDING PERMIT-
0 ODE/PLAN ANALYSIS-Required information is detailed on the code Analysis form within the application.
ComCheck Energy Analysis-Prepared by an Idaho licensed architect or engineer. (Required on remodel when changing
fixtures)(Include envelope,interior and exterior lighting&mechanical compliance worksheets)
❑ Architectural Site Plan(This is REQUIRED in addition to the civil site plan)To include:
❑ Scale to be a minimum of 1/8"per foot for large projects and W per foot for smaller ones.
❑ Sheet sizes shall not be less than 24"x 36"and not more than 30"x 42".
❑ Location of new and existing structures with fully dimensioned measurements to property lines&other structures;
❑ Parking lot design-Including fully dimensioned space and aisle layout and detailed handicapped parking spaces.
❑ Accessible route of travel from parking spaces to the building entrance and connecting to the public right-of-way.
❑ Foundation Plan-(stamped by the Design Professional performing the structural calculations)
Include all required structural steel reinforcing,tie downs and special inspection criteria.
❑ Floor Plan-Including all exit schemes,exterior wall openings,door swings,use designations,exit signage,location of fire extinguishers,
high pile storage areas. For tenant improvements or remodels,include floor plan of the entire building. Indicate the existing occupancies of
tenant spaces in contact with new tenant improvement or remodel.
❑ Elevations-North,South,East,West(show building height dimensions)
❑ Building Sections and Details-Including the room finishes for ceilings,walls and floors. Also,include schedules for all windows and
doors,indicating the type,size,safety glazing,and door hardware. UL Listings and details for fire separations. Provide fire stop material
specifications along with U.L.design details.Include sections of all walls showing height and how to be built.Also show any dropped down
ceilings or storage above ceilings and framing details.
❑ Structural Plans(stamped by the Design Professional performing the structural calculations)-Roof framing plan,floor framing plan,
header and beam schedules,strap locations,structural details,shear walls,shear wall schedule,lintels,lintel schedule and all other
structural information as indicated in the calculations or required by the Building Official.Any special details(i.e.,storage above restrooms)
Provide statement of special inspections per IBC 1704.1.1. A final report documenting required special inspections and correction of any
discrepancies noted in the inspections shall be submitted at a point in time agreed upon by the permit applicant and the building official prior
to the start of work.
❑ Conservation Elements-Insulation R-values,glazing U-Factors,glazing solar heat gain coefficient(SHGC)value,rough opening sizes,
❑ Electrical Plans-Exit signage,switching diagrams,lighting schedule with fixture,bulb and ballast type,number of bulbs per fixture,and
fixture wattage;exterior lighting bulb and ballast type,and type of control. Location of exit signage and emergency lighting shall coordinate
�"ith the floor plan or the reflected ceiling plan.(list and give details of any classified areas)
kMechanical Plans-Equipment schedule listing the make and model of the equipment and other information pertinent to compliance with
IECC;duct insulation R-values,mechanical system control schematic load calculations. Information regarding all fire rated penetrations,
smoke dampers,fire dampers,etc. Ventilation design&calculations. Mechanical engineering plans may be required on certain projects.
rovide calculations on plans if using natural instead of mechanical ventilation)
Plumbing Plans-Plumbing plan,isometrics,grease/sand interceptor details,and calculations to determine actual interceptor sizing
according to the requirements in the Uniform Plumbing Code. Be sure to include the sewer connection location,type and location of
reduced pressure backflow devices(s),gas line piping materials and calculations,water line piping layout and materials,and
drain/waste/vent piping layout and materials. Ak►-f t -( h M c .k, ct-ki I Cge-1 V 10Ln5 a
❑ MSDS Sheets-(2)Two copies of the Material Safety Data Sheets and the location and quantities of storage of such materials shall be
provided with the building permit submittal where any chemicals or hazardous materials may be present.
❑ Structural Engineering Calculations—(2)two sets of Structural engineering calculations are required for all new construction,additions or
structural improvement/remodels/retrofits within existing buildings. Calculations must be stamped and signed by an Idaho Registered
Engineer or Architect. (Exception: parameters of section 2308 of the IBC 2012,and design will be required)
❑ Metal Building Drawings and Calculations—Metal Building Drawings and structural engineering calculations will be required for all pre-
fabricated metal buildings,including concrete footing details. Calculations must be stamped and signed by an Idaho Registered Engineer or
Arch itect.
