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Home My WebLink AboutGEICO Phase 3 signed CDR.pdf'�Ne s�nrp5k �� ,; � ,_ �1 1' °,�,... ;• �eie"'• APPLICATION FOF2 CONSTRUCTION DESIGN RELEASE State Form 37318 (R15 / 1-12) Approved by State Board of Accounts, 2012 lNSTRUCTIOlVS: Please type or print clearly. /f multip/e design professionals are involved INDIANA DEPARTMENT OF HOMELAND SEGURITY DIVISION OF FIRE AND BUILDING SAFETY PLAN REVIEW BRANCH 302 West Washington Street, Room E245 �,> Indianapolis, IN 46204 � www. in.govld hs/2372.htm in the certification process, su,bmit an additional page 1 with the appropriate information. ,��,�,�,��, Type of application 0 Standard ❑ Partial ❑ Foundation Request -• � • . . - . Name of project Closest intersecting street or road GEICO Indiana Regional Facility 103rd and Meridian Address (site location, numberand streef) Suite or floor Direction FROM intersection TO project 101 West 103rd Street 2nd floor ❑ North ❑ 5outh ❑ East 0 West City County Is project within city limits? Is building State owned? Carmel Indiana ❑ Yes � No ❑ Yes � No • -. As owner of the project for which this application is being filed, I hereby certify: 1. the description of use and information contained on this application are correct; 2. the project will be constructed in accordance with the released documents and applicable rules of the Fire Prevention and Building Safety Commission; and 3. any changes to the released documents will be filed with the Indiana Department of Homeland Security, Division of fire and Building Safety, Plan Review Branch. Authorized signature Date (month, day, year) 02.05.2014 Name (typed or printed) Title Derrick Millard Project Manager Telephone number Fax number E-mail address ( 317 } 986.3063 ( 301 ) 718.5206 dmillard@GEICO.com Name of owner or business Facility use GEICO Office Space Address (number and street, city, state, and Z1P code) 4608 Willard Ave., Mailstop REFM-1 W Chevy Chase, MD 20815 Foundation Requested - I agree to take full responsibility for removing and replacing any construction found, by plan examination or by inspection, to be in violation of the building codes. I further agree not to proceed with above grade construction until the complete building pians and specifications have been reviewed and released by the Indiana Department of Home land Security, Division of Fire and Building Safety, Plan Review Branch. � -• � • � � � � � � a • r • � • 1 ! I / • � � � r As the design professional for the project for which this application, plans and specifications are being filed, I hereby certify: 1. I am qualified and competent to design such buildings, structures, and systems and have attached a copy of my current registration card; 2. the plans and specifications filed in conjunction with this application were created by me and / or by my persons under my immediate personal supervision and will comply with all applicable buiiding laws and rules of the Commission; 3. the project data contained on this application are correct and correspond with the plans and specifications to be filed in conjunction with this application; 4. the design professional identified below will inspect the construction covered by this application at appropriate intervals to determine general compliance with the released documents and applicable rules of the Commission and will cause all noted deviations from released documents and code violations to be corrected or notify the owner and authorities having jurisdiction of all specific deviations and code violations; and 5. I affirm under penalty of perjury that the representations contained herein are true and i further understand that providing false information constitutes an act of perjury, which is a Class D Felony punishable by a prison term and a fine of up to $10,000. Responsibility is for the following systems: ❑ Plumbing ❑ Foundation ❑ Structural ❑ Architectural � Mechanical ❑ Site ❑ Electrical ❑ Fire Suppression ❑ All of the above ❑ Other Signature .