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BP-494 BUILDING PERMIT FIELD INSPECTION Dartmouth Building Department � , q �r Plat: 79 400 Slocum Road-P.O. Box 9399 ,<<,I�,;L � ' Lot(s) : 48-30 North Dartmouth, MA 02747 Lot Size: 73,494 Telephone 508-999-0720 Zone Dist. : sra Issued Date: 02/13/95 Permit No. : 494 Project Location: 30 Sundance Road Number Street Subdivision Name: Fox Run Terrace Nearest Cross Street: Applicant/Agent: James & Caroline Demers Contact Person Phone #: ( ) 508-995-5207 Proposed Use: Residential Residential,Commercial, Industrial,etc. Permit Issued To: Alteration Type of Improvement,Add,Alter,New Const.,Demo,Land/Move,etc. finsih 2nd floor (681 sq. ft. ) indicate no.of bedrooms and bathrooms and other rooms Owner(s) of Record: James & Caroline Demers Address: 30 Sundance Road, South Dartmouth, MA 02748 DATE TIME TYPE OF INSPECTION REMARKS ( INITIAL 95- f!. uej 14 "Tn s e C l J O 4.14e 1-41-1Q ,-/a-9G //rl••, ©�....�.., fig.-.,R� 4� ,,, T ✓) DU PMMIT Dartmouth Building Department Plat : 79 400 Slocum Road-P. O. Box 9399 Lot (s) : 48-30 North Dartmouth, MA 02747 Lot Size : 1. 69A Telephone 508-999-0720 Zoning Dist. : SRA February 2, 1995 (typed) Permit No. : 494 Issued Date : 02 /1 3 / 1995 Clerk : sgh M - Project Location: 30 Sundance Road Nuabir Street Subdivision Name: Fox Run Terrace Nearest Cross Street : Applicant/Agent : James & Caroline Demers Address : 30 Sundance Road, North Dartmouth, MA 02747 Contact Person Phone #: ( ) 508-995-5207 Type of License: Owner: (x) Const. Superv. License #: ( ) Architect : ( ) Engineer: ( ) Other: ( ) Proposed Use: Residential Residential, Commercial, Industrial, etc. Permit Issued To: Alteration Type of laproveaent, Add. Alter, Mee Const., Demo. Land/Move, etc. finish end floor indicate, no. of bedrooms and bathrooms and other rooms Gross Area of Const. : 681 sq. ft. Cost of Const. $ 5, 000. 00 Cost-Other Const. : TOTAL FEE: $ 41. 00 Owner (s) of Record: James & Caroline Demers __ Address : 30 Sundance Road, South Dartmouth, MA 02747 All work shall comply with 780 CMR 5th Ed. (MGL Chap. 142) and any other applicable Mass. Laws or codes and plans on file. • I hereby certify that the proposed work is authorized by the owner of record and I have been authorized by the o ner to make this application as his authoriz gent. A.-, J ' Signature of Owner/Agent : _._ Address : *************** * ******** ************************************** / Signature: /` �7 "` Approved/Iss,1 By : James A. Muse, Local Building Inspector CO MENTS: ORIGINAL 0 APPLICANT ❑ ASSESSORS 0 CLERK 0 COPY QUIL.1) I NG PC PM IT ()art:mouth fluilding Department / Platt 79 400 Slocum Road-P. O., Box 939'4' Lot (s) : 46-30 N r Dartmouth! 14 C.11?7 et 7 L*t 5ize: 1 . 69.14 Telephone 50B -07?0 ioning D 'SRO Febr uar y i 99.3 (t y ped PQr'it it No. si 5'Li ell Oat e / C 1 or t rat rt , :314, Sun _ tit,(1,1c1 31 vision t-4 r rqb,g, Nearest Crose Stremt ; Addr f? tkn p n 0914, 12 ort h a m Lkt, 7 Contact Pers,on Phone #: ( 7 Type of Liuense : Owner: (x) Con!A. Superv„. License *: ( Archttect : ( ) Eca n Pr-oposed Use •,,t Rizt.,4chvAtial. 1 ;.-,fiet4,14v1., PerMit n 4%‘$F.fot tAltftrinfA9,21t; % .t er,e2 *t1"4-ar Gr t• Area o C S t t L1.5. 8 1pt o C.on Cot-Oth TOTAL Oicar !.; o f e & All wor shall comply with 780 CMR 5th Ell,, 04a4„ t7helo.> 14P) and artv -4.1.tber appl. bable Ma5S. Laws or t2o0ess and pi.ons on hereby (;-:ertify that the w-opbsed wor4i authorized, by the owner. of r-Ferr:ord I hove been autnorized by the owner to make thit, appiicat 'fcn as hi si author _aqent, Si ;" of Own /qoot Odde s Jane s A. Muse. Local Pwilf,.'