❑ Modular Buildings—Structural engineering calculations will be required for the foundation design for all modular buildings. Calculations
must be stamped and signed by an Idaho Registered Engineer or Architect. (Modular buildings are required to have Idaho Division of
Safety approval.)
❑ Additional Handicap Accessibility Information—Define all handicapped access features for new construction per the current
International Building Code,ANSI A 117.1. For remodeling and tenant improvements,the area of improvement shall comply with the
access requirement for new construction. An accessible route of travel will be required to the remodeledlimproved area.
❑ Fire Department Requirements—Location and type of fire extinguishers,fire alarms,hoods,sprinkler system,etc.
B Mechanical—HVAC Ventilation design IBC 1203.4(New as of 1-1-09) NA) 60� dDivn bo1 '�t/^
❑ Provide statement of special inspections per IBC 1705.
❑ Completed Waste Water Survey(see http://www.tfid.org/departments/p-z/building/133-building-information)
CIVIL PLANS(NEW CONSTRUCTION&ADDITIONS)'"NOT TYPICALLY REQUIRED ON INTERIOR REMODELS`** /V/14
Civil Site Plan(Licensed Engineer or Architect required)—To include: �/4
❑ Scale and format to be standard scale at between 1:10 to 1:60 scale;
❑ Sheet sizes shall not be less that 18"bv 24".
❑ Legal description and/or record of survey for the property and a vicinity map and north arrow;
❑ Property lines and lot dimensions and building setbacks from property lines
❑ Right-of-way details including access,easements,utilities,drainage,wastewater,right of way to be dedicated;
❑ Right-of-way improvements,both existing and proposed;
❑ Fire department access(access must be 20 feet wide with a 70,000 pound load capacity and reach within 150 feet of any/or all ❑
portions of the exterior walls of the building(s);
❑ Fire hydrants within 1000 feet&fire line location must be shown on the site plan;a water model may be required to determine fire
flow.
❑ Any areas used for the storage or use of materials regulated by the IFC;
❑ Storm Drainage—On site retention structure design and calculations by a P.E.;
❑ Grading plan including finished floor elevations,accessible route and top of curb elevations.
❑ Utility services—Number of water services including size and location;sewer location and proposed connection to the main;
irrigation service size and location,grease interceptor(including a detailed design)for all food service occupancies;
❑ Landscaping—Including all types and locations of landscape areas with topography showing berms,tree,fencing,retaining walls,
waterways,trash enclosure/mechanical equipment areas with method of screening,loading docks,storage areas,pedestrian
ways,exterior lighting fixtures,irrigation methods and proposed building pad; &storm water retention(City Code 10-11-2)
❑ Location of new and existing structures and distance between them.
❑ Parking lot layout,including fully dimensioned space&aisle layout,detailed handicapped parking spaces&accessible route
❑ Storm Drainage Calculations—To be stamped by an Idaho Registered Civil Engineer or Landscape Architect.
❑ Geotechnical report—when building within 1 00'of canyon rim.
❑ Water tap size needed(or well permit,if applicable)
❑ Sewer lateral location
❑ Proposed and existing curb,gutter,sidewalk,and driveway approaches.
❑ Flood Plain indicated if within 100 year or less flood zone.
HEALTH DISTRICT APPROVAL IS REQUIRED FOR ALL BUILDINGS WHERE FOOD IS BEING PREPARED. A LETTER
R
OF APPROVAL MUST BE SUBMITTED TO THE BUILDING DEPARTMENT PRIOR TO PERMIT ISSUANCE.
I(the designer in responsible charge) (Architect or Engineer)hereby certify that I have read and examined the above
application and checklist, and that all of the information provided and items checked are included as part of the initial permit
application submittal and are true to the best of my knowledge.
04-16-2019
Signature Date Date
***SAMPLE***
(may not be all inclusive)
City of Twin Falls
Plan Analysis Based on Latest Edition of IBC & IFC
Architect or Engineer of Record:McClure Engineering, Inc.