�----- Date (month, day, year) /��j-> �%� _ 02.05.2014 Name (typed or printed) Indiana registration number ❑ ArchiteCt Timothy M. Anderson PE60910324 ❑� Engineer Telephone number Fax number E-mail address ( 317 ) 810-4141 ( 317 ) 810-4140 tanderson@applied-e-s.com Name of firm (if applicable) Applied Engineering Services, IN Address (number and street, city, state, and Z!P code) 9100 Keystone at the Crossing, Suite 200, Indianapolis, IN 46240 Designated inspecting design professional Indiana registration number Telephone number Timothy M. Anderson PE60910324 ( 317 ) 810-4141 STANDARD FILING FEE PROCESSING PARTIAL FOUNDATION INSPECTION LATE FILING TOTAL Page 1 of 2 ��e srarF�k �� a �� = r ,, ,,, ` 4 `�816 Y` APPLICATION FOR CONSTRUCTION DESIGN RELEASE State Form 37318 (R15 / 1-12) Approved by State Board of Accounts, 2012 lNSTRUCTlONS: P/ease fype or print clearly. !f multiple design professionals are involved INDIANA DEPARTMENT OF HOMELAND SECURITY DIVISION OF FIRE AND BUILDING SAFETY PLAN REVIEW BRANCH 302 West Washington Street, Room E245 Indianapolis, IN 46204 www.in.gav/d hs12372. htm �� , ��, ,� � :> in the certification process, submit an additional page ? with the appropriate information. ��;�,,,��,�, Type of application � Standard ❑ Partial ❑ Foundation Request -• . • . . . Name of project Closest intersecting street or road GEICO Indiana Regional Facility 103rd and Meridian Address (site location, number and street) Suite or floor Direction FROM intersection TO project 101 West 103rd Street 2nd floor ❑ North ❑ South ❑ East �i West City Couniy Is project within city limits? Is building State owned? Carmel Indiana ❑ Yes 0 No ❑ Yes �❑ No • -. As owner of the project for which this application is being filed, I hereby certify: 1. the description of use and information contained on this application are correct; 2. the project will be constructed in accordance with the released documents and applicable rules of the Fire Prevention and Building Safety Commission; and 3. any changes to the released documents will be filed with the Indiana Department of Homeland Security, Division of fire and Building Safety, Plan Review Branch. Authorized signature Date (month, day, year) 02.05.2014 Name (typed or printed) Title Derrick Millard Project Manager Telephone number Fax number E-mail address ( 317 ) 986.3063 ( 301 ) 718.5206 dmillard@GEICO.com Name of owner or business Facility use GEICO Office Space Address (number and street, city, state, and ZIP code) 4608 Willard Ave., Mailstop REFM-1 W Chevy Chase, MD 20815 Foundation Requested - I agree to take full responsibility for removing and replacing any construction found, by plan examination or by inspection, to be in violation of the building codes. I further agree not to proceed with above grade construction until the complete building plans and specifications have been reviewed and released by the Indiana Department of Home land Security, Division of Fire and Building Safety, Plan Review Branch. • -• • -. . . •. � ir� . . . As the design professional for the project for which this application, plans and specifications are being filed, I hereby certify: 1. I am qualified and competent to design such buildings, structures, and systems and have attached a copy of my current registration card; 2. the plans and specifications filed in conjunction with this application were created by me and I or by my persons under my immediate personal supervision and will comply with all applicable building laws and rules of the Commission; 3. the project data contained on this application are correct and correspond with the plans and specifications to be filed in conjunction with this application; 4. the design professional identified below will inspect the construction covered by this application at appropriate intervals to determine general compliance with the released documents and applicable rules of the Commission and will cause all noted deviations from released documents and code violations to be corrected or notify the owner and authorities having jurisdiction of all specific deviations and code violations; and 5. I affirm under penalty of perjury that the representations contained herein are true and i further understand that providing false information constitutes an act of perjury, which is a Class D Felony punishable by a prison term and a fine of up to $10,000. Responsibility is for the foilowing systems: ❑ Plumbing ❑ Foundation ❑ Structural ❑ Architectural ❑ Mechanical ❑ Sit 0 Electrical ❑ Fire Suppression ❑ All of the above ❑ Other Signature Date (month, day, year) 02.11.2014 Name (type r printed) Indiana registration number ❑ Architect Ralph J. ower, P.E. PE60860395 �■ Engineer Telephone umber Fax number E-mail address ( 317 ) 810.4141 / 173 ( 317 ) 810.4140 rpower@applied-e-s.com Name of firm (if applicable) Applied Engineering Services Address (number and street, city, state, and ZIP code) 9100 Keystone Crossing, Suite 200 Designated inspecting design professional Indiana registration number Telephone number Ralph J. Power, P.E. PE60860395 ( 317 ) 810.4141 / 173 STANDARD FILING FEE PROCESSING PARTIAL FOUNDATION INSPECTION LATE FILING TOTAL Page 1 of 2