.1ing Inspec.tc)r COMMENTS: (.1.1 OR G NAL 1-1 F4PPL Ci-4NT Ntei ASSESSORS VCLE . COP Plat -2/ Lot T 3 V Address 3 o s"a,,^ C Required approval Approvals received please (X) :approvals Please (X) approvals and required for this project Initial as received DATE INITIALS Zoning Building Comm. A-- //fr.- Board of Appeals Water Card Sewer Card / / Board of Health //rT(q?) - Bond Selectmen Conservation Fire Chief Ok Cross Connections Licensed Contractor Controlled Const. Affid. Other information required 67 .n_ y PERMIT NO. =Y l '/7 TOWN OF DARTMOUTH DATE ISSUED _ O ' g'I TOTAL COST `r y3 yn,`':/ APPLICATION FOR LESS APPLICATION FEE 1 \aea sy BUILDING PERMIT f:7.;;^it r FINAL PERMIT FEE ,G ti -vs,.1! J -13 a 4 Lim LOCATION OF BUILDING ,') 01 Number & Street !0 Jk,k.eba 1Ce K-F:f 01.1 Zoning District/ ` ` 02 Cross Streets(between) and 03 Lot Plat 1 1 04 Subdivision Lot OWNERSHIP COST 05 ❑ Private (individual, corporation, 36 Cost of Improvement non-profit institution, etc.) 36.1 To be installed but not 06 ❑ Public (Federal, State, or local government) included in the above cost TYPE OF CONSTRUCTION 36.2 Electrical 07 ❑ New Construction 36.3 Plumbing ddition -Type of Room(s) 36.4 HVAC 09 TS,46kIteration.WliSVN 23,%-el 41.crur 36.5 Other - Specify 10 ❑ Foundation Only example: elevator 11 ❑ Demolition (#of units if residential) 37 TOTAL l CVO (A)12 CI Moving (relocation) STRUCTURE STATISTICS 38 ❑ Wood Frame 13 Number of Bedrooms 39 ❑ Masonry (wall bearing) 14 Number of Bathrooms (Total) 40 ❑ Structural Steel Full-Tub 41 ❑ Reinforced concrete 3/4 - Shower 42 ❑ Other- Specify 1/2 - Toilet Only RESIDENTIAL-PROPOSED USE DIMENSIONS 15 ❑ One-Family 43 Number of stories Q6 ❑ Two or more families 44 Total square feet of floor area, all floors, Number of units based on exterior dimensions 5 17 ❑ Garage 45 Total land area s uare feet /& 18 CI Shed q /' 19 ❑ Carport 20 ❑ Swimming Pool SEWAGE DISPOSAL In-Ground Above-Ground 21 ❑ Woodstove 46 ❑ Public or private company 22 ❑ Fireplace 47 Krivate (septic tank, etc.) 23 ❑ Other- Specify WATER SUPPLY Y 48 ❑ Public or private company NON-RESIDENTIAL - PROPOSED USE ,49 JPrivate, (well, cistern) , 24 ❑ Amusement, recreational PRINCIPAL TYPE OF HEATING FUEL 25 ❑ Church, other religious 26 ❑ Industrial 50 ❑ Gas 27 ❑ Parking Garage 51 SOil 28 ❑ Service station, Repair garage 52 ❑ Electricity 29 ❑ Hospital, institutional 53 ❑ Coal 30 ❑ Office, bank, professional 54 ❑ Other - Specify 31 ❑ Public utility 32 ❑ School, library, other educational TYPE OF MECHANICAL 33 ❑ Stores, mercantile 55 Will there be central air conditioning? ❑Yes ❑ No 34 ❑ Tanks, towers 56 Will there be an elevator? ❑Yes ❑ No 35 ❑ Other- Specify PARKING PER ZONING BY-LAWS 57 Cl Enclosed 58 ❑ Outside RECEIPT FOR PERMIT 4��ouTH.ya TOWN OF DARTMOUTH ^ 4 V 0 yr' PERM NO. s c� 1 ►=ll T, di y� - No 1884: i Date a,f i Received From ``.-/-Y0--'"�� 71L(.C.-�yv2 •��' 1 a / 3 Owner --a_..1f!1-4 cam., Location 3' O -G.-a`-1- t -1--e -c--R-- ,�` a Type ?4..i`,.. ...e.:-f.--`r Amount Paid --- - i; 46 s ,.`?,'513 1 r^ Received By ,Jr; '----&-.-(_--4 RECEIPT FOR PERMIT oTTI. TOWN OF DARTMOUTH ivmuN w, PERMIT N y - = .� N�:4-.A-C-' .q 3o i=*, Date ' 3 16 Received'�From 1 �✓� 1` " ,!r 0.- Owner 4 V c. ' `1"*"" Location z'-a'"6' .. . e-e. ,."? ,. r'.ei._ C.. ,S'•-- f r - t f -F s' Type f. , -/✓...--- _ .�',,,, ?,_... / % f r Amount Paid y[P ( ,`) = t� "E� ,7,2C Lf/16 Received By Yf r, ''�° )11111 59 Does this building contain asbestos? ❑ YES ❑ NO If yes complete the following: Name & Address of Asbestos Removal Firm: r , t IDENTIFICATION - To be completed by all applicantspl���PLEASE PRINT 60 Owner (print) _ �.IL _ _.�I �( 1[i'1 MIt ' 1t!/t y i NAME MAILI.G ADDRESS TELEPHONE NO. 61 Signature �A' �c"9- ,4_/tu�,ra - i / Li.A' G df;ll :+i= DATE / ? C timmummmi 4 ""' Builder's 62 Contractor (print) /i License No. NAME MAILING 'DR S 1, / ' F TELEPHO -•. 