Job Address:277 Maurice St. N. city:Twin Falls St: ID Zip:83301
Legal Description:
Occupancy Classification: R-2 Occupant Load Per Area: 1: 2:
3: 4:
5: 6:
Number of Stories: 1 Vestibule Req'd?:Yes: No: Total:
Floor Area: Basement: 1st:32,562 Exits Required: Basement: 1st:
2nd: 3rd: 4th: 2nd: 3rd: 4th: stories
Actually furthest travel distance to exit: (IBC Table 1016.1 &Table 1021.2)
Type of Construction:Replacing Boilers only Allowable Area Calcs:
Area Increase:0
Sprinkler System: Yes: No: Exit Signs: Yes: No:
Maximum Floor Area Allowed: Emergency Lights: Yes: No:
Special Inspections Required?Yes: No: Lighting Layout&ComCheck: Yes: No:
Firewalls Required?Yes: No: (If Yes, please provide cross section &UL Listing)
Occupancy Separation Required? Yes: No: (If Yes, please provide cross section &UL Listing)
Area Separation Required? Yes: No: (If Yes, please provide cross section &UL Listing)
Classified Areas? Yes: No:X (If Yes, please show on plans and explain classification)
FIRE HYDRANTS WITHIN 1000 FT. Comments:
1. ft. GPM Flow:
2. ft. GPM Flow:
3. ft. GPM Flow:
Total:
Minimum Req'd Flow for Building:
Model Required?: Yes: No:X
Date:04-16-2019 Prepared By: David BastOw ***Fee may be accessed for water model***
CH2M HILL
350 Canyon Springs Road
PO Box 5158
Twin Falls, ID 83301
Dear Wastewater Customer,
We are engaging in a study to determine the nature of the wastewater discharged by our
customers. This study, called an Industrial Waste Survey(IWS), is performed periodically during
the course of our IPDES permit cycle to ensure the safe operation of our wastewater treatment
plant(WWTP) and maintain compliance with our discharge permit. The results of the survey
will be sent to the Idaho Department of Environmental Quality(DEQ) for review.
Enclosed you will find the IWS, which requests details about your facility's operations,
materials, and production processes. We request that the survey be returned to the address on the
enclosed envelope by October 23, 2017.
Completion of this survey is required under the Clean Water Act(CWA) and the Rules
Regulating the Idaho Pollutant Discharge Elimination System Program(IDAPA 58.01.25).
Failure to complete this survey or falsifying information reported on the survey is"an offense
punishable by enforcement action,which includes termination of treatment services and/or civil
and criminal penalties".
If you have questions or concerns,please contact Lance Nielsen at 208-734-9933, or email
"Lance.Nielsen@ch2m.com."
Thank you for your cooperation.
Sincerely,
Lance Nielsen
Industrial Pretreatment Coordinator
40 CFR 403.12 p)(1)The Industrial User shall notify the POTW,the EPA Regional Waste Management Division
Director, and State hazardous waste authorities in writing of any discharge into the POTW of a substance,which,
if otherwise disposed of, would be a hazardous waste under 40 CFR part 261. Such notification must include the
name of the hazardous waste as set forth in 40 CFR part 261, the EPA hazardous waste number, and the type of
discharge (continuous, batch, or other). If the Industrial User discharges more than 100 kilograms of such waste
per calendar month to the POTW,the notification shall also contain the following information to the extent such
information is known and readily available to the Industrial User: An identification of the hazardous constituents
contained in the wastes, an estimation of the mass and concentration of such constituents in the wastestream
discharged during that calendar month,and an estimation of the mass of constituents in the wastestream expected
to be discharged during the following twelve months. All notifications must take place within 180 days of the
effective date of this rule. Industrial users who commence discharging after the effective date of this rule shall
provide the notification no later than 180 days after the discharge of the listed or characteristic hazardous waste.
Any notification under this paragraph need be submitted only once for each hazardous waste discharged.
However, notifications of changed discharges must be submitted under 40 CFR 403.12 0). The notification
requirement in this section does not apply to pollutants already reported under the self-monitoring requirements
of 40 CFR 403.12 (b), (d), and(e). (2) Dischargers are exempt from the requirements of paragraph(p)(1) of this
section during a calendar month in which they discharge no more than fifteen kilograms of hazardous wastes,
unless the wastes are acute hazardous wastes as specified in 40 CFR 261.30(d) and 261.33(e). Discharge of more
than fifteen kilograms of non-acute hazardous wastes in a calendar month, or of any quantity of acute hazardous
wastes as specified in 40 CFR 261.30(d) and 261.33(e), requires a one-time notification. Subsequent months
during which the Industrial User discharges more than such quantities of any hazardous waste do not require
additional notification. (3)In the case of any new regulations under section 3001 of RCRA identifying additional
characteristics of hazardous waste or listing any additional substance as a hazardous waste, the Industrial User
must notify the POTW, the EPA Regional Waste Management Waste Division Director, and State hazardous
waste authorities of the discharge of such substance within 90 days of the effective date of such regulations. (4)
In the case of any notification made under paragraph(p)of this section,the Industrial User shall certify that it has
a program in place to reduce the volume and toxicity of hazardous wastes generated to the degree it has determined
to be economically practical.
