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Home My WebLink About0003.99 State Release1. torn I.Ir'It..AI r Ur GVMHLIANGE (to be'comp/eted by submitter) FOR'OF.FICE,USE ONLY - Please:indicate how you: wish to receive the design release and plans. We will mail.to the.design professional (ownerif no'design professional MAIL We will call the'design professional (owner if ^o design professional ❑ CALL FOR PICK-UP me of Naprojecf Closest intersecting street or road E r C(_u 612,1- .i� Jeff ao Address (sae location, number and street) ,�_ ? Suite or floor (it applicable) 'Direction FROM intersection TO project - C)�O4 G • ❑ North .. ❑, South East ❑ West city and county , . _ Is project within city limits? -t f A hl:l TC1J Yes ❑ No As owner of the project for which this application is being filed, I hereby certify: -1. thedescrl Lo use and information contained on this application are correct; 2. the jeeF,will .b constructed in accordance with the releaseddoeuments and applicable rules of the Commission; 3. changes to ased docu is will be filed with the Off Ice of the State Building Commissioner. Auth zed signatur Name of owner or business r Name (type rprinted) Address (number and str / Ttle rescl � City s ate, ZIP code Telephone number Facility uses As the design professional for the project for -which this application, plans antl'specifications are being filed, I hereby-cerfify: 1. I.am qualified, and competent.to design such. buildings, structures,. andsystems and have attached,a copy of,my: current registration card; 2. the plans andspecifications filed in conjunction with this application were created by me and or by my -persons under my immediate personal supervision and will. comply with allapplicable building laws and rules of the Commission; 3. the project data contained on this application are correct and correspond with theplans and specifications to be filed in conjunction with this application; 4, the design' professional identified below willinspectthe 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 ail noted deviations: from released documents and code violations to.beeorrected or notify the owner and, authorities having jurisdiction of all specific deviations and code violations; and 5. 1 affirm under penalty of perjury that the representations containedherein are true and Ifurther understand that providing false information constitutes an act of perjury, which is a Class D Felony punishable by aprison term and a fine of up to $10,000. Responsibility Is for the following systems: Site Foundation Structural - _ . _ ❑ ❑ ❑ �. Architectural ,® Mechanical' • kC] lIA�4J6 S jElectrical ❑ All Above ❑ Other (specify) ��i, Signature Name of film (i/applicable) o �'�JP�GISTexit ' L Name,(typed or printed) yddress(number and street) - -'- Lp[ lt�TUA2T P, I 2 rAkJ(, L/uE 202 STATF { a Indiana registration number Architect Ciy, state, ZIP codeAJ 1 ^ A`JIAN: •''(. 19 O ❑ EngineerCbP_MtL IN 4(eo 52 NOTE: Seal and signature. affixed before, reproduction shall appear on each page of all drawings antl the Teeeephone /�� ,`a1� •v �, _ `� 1 e rypage s g ndenlce will be too design Architect/Engineer,it none then to the owner. Onu,(mb�er 'L (Jr, 7) GTf•y ` O J Z Nang. of Inep _ n prgfepyoQal (typedprprintedl. NOTARY CERTIFICATE r. SL-i bo __1uAjur STATE OF r_ri —Th i L ci- COUNTY OF T �G-✓VL I H-6 n } SS: Indlana registration number Architect 41541 ❑ Engineer Before me the undersigned, a Notary Public for said County and State,, personally appeared Name of firm (it applicable) Fll rar I .S cjp— who under the penalty f perjury acknowledges the �ar'f R Q,, j 6iu foregoing statements as true this 3 Crfk day of &) D L)eltnUe r Address (number and street) W1 21 S. j24l�.�-Ll t I,, co L Signature of Notary Public G, City, state, ZIP code LDwll,t� I� (co>� My commission expir s: County of residence S /u 9 QOon Page 2 J. rlYudtc I DATA (To be completed by submitter) Please answer all pertinent questions. SBC project number Filing date 2 6 2 NOV 3 0 1998 Scope of work Total existing (If applicable) ❑ New buildin U Addition Remodelin S . FL Is this construction the result of fire or natural disaster? Sewer ❑ Existing ❑ Proposed Addition(If applicable) Addition (If applicable) ❑ Yes No ❑ Public ❑ Private ❑ None S . Ft. $ Fire suppression system in building Detailed suppression system plans and specs Remodeled (if applicable) Remodeling (If applicable) - ❑ Full ❑ Partial 1�4None El Provided, ElTo follow S . Ft. $ 000 If partial, specify where' Located in flood plain (✓county Total building area Square feet 'Total project cost "El /an commission/❑ YB ❑ No I �� Building construction type and occupancy classification Building height Number of buildings this submittal Volume cuoic eat 2 (Stories) ' I (Describe it necessary)"' ( Fee category E only) Indiana rehabilitation standard (Rule 8) used? Evaluation documents provided? Use of conversion rule (Rule 13) proposed? ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Does project include: (Check if Yes) - ❑ Elevator or lift ❑ Combustible fibers storage ❑ Fireworks storage ❑ Explosives storage ❑ High ple 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' HCATu........-C�U.b........_._._......................._ — ....................................................................................................................................................................................................................... - Describe previous or current use of facility IN DETAIL (If existing facility).' .......................................................................................