4 63 Signature DATE 64 Architect or Engineer (print) NAME MAILING ADDRESS TELEPHONE NO. 65 Signature DATE CERTIFICATION TO PERFORM WORK 66 I/We hereby appoint NAME ADDRESS as my/our agent for the purpose of applying for and obtaining a building permit for the work to be done described in this application. Signature DATE ADDITIONAL INFORMATION 67 Has A-1 or Determination been issued by Conservation Commission? ❑ YES ❑ NO Submit copy of notification sent to DEQE and the State Dept. of Labor Industries and result of air sample analysis after asbestos removal is complete. 68 Owner or Agent - I certify under peril of the penalties of perjury that the information herein is accurate to the best of Sig Signature‘ knowled � (� -( / 1 l Si natures �'� � DATE l �.3/%S ner or Agent 69 BOARD OF HEALTH REVIEW DATE Inspector or Authorized Person COMMENTS: 70 DPW - WATER Service No. SEWER Service No. To be completed upon issuance of permit- (if applicable) 0- 71 I will post permit and address so as to be visible from street. Signature DATE Owner or Agent 72 'I have received list of regqur inspections Signature s v -ti .t!0i%!) DATE )/2`3/ "-.... / Owner or A nt e 73 , FOR RESIDENTIAL PROJECTS OTHER THAN NEW DWELLINGS: Are you a Home Improvement Contractor subject to the registration law(780 CMR-6)? YES NO a Are you claiming an exemption from the law by homeowner sign-off? YES NO (if yes.submit required signed affidavit) Contractor's Signature: Date PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (780 CMR-6) QUESTIONS or COMPLAINTS? Call or write: Home Improvement Contractor Registration One Ashburton Place-Room 1301 Boston,MA 02108 9... "./.., 617-727-8598 Owner's Signature: C1/�+�a Zeivt-C4A-r..- Date: 7 L 5 8 9$ TOWN OF DARTMOUTH BUILDING DEPARTMENT TELEPHONE 508-999-0720 FAX 508-999-0738 TO: Fire Chief Dist. 1, 2, 3 )11 Board of Appeals Tax Collector ❑ D.P.W. Engineering Board of Health ❑ D.P.W. Water/Sewer I 1 Conservation Comm. E Cross Conn./Water Div. LiSelectmen-Licensing ❑ Planning Board ❑ Town Clerk 9-1-1 Police Department The following is forwarded to your office for your information only - no response is required. PLEASE PRINT The Building Department is in receipt of an application for Plat 11 Lot kiv.;0 , Address 30 `S LAIn n J )12i1 Ad by , /� l-(f //3c1l c C fl' 491, lliato CIS/Cl,,-- 2 lieer CONTACT PERSON&TELEPHONE# demo,construct,alter,occupy.etc. a(n) The plan was received by this office on //�3/J5- • date This office will review said plans and subject to availability of potable water, where required, the provisions of Zoning By-law per MGL Chapter 40A and MSBC 780 CMR 5th Edition will have available to issue or will deny a permit for the above-mentioned work within 30 days of date of receipt. The applicant has been advised that your office as indicated above may require them to apply for licenses or permits subject to your jurisdiction and that they should contact your office, as indicated, for specific information. It is not necessary to respond to this notice unless there is a specific issue at hand or you wish to forward material or information required for permitting. When required, an Occupancy Permit will not be issued until all Town Agencies have had the opportunity to "sign off" that the work under their jurisdiction is complete to their satisfaction. To The Applicant: Be advised that this notice will be sent to the Agencies checked above as they may have separate jurisdiction for your project. Any questions about the Agencies Regulations & Policy should be addressed to the individual Agency. Your signature acknowledges your receipt of a copy of this notice. 