For links to 40 CFR regulations go to www.gpoaccess.gov and click on Code of Federal Regulations.
CH2M HILL
2
. 350 CANYON SPRINGS ROAD
M �'e ,:=. w`,;.'; 4 PO BOX 5158
Ch
TWIN FALLS, ID 83301
WASTEWATER DISCHARGE SURVEY A 4C�® ��'� ��� oes
or0h&ti r�ry cfrS ' ar���
The purpose of this survey is to obtain general information needed by the City of Twin Falls to comply
with Wastewater Plant's NPDES permit requirements. Please fill out the form completely and return it
to the address listed above within 30 days of receipt.
Company Name: "U '`
Facility Address: c, ,
Mailing Address: T
Contact Person: 7'wp� Title: '
Phone: FAX: Email: -h1afit t
f—�virt�`a I15K S(s .cmov�'1
Type of business(Check any that apply):
❑Arts and Crafts Shop ❑ Paint and Body Shop
❑ Dental Clinic ❑ Photo Shop
❑ Fruits and Vegetables Processing ❑ Print and Photo Copy
❑ Garage/Full Service Gas Station ❑ Radiator Shop
❑ Hospital/Doctor's Clinic ❑ Restaurants
❑ Industrial/Commercial Laundries ❑ Retail
❑ Small Office ❑ School/College/University
❑Transportation Facility ❑Waste Hauler
❑ Laboratory/Pharmacy ❑Other
Description of primary business product(s)or service(s)
IVY u( i- re:51 d eA47 ca,] aA� :s whick are,
Does the facility perform processes in any of the industrial categories or business activities listed
below?
❑Airport Deicing ❑ Leather Tanning and Finishing
❑Aluminum Forming ❑ Meat and Poultry Products
❑Asbestos Manufacturing ❑ Metal Finishing
❑ Battery Manufacturing ❑ Metal Molding and Casting
❑ Canned and Preserved Fruits and Vegetables ❑ Metal Products and Machinery
❑ Canned and Preserved Seafood ❑ Mineral Mining and Processing
1
❑ Carbon Black Manufacturing ❑ Nonferrous Metals Forming and Metal
Powders
❑ Cement Manufacturing ❑ Nonferrous Metals Manufacturing
❑ Centralized Waste Treatment ❑ Oil and Gas Extraction
❑Coal Mining ❑ Ore Mining and Dressing
❑ Coil Coating ❑ Organic Chemicals, Plastics,and Synthetic
Fibers(OCPSF)
❑ Concentrated Animal Feed Operations(CAFO) ❑ Paint Formulating
❑ Concentrated Aquatic Animal Production ❑ Paving and Roofing Materials(Tars and
(CAAP) Asphalt)
❑ Construction and Development ❑ Pesticide Chemicals
❑ Copper Forming ❑ Petroleum Refining
❑ Dairy Products Processing ❑ Pharmaceutical Manufacturing
❑ Electrical and Electronic Components ❑ Phosphate Manufacturing
❑ Electroplating ❑ Photographic Processing
❑ Explosives Manufacturing ❑ Porcelain Enameling
❑ Ferroalloy Manufacturing ❑ Pulp, Paper, and Paperboard
❑ Fertilizer Manufacturing ❑ Rubber Manufacturing
❑ Glass Manufacturing ❑Soap and Detergent Manufacturing
❑ Grain Mills ❑Steam Electric Power Generating
❑ Gum and Wood Chemicals Manufacturing ❑Sugar Processing
❑ Hospitals ❑Textile Mills
❑ Ink Formulating ❑Timber Products Processing
❑ Inorganic Chemicals Manufacturing ❑Transportation Equipment Cleaning
❑ Iron and Steel Manufacturing ❑Waste Combustors
❑ Landfills
Number of Employees: Day: Swing: Grave: Total:
Applicable SIC and/or NAICS code(s)
SIC:
NAICS
Average total monthly water usage in gallons(monthly water billings will show this).
Maximum and Average daily flows discharged from this facility(gallons per day)
Average nutrient load at this facility(pounds per day)
Is the building presently connected to the sewer system? Q Yes Q No
Are there floor drains present at your facility? Q Yes Q No
Do you use a dental amalgam separator? Q Yes Q No
Do you or will you use non-petroleum oils or grease(cooking types of oil/grease) in Q Yes O No
your business?
