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Home My WebLink AboutACDR.pdf�E STAPF \ O� � . �\ 0 a,�' �'' � I reie `�� i • - t • \ �' � \ � � ' i �' � � � State Form 37318 {R15 ( 1-12) Approved by State Board of Accounts, 2012 0/VSTRUCTfONS: Please type or print ctearly. lf muitiple design professionals are invotved INDIANA DEPARTMENT OF MOMELAND SECURITY DIVISIONg9O��q F�pIRE qA>eNDyp�BpU�ILqDp9l�Na�G9 SAFETY i"i..I^11Y REYiEYY OISMIV0.seB 3Q2 West Washington Street, RoQm E245 Indianapolis, IN 462�4 www. i n.gov/dhs/2372. htm in the certification process, submit an additional page 9 with the appropriate information. ��;';�,,,,��,,,,M�,�;;,;� Type of application � Standard ❑ Partial ❑ Foundation Request -• • • . . - . a Name of project CEosest intersecting street or road Baume Psychological Services Carmel Drive Address (site focafion, number and street) Suits or floor Direction FROM intersection TO project 12337 Hancock Street Suite 20 ❑ North �■ South ❑ East ❑ West City County Is project within city limits? Is building State owned? Carmel Hamilton ❑■ Yes ❑ No ❑ Yes �■ No • ., As owner of the project for which this application is being filsd, 1 hereby certify: 1, the description of use and information contained on this application are correct; 2. the proaect wiil be constructed in accordance with the released documents and applicable rules of The Fire Prevenfion and Building Safety Commission; and 3. any char�ges to the released documents will be filed with the Indiana Department ofi Homeland Security, Divisior� of fire and Buildir�g Safety, Piar� Review Brar�ch. Authorized signaCure Date (monYh, day, year) 6 August, 2014 Name (Cyped or prinCed) TiYle Richard Carriger Building Owner Telephone number Fax number E-mail address ( 317 } 846-9221 ( } rcarriger@richardcarriger.com Name of owner or business Facility use Hancock Place Office Address (number and sCreet crty, sCate, and ZfP code) 12315 Hancock Street, Carmel, Indiana 46032 Foundation Requested - I agree to take full responsibility for removing and repEacing any construction found, by plan examination or by inspection, to be in violafion of the buildir�g codes. I further agree not to proceed with above grade construction until the complete building plans and specifications have been reviewed and reieased by the Indiana Department of Home land Security, Division of Fire and Build'sng Safety, Plan Review Branch. , -• • -� � . s � r • .e• � '� • / l/! � • � • � 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 attacned 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 camply with aIl applicable building laws and rules of the Commission; 3. the praject 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 wil! inspect the canstruction covered by this application at appropriate intenrals to determine ger�eral compliance with the released documents and applicable rules of the Commission and will cause aIl 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 aff'srm under penalty of perjury that the representations contained herein are true and i further understand fhat providing false information constitutes an act of perjury, which is a Glass D Felany pur�ishable by a prison term and a fine of up to $1Q,000. Responsibility is for the foliowing systems: ❑■ Plumbing ❑ Foundation ❑ Structural � Architecturai ❑■ Mechanical ❑ Site ❑■ Electrical ❑ Fire Suppression ❑ AII of the above ❑ Other Signature Date (monYh, day, year) Name (typed orprinted) Indiana registration number 0 ArChiteCt Stuart R Shade AR00034184 ❑ Engineer Telephone number Fax number E-mail address { 317 } 218-6307 ( ) stushade@att.net Name of firm (if appticabte) Stuart R Shade R.A. Address (number and sCreet crty, sCate, and ZfP code) 13245 Ailisonville Rd, Fishers, Indiana 46038 Designated inspecting design professional Indiana registration number Telephone number Same AR00034184 ( 317 ) 218-6307 STANDARD FILING FEE PROCESSING PARTIAL FQUNDATIQN INSPECTiON LATE FILING TOTAL J CT T ParC of StaCe Form 37318 (R151 1-12) fNSTRUCT(ONS: This page must be completed by the submitter. .