__............._...................-........................................................... Number of persons employed (Max/shift) General comments' Number of persons (public) Has_;,hex work it this location ever been filed? Does project include use of a master plan design release or a factory built modular or mobile structure? L�J Yes ❑ No ❑ Unknown ❑ Yes ❑ No What year and month Previous SEC project number Name of manufacturer (if factory buill) Master plan / Modular file number or modular / mobile seal number Has construction start ? If Yes, has a notice of violation or investigation been issuetl? If No, probable construction starting date? ❑ Yes L/J .No ❑ Yes ❑ No / DEG: .9, DATA. Indiana climate/zone Type o/f�heating fuel Number of tenants No. of elecVlc'meters No. of gas meters BTU/HR/SF/Deq. F walls El North El Central ❑ South CABS 1 1it' (Adjusted for openings) Uo Does project contain skylights, greenhouse, solarium, or large glass area? If Yes, OTTV of roof OTN of Walls Roof/ceiling assembly Yes No IDEl(� I �/ �/N Uo Energy calculations provided? Potable hot water provided? Is it recirculated? Air infiltration rate per Table 502.4.2 Floors (Unheated be/ow) ❑ Yes ---❑-No-- — ❑ Yes- ❑ No- - ❑ Yes ❑ Nc- ❑-Yes-- 0-No - . —-- -Uo'- Total Non-residential lighting power budget Thermostat range heating Thermostat range cooling Slab at grade KW R General comments' Crawl space walls - ACCESSIBILITY* ,,......,,,(( Yes ❑ No Have accessible parking spaces and signage been provided? R SEISMIC DESIGN Is this classified ESSENTIAL FACILITY, ,LI Yes ❑ project as an GROUP d1 ICJ No Does access within building comply with IBC Chapter 11? or HIGHRISE? ❑ Yes ❑ No [��r Yes ❑ No Do toilet rooms and equipment meet accessibility code? (See IBC Chapter',16) Ef Yes ❑ No Does access to building meet accessibility code? Have seismic design procedures been followed per code ❑ Yes ❑ No IJ Yes ❑ No Is buildin desi ned.fon, accessadaptability? requirement? Type of facility (as licensed by Indiana Department of Health) If nursing home ❑ Residential custodial care Nursinghome ❑ Out anent sure ❑ Hos ital ❑Intermediate care ❑ Skilled care Admitting and discharge policy provided Plans show critical heating area Emergencypower ❑ Generator ❑ Battery ❑ None �' ❑ Yes ❑ No ❑ Yes ❑ No Service ❑ .Other (Specify)' NOTE., USE SEPARATE SHEET IF ADDITIONAL SPACE IS REOUIRED Page 3 _y `dM•"'°P 15 :DEC, 1998, 09:.29 i _ CONSTRUCTION„DESIGN RELEASE State Form 41191 (R915-98). s .'Indiana Department of Fire�arid.Building Services 'PLANREVIEW DIVISION .. ` Office of•thiii State Building Commissioner 402. W. Washington. St_ Room,E245 Iri lianapolis; Indiana 46204 SRS ARCHITECTS. ATTN:STUART R SHADE A4184 1132 S ,RANCEL•INE 202 CARMEL IN-46032 F.ire.Prevention and Building Safety, Commission The.pi below. THIS .ISNOTA BUILDING PERMIT All required All construction work must be;in"full compliance.with all with and released by,,this Office before any work: is,alt6bd oLany, rales'of the Commi_ssiom or if it is based on Incove if the work authoriied is not,commenced within one (1).ye CONDITIONS:, 1. No Conditions. . a if an Project number Receipt number Release date 262352 •00 62352 12 14/98 Construction, type occupancy classification" , U-N & REMODEL, Scope of release - h1ECH PLUM ELEC PART ARCH Type of release STANDARD Project name HEALTH, CLUBS OF AME.RICA Street address + 4000 fd 10GTHST City, county CARMEL HAMILTON ad project have been reviewed for compliance with the,.applicable rules of the .A set ofdocuments,released.by lhisbffice`shall be-maintaineHon the conshuction"site,untiLtFie structure is,occupied.,(675 IAC 12-6-19)., Attachments - r Co Rcial ' _ n State Amu Commissioner i•-� Terr}1 Jones f t Dep. of Community Development One Civic ':Square' Carmel ,IN 46032 1 3.9g CONSTRUCTION DESIGN RELEASE a1 State Form 41191 (R9.15-98) S.. 6i Indiana. Department of Fire and Building Services PLAN REVIEW DIVISION Office ofthe State Buildings Comm issioner 402. W. Washington 5t.,,:Roorri E245 Indianapolis,Indiana 46204" SRS ARCH:(TF.CTS ATTN,STUART R SHADE A4184 1,132 S RANCELTNF 9f12 CARME:L [N 46032 26235:2 10 2352 1.2f'1.4/98 E MECH PLUM ELEC PART ARCH STANDARD HEALTH CLLIBS 00 AMERTCA 000 (d 1.06'119 ST CARMEL HAMT.f.TON The plans,. specifications and ap'plicalionsubmitted"for the above referenced project have been reviewed for compliance with -the applicable, rules of the Fire. Preventiooand Building Safety Commission. The project is released for construction subject to, but no4necessarily"limited 'to, the: conditions fisted. ,below. THIS,ISNOT AIBUILDING PERMIT. .All .required.local,permits`and.licenses must be oblainedprior lobeginning,construction work.. All construction work must'be in Iull compliance -with all. applicable State rules. Any changes in the released plans and/or specifications must be filed .with and releasedby this Officebefore any work is alteretl.- This -release may be suspen_ ded or revoked: if it is determined to be issued'io:error,'.in`violation. oPany rules of the Commission or if it is based on'incorrector insufficient information. This release shall expire.bylimitation, and become null and void; if the work authoriied'is notcommenced within one (1),year from the above date. CONDITIONS: 1. No Concliti.nns. is ,A set -of documents, released, by' this office shall be maintained on the construction site until the structure is occupied (675 IAC 12-6-19). Terry :tones / Dept , of "Cnrmnuni.ty Devel r pment One 'Ci.vic Square Cannel TN 46n32