2
Do you or will you us petroleum oils or greases in your business? Q Yes Q No
Grease trap(s) present? Q Yes Q No
How frequently is your grease trap(s)emptied?
Do you or will you store chemicals on site in excess of household quantities? Q Yes O No
Do you or will you discharge, other than domestic wastes from toilets and showers, Q Yes Q No
to the sewer system?
Do you or will you have an Accidental Spill Prevention Plan (ASPP)? Q Yes Q No
Indicate the types of waste generated by this facility:
❑ Domestic Waste ❑ Noncontact Cooling ❑ Boiler/Tower ❑ Contact Cooling
Blowdown Water
❑ Process ❑Washdown ❑Air Pollution ❑Storm Water Runoff
Control
Indicate where waste is discharge:
❑ Sanitary Sewer ❑Storm Sewer ❑Surface Water
❑ Ground Water ❑Waste Hauler ❑ Evaporation
List pollutants discharge by this facility:
Describe any existing pretreatment technology:
Indicate whether any of the following chemicals are used in your facility:
LEGEND:
Leave blank if Status is Absent
Mark"S"if Status is Suspected Absent
Mark"P"if Status is Present
Mark"M"if Status is Suspected Present
Chemical Compound Status Chemical Compound Status
ACENAPHTHENE ACENAPHTHYLENE
ACROLEIN ACRYLONITRILE
ALDRIN ALPHA-ENDOSULFAN
ALPHA-LINDANE ANTHRACENE
ANTIMONY AROCLOR 1016
3
AROCLOR 1221 AROCLOR 1232
AROCLOR 1242 AROCLOR 1248
AROCLOR 1254 AROCLOR 1260
ARSENIC ASBESTOS(FRIABLE)
BENZ(A)ANTHRACENE BENZENE
BENZIDINE BENZO(A)PYRENE
BENZO(B)FLUORANTHENE BENZO(GHI)PERYLENE
BENZO(k)FLUORANTHENE BENZYL BUTYL PHTHALATE
BERYLLIUM BETA-ENDOSULFAN
BETA-LINDANE BIS(2-CHLORO-I-METHYLETHYL)
ETHER
BIS(2- BIS(2-CHLOROETHYL) ETHER
CHLOROETHOXY)METHANE
BIS(2- BIS(2-ETHYLHEXYL)PHTHALATE
CHLOROISOPROPYL)ETHER
BIS(CHLOROMETHYL) ETHER 4-BROMOPHENYL PHENYL
ETHER
CADMIUM CAMPHECHLOR
CARBON TETRACHLORIDE 4-CHLOR-M-CRESOL
CHLORDANE CHLOROBENZENE
CHLORODIBROMOM ETHANE CHLOROETHANE
2-CHLOROETHYL VINYLETHER CHLOROFORM
CHOLOROMETHANE 2-CHLORONAPHTHALENE
2-CHLOROPHENOL 4-CHLOROPHENYL PHENYL
EHTER
CHROMIUM CHRYSENE
COPPER CYANIDE
DDD DDE
DDT DELTA-LINDANE
DI-N-OCTYL PHTHALATE DI-N-PROPYLNITROSAMINE
DIBENZ(A,H)ANTHRACENE 1,2-DIBROMOETHANE
DIBUTYL PHTHALATE 1,4-DICHLOROBENZENE
1,2-DICHLOROBENZENE 1,3-DICHLOROBENZENE
3,3'-DICHLOROBENZIDINE DICHLOROBROMOM ETHANE
1,2-DICHLOROETHANE 1,1-DICHLOROETHANE
1,1-DICHLOROETHYLENE DICHLOROMETHANE
2,4-DICHLOROPHENOL 1,2-DICHLOROPROPANE
1,3-DICHLOROPROPENE DIELDRIN
(MIXED ISOMERS)
DIETHYL PHTHALATE DIMETHYL PHTHALATE
2,4-DIMETHYLPHENOL 4,6-DINITRO-O-CRESOL
2,4-DINITROPHENOL 2,4-DINITROTOLUENE
2,6-DINITROTOLUENE 1,2-DIPHENYLHYDRAZINE
ENDOSULFAN SULFATE ENDRIN
ENDRIN ALDEHYDE ETHYLBENZENE
4
FLUORANTHENE FLUORENE
GAMMA-LINDANE HEPTACHLOR
HEPTACHLOR EPDXIDE HEXACHLORO-I,3-BUTADIENE
HEXACHLOROBENZENE HEXACHLOROCYCLOPENTADIENE
HEXACHLOROETHANE INDENO(1,2,3-CD)PYRENE
ISOPHORONE LEAD
MERCURY METHANAMINE, N-METHYL-N-
NITROSO
METHYL BROMIDE N-NITROSODIPHENYLAMINE
NAPTHALENE NICKEL
NITROBENZENE 4-NITROPHENOL
2-NITROPHENOL PENTACHLOROPHENOL
PHENANTHRENE PHENOL
PYRENE SELENIUM
SILVER 2,3,7,8-TETRACHLORODIBENZO-
P-DIOXIN (TCDD)
1,1,2,2-TETRACHLOROETHANE TETRACHLOROETHYLENE
2,3,4,6-TETRACHLOROPH ENO L THALLIUM
TOLUENE 1,2-TRANS-DICHLOROETHYLENE
TRIBROMOMETHANE 1,2,4-TRICHLOROBENZENE