-. . SBC project number Filing date (month, day, year) Please answer all pertinent questions and use a separate sheet if additional space is required. One Application for Construction C?esign ReBease (original srgnatures), together with correct filing fees. (See fee schedule.) One complete set of plans and specifications. This set will be returned to the applicant for use at the job site. Additional collated sets may be submitted and returned if stamped sets are needed for other purposes. Please limit the weighf of each submiited package to 3Q pounds. A. Site plan showing dimensioned location of building ta all property Iines and To aIl exisiing buiidings on the property, as weli as width of any sTreets or easements bordering the property. B. Foundation and basement plans and details. C. Dimensioned floor plans for ail floors. Ct. Fire and iife safety plan showing graphically or by Iegend the Iocation and rating of b�ailding elements such as area separation walls, smoke barriers, fire-resistive corridor walls, stair enclosures, shaft enclosures and horizontal exits. E. Wall elevations of all exterior walls including adjacent graund elevation. F. Sections and details of walls, floors and roof, showing dimensions, materials, and heat transfer factors (R-Values). G. Sfructural plans and elevafions showing size and iacation of aIl members, truss designs showing aIl connection details, and all stress caiculafions, if specifically requested. FE. Room finish schedule showing finishes for walls, ceilings and floors in alI rooms, stairways and corridors. I. Door schedule showing material, size, thickness and fire-resistive rating for alI doors. J. Construction specifications (may be on plans for smalt projects). K. Electrical plans, diagrams, details of service entrance, and power or Iighting information required for energy conservation. �. Plumbing plans showing location of fixtures, risers, drains and piping isomeirics. M. Mechanical plans showing iocation and size of ductwark, equipment, fire dampers and smoke dampers and equipmeni schedules showing capacity. -• � • . . •�- � • Scope of work To#a! existing (if appticabfe) ❑ New building ❑ Addition � Remodeling 7312 Square Feet Is this construction the result of Fire or Sewer � Existing ❑ Proposed Addition (!f appticable) Addition (li applicable} natural disaster? � Yes 0 No ❑ Public ❑ Private ❑ Norte Square Feet $ Fire suppression system in building Detailed suppression system plans I specs Remodeled (Ifappfrcable) Remodeling (lf appficabfe) ❑ Full ❑ Parkial 0 None ❑ Provided ❑ To follow 1723 Square Feet $ If partial, specify whsre' Located in flood plain (check county plan Tota! buiiding area square feet To#al project cost commissron) ❑ Yes ■� No 7312 $ Building construction type and occupancy classification Building height Number of buildings this submittal Volume cubic feet VB g (Stories) ,� (Describe if necessary) ",� (Fee category E only} , Indiana rehabilifaiion standard (Chapter 34) used? Evaluation documents provided? Use of conversion rule (Rule 93) proposed? ❑ Yes � No ❑ Yes 0 No ❑ Yes � No Does project include: (Check if Yes) ❑ Hign pile sforage ❑ Boiier or pressure vessel ❑ Hazardous or flammable materials storage ❑ Elevator or lift ❑ Combustible fibers storage ❑ Fireworks sfiorage ❑ Explosives storage Describe proposed use of facility IN DETAI�, including types of flammabls or combustible materials stored or handled --------------------------------------------------------------------------------------------------------------------------- OFFICE Deseribe previous or current use of facility !N DETAIL (!f exrsting facility). ------------------------------------------------------------------------------------------------------------ OFFICE General comments Remodel of an existing sheil suite Rlumber of persons employsd (Ma�cimum per shift) Number of parsons (pubfic) 7 7 .- . Has other work at this location ever been filed? Does project inciude use of a master plan design release or a factory built modular or mobile structure? ❑ Yes ❑ No ❑■ Unknown ❑ Yes �■ No What year and month Previous SBC project number Name of manufacturer Master plan / modular number Has construction started? If Yes, has a notice of violation or investigation been issued? If No, probabEe construction starting date? (month, day, year) ❑ Yes � No ❑ Yes �■ No 7 January, 2015 Page 2 of 2