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APPLICATION FOR CONSTRUCTION DESIGN RELEASE STANDARD /PARTIAL FOUNDATION REQUEST State Form 37318 (R13 /8-99) Approved by State Board Of Accounts 1999 Return to: INDIANA DEPARTMENT OF
FIRE AND BUILDING SERVICES PLAN REVIEW DIVISION OFFICE OF THE STATE BUILDING COMMISSIONER INDIANA GOVERNMENT CENTER SOUTH 402 W WASHINGTON ST RM E245 INDIANAPOLIS IN 46204-2739 www.in.gov/sema/osbc/p
lan/index.html PLEASE PRINT CLEARLY PROJECT LOCATION (Must Be Complete and Accurate) Name of Project TRADE SOURCE Closest intersecting street or road SW 1ST AVE Address (site location,
number and street) 200 S RANGELINE ROAD Suite or Floor Direction FROM intersection TO project North South East West City CARMEL County HAMILTON Is project within city limits? Yes
No Is building State owned Yes No OWNER’S CERTIFICATE (Must Be Executed) 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: 3. Any changes to the released documents will be filed with the Office of the State Building Commissioner. Authorized signature Name of owner or business
PEDCOR RESIDENTIAL LLC Name (typed or printed) BRUCE CORDINGLEY Address (number, street, PO Box if applicable) 770 THIRD AVE SW Title PRESIDENT City, State, Zip Code CARMEL, IN 46032
Telephone Number: 317-587-0320 Fax Number: 317-587-0340 E-Mail: Facility use: MERCANTILE 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 Foundation Requested 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 Fire and Building Services. DESIGN PROFESSIONAL CERTIFICATE (Must Be Executed for all new buildings
or additions exceeding 30,000 Gross Cubic feet or any alteration affecting Structural Safety) As the design professional for the project for which this application and plans are being
filed, I hereby certify: 1. I am qualified and competent to design such buildings, structures, and systems; 2. the plans filed in conjunction with this application were created by me
and /or by 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
is correct and corresponds with the plans that are being filed in conjunction with this application: 4. the design professional identified below or a designee 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: Site Foundation Structural Architectural Mechanical Plumbing Electrical
Fire Suppression All Above Other (specify) _____________________________ Signature Name of firm (if applicable) SPACE and SITES, LLC Name (typed or printed) STEPHEN C MCPHERSON Address
(number, street, PO Box if applicable) 6 EAST TAYLOR ST Indiana Registration Number: Architect PE 18900056 Engineer City, State, Zip Code SHELBYVILLE, IN 46176 Telephone Number: 317-392-4444
E-Mail: Spaceandsites@sbcglobal.net Fax Number: 317-392-0709 Designated Inspecting Design Professional: STEPHEN C MCPHERSON Indiana Registration Number: PE 18900056 Telephone Number:
317-392-4444 STANDARD FILING FEE PROCESSING PARTIAL FOUNDATION INSPECTION LATE FILING TOTAL IF MULTIPLE DESIGN PROFESSIONALS ARE INVOLVED IN THE CERTIFICATION PROCESS, SUBMIT AN ADDITIONAL
PAGE 1 WITH THE APPROPRIATE INFORMATION. Page 1
FOR PROJECT DATA OFFICE USE ONLY (to be completed by submitter) Please answer all pertinent questions SBC project number Filing date DOCUMENTS REQUIRED FOR FILING 1. One Application
for Construction Design Release, together with correct filing fees. (See Fee Schedule) 2. One complete filing (paper or e-mail). This filing will not be returned to the applicant. A
set of drawings identical to those released by the Office of the State Building Commissioner shall be maintained on the project site. Weight limit of each submitted package is 30 pounds.
A. Site plan showing dimensioned location of building to all property lines and to all existing buildings on the property, as well as width of any streets, access roadways or easements
bordering the property. B. Foundation and basement plans and details. C. Dimensioned floor plans for all floors. D. Fire and life safety plan showing graphically or by legend the location
and rating of building elements such as area separation walls, smoke barriers, fire-resistive corridor walls, stair enclosures, shaft enclosures and horizontal exists. E. Wall elevations
of all exterior walls including adjacent ground elevation. F. Sections and details of walls, floors and roof, showing dimensions, materials. G. Structural plans and elevations showing
size and location of all members, truss designs showing all connection details, and stress calculations. H. Room finish schedule showing finishes for walls, ceilings and floors in all
rooms, stairways, hallways and corridors. I. Door schedule showing material, size, thickness and fire-resistive rating for all doors. J. Electrical plans, diagrams, details and grounding
of service entrance and power or lighting information required for energy conservation. K. Plumbing plans showing location of fixtures, risers, drains, and piping isometrics. L. Mechanical
plans showing location and size of ductwork, equipment, fire dampers, smoke dampers and equipment schedules showing capacity. M. Fire protection plans showing type of system, location
of sprinkler heads, standpipes, hose connections, fire pumps, riser and hanger details. PROJECT DESCRIPTION (Must Be Complete) FLOOR AREAS ESTIMATED COSTS Scope of work: New building
Addition Remodeling Total existing (if applicable) Sq. ft. Is this construction the result of fire or Natural disaster? Yes No Sewer : Existing Proposed Public Private None Addition
(if applicable) Sq. ft. Addition (if applicable) $ Fire suppression system in building Full Partial None Detailed suppression system plans/specs Provided To follow Remodeled (if applicable)
Sq. ft. Remodeling (if applicable) $ If partial, specify where* Located in flood plain (check county plan commission) Yes No Total building area square feet Total project cost $ Building
construction type and occupancy classification Building height (stories)* Number of buildings this submittal (Describe if necessary)* Volume cubic feet (Fee category E only) Indiana
rehabilitation standard (Rule 8) used? Evaluation documents provided? Yes No Yes No Use of conversion rule (Rule 13) proposed? Yes No Does project include: (Check if yes) Elevator or
lift Combustible fibers storage Fireworks storage Explosives storage High-piled storage Boiler or pressure vessel Hazardous or flammable materials storage Describe proposed use of facility
IN DETAIL including types of flammable or combustible materials stored or handled * Describe IN DETAIL previous or current use of facility (if existing facility)* Number of persons employed
(max/shift) General comments* Number of persons (public) GENERAL INFORMATION Has work at this location ever been filed? Yes No Unknown Does project include use of a master plan design
release or a factory built modular or mobile structure? Yes No What year and month? Previous SBC Project Number Name of Manufacturer Master Plan /Modular Number Has construction started?
Yes No If yes, has notice of violation or investigation been issued? Yes No If no, probable construction starting date? *NOTE: USE SEPARATE SHEET IF ADDITIONAL SPACE IS REQUIRED. Page
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