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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 Tenant Improvement for Prudential Insurance Closest intersecting street or road East
New Market Street Address (site location, number and street) 12775 Horseferry Road Suite or Floor 150 Direction FROM intersection TO project North South X East West City Carmel County
Hamilton Is project within city limits? X Yes No Is building State owned Yes X 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 Regents Building, LLC Name (typed or printed) George Sweet Address (number, street, PO Box if applicable) 12821 East New Market Street, Suite 200
Title Manager City, State, Zip Code Carmel, IN 46032 Telephone Number: 317-574-3400 Fax Number: E-Mail: Facility use: Office 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 X Architectural
X Mechanical X Plumbing X Electrical Fire Suppression All Above Other (specify) _____________________________ Signature Name of firm (if applicable) John Mosele Architect Name (typed
or printed) John Mosele Address (number, street, PO Box if applicable) 12760 Horseferry Road, Suite 200 Indiana Registration Number: X Architect 00033389 Engineer City, State, Zip Code
Carmel, IN 46032 Telephone Number: 317-574-9408 E-Mail: jmaarch@comcast.net Fax Number: 317-574-9408 Designated Inspecting Design Professional: John Mosele Indiana Registration Number:
00033389 Telephone Number: 317-574-9408 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 PROJECT DATA FOR 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 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 X Tenant Improvement
Total existing (if applicable) Sq. ft. Is this construction the result of fire or Natural disaster? Yes X No Sewer : X Existing Proposed X Public Private None Addition (if applicable)
Sq. ft. Addition (if applicable) $ Fire suppression system in building X Full Partial None Detailed suppression system plans/specs Provided X To follow Remodeled (if applicable) (Tenant
Improvement) 1,430 Sq. ft. Remodeling (if applicable) $ If partial, specify where* Located in flood plain (check county plan commission) Yes X No Total building area square feet 1,430
Sq. ft. Total project cost $40,000 Building construction type and occupancy classification V-B B Occupancy Building height (stories)* 2 Number of buildings this submittal One Suite Volume
cubic feet (Fee category E only) Indiana rehabilitation standard (Rule 8) used? Evaluation documents provided? Yes X No Yes X No Use of conversion rule (Rule 13) proposed? Yes X 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 * Office use. Describe IN DETAIL previous or current use of
facility (if existing facility)* None – this will be the first Tenant Improvement for this space. Number of persons employed (max/shift) 3 General comments* Number of persons (public)
4 GENERAL INFORMATION Has work at this location ever been filed? X Yes No Unknown Does project include use of a master plan design release or a factory built modular or mobile structure?
Yes X No What year and month? May 2007 Previous SBC Project Number 325616 Name of Manufacturer Master Plan /Modular Number Has construction started? Yes X No If yes, has notice of violation
or investigation been issued? Yes X No If no, probable construction starting date? October 1, 2010
*NOTE: USE SEPARATE SHEET IF ADDITIONAL SPACE IS REQUIRED. Page 2