1,1,2-TRICHOLOROETHANE 1,1,1,-TRICHLOROETHANE
TRICHLOROETHYLENE 2,4,6-TRICHLOROPHENOL
VINYL CHLORIDE ZINC
In accordance with Title 40 of the Code of Federal Regulations Part 403 Section 403.14,information
provided in this questionnaire will be available to the public without restriction. Requests for
confidential treatment of other information shall be governed by procedures specified in 40 CFR 2.
"I have personally examined and am familiar with the information submitted in this document. Based
upon my inquiry of those individuals immediately responsible for obtaining the information reported
herein,I believe that the submitted information is true,accurate,and complete. I am aware that
there are significant penalties for submitting false information, including the possibility of fine and/or
imprisonment."
Name print): Signature-
JD
Title: Date:
5
The US Environmental Protection Agency requires that
Renovation, repair and painting projects that disturb lead-
based paint in pre-1978 homes, childcare facilities and
schools must be performed by an EPA Certified Renovator
working for an EPA Certified Firm and specific work practices
must be implemented to prevent lead contamination . More
information is available at 1800-424- LEAD [ 5323] or
http : //www2 . epa . gov/lead
Laurie Fay
US Environmental Protection Agency Region 10
1200 Sixth Avenue
Suite 900, MS AWT-128
Seattle, WA 98101
Phone: 206-553-1541
Fax: 206-553-8509
Email: fay.laurie(@epa.gov
You may also find information about Asbestos at
http : //www2 . epa . gov/asbestos or the State of Idaho has
information on their website at http : //deg . idaho. gov/air-
quality/air-pollutants/air-toxics/asbestos . aspx
Please note that EPA R10 in Seattle handles asbestos in
schools (AHERA regulation) . R10 Seattle no longer handles
asbestos NESHAP issues - these are referred to John Pavitt,
EPA R10 Anchorage, AK office - his contact information is
phone (907-271-3688) and/or email (pavitt . john(@epa . gov) .
SEWER CAPACITY FEE WORKSHEET
Business Name: Twin Falls Housing Authority- Duvall Courts(existing) Address:277 Maurice St. N.;Twin Falls, ID 83301
1. Please indicate the number of new and exisiting plumbing fixtures in the appropriate boxes below.
2. Also, the number of holidays being closed, the number of days the business is open in a week, and how many hours open
during the day.
3. If no plumbing fixtures are bing installed, signify at the bottom of the form and sign.
4. Sign and date.
VALUES Number VALUES Number
New DFU/Unit Existing DFU/Unit
Lavatories Lavatories
Water Closets Water Closets
Urinal Urinal
Water Softener Water Softener
Hand Sink Hand Sink
Dishwasher Dishwasher
Bar Sink Bar Sink
Clothes Washer Clothes Washer
Kitchen Sink Kitchen Sink
Shower Shower
Drinking Fountain Drinking Fountain
Mop/Svice-Sk/Tr Dr Mop/Svice Sk/Tr Dr
Hose Bibb Hose Bibb Holidays
Laundry Sink Laundry Sink Days/Wk
Floor Drain/Sinks Floor Drain/Sinks Hrs/Da
Swimming pool Swimming pool
Hot tub/whirl pool Hot tub
Other Other
*No plumbing fixtures are being installed. Initial DAB
Signature below indicates all information provided for on this form is accurate.
Name David A. BaStow Date 04-16-2019