975- 5,-76 )60/ii„, ih32/9s- APPLICA\T,TELEPHONE(PLEASE PRINT) SIGNATURE DATE LICENSED CO\TRACTOR'S NAME/TELEPHONE(PLEASE PRINT) DATE DEPARTM.NOT 11.13.94 VA` COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 WASHINGTON STREET James Campbel; BOSTON, MASSACHUSETTS 02111 ,Sor ninssione• WORKERS' COMPENSATION INSURANCE AFFIDAVIT I> (licensee/permittee) with a principal place of business/residence at: (City/State/Zip) do hereby certify, under the pains and penalties of perjury, that: [J I am an employer providing the following workers' compensation coverage for my employees working on this job. Insurance Company Policy Number [ ] I am a solc proprietor and have no one working for me. [ ] I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation insurance policies: Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number 0 I am a homeowner performing all the work myself. NOTE: Please be aware that while homeowners who employ persons to do maintenance,construction or repair work on a dwelling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto are not generally considered to be employers under the Workers' Compensation Act(GL C. 152,sect. 1(5)),application by a homeowner for a license or permit may evidence the legal status of an employer under the Workers' Compensation Act. I understand that a copy of this statement will be forwarded to the Department of Industrial Accidents'Office of Insurance for coverage verification and that failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties consisting of a fine of up to 51500.00 and/ imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fine of 5100.00 a day against mc. Signed this a, Z6. day of 19 Licensee/Permirtet Licensor/Permittor ' N _ THE COLLEC •R?S OFFICE DATE: / c2 cf i 9‘ TO: BUILDING DEPARTMENT FROM: COLLECTOR'S OFFICE RE: PAYMENT OF PAST DUE TAXES PLEASE BE ADVISED THAT N THIS DAY /- '7 THE TAXES FOR PROPERTY LOCATED ON (36 , �1 PARCEL. # 7 J- /a~3 d HAVE BEEN PAID. THE PERMIT WHICH HAS BEEN REQUESTED MAY BE ISSUED. IF YOU HAVE ANY QUESTIONS CONCERNING THIS PLEASE CALL. cc:DEBORAH L. P1VA TOWN COT,T.F,CTOR I UVVIV or DAII.l IVIVU I n au1LUUIVV Utt'At1I MCA! TELEPHONE 508-999-0720 FAX 508-999-0738 TO: 79 1 Fire Chief Dist. 1, 2, 3 Board of -Appeals • / . ;- Tax Collector D.P.W. En0gi�neering 4-r P Board of Health ❑ D.P.W. Water/Sewer Conservation Comm. ❑ Cross Conn./Water Div. Selectmen-Licensing ❑ Planning Board Town Clerk 9-1-1 Police Department The following is forwarded to your office for your information only - no response is required. PLEASE PRINT The Building Department is in receipt of an application for Plat 11 Lot -3a Address Scii n� t2A iriby (. Jgr71r./ (/fl(,( ` a/dx4 P/IT'4'to ll / 2 d( CONTACT PERSON&TELEPHONE# demo.construct.alter,occupy.etc. a(n) The plan was received by this office on //.L3/r5 _ date This office will review said plans and subject to availability of potable water, where required, the provisions of Zoning By-law per MGL Chapter 40A and MSBC 780 CMR 5th Edition will have available to issue or will deny a permit for the above-mentioned work within 30 days of date of receipt. The applicant has been advised that your office as indicated above may require them to apply for licenses or permits subject to your jurisdiction and that they should contact your office, as indicated, for specific information. It is not necessary to respond to this notice unless there is a specific issue at hand or you wish to forward material or information required for permitting. When required, an Occupancy Permit will not be issued until all Town Agencies have had the opportunity to "sign off" that the work under their jurisdiction is complete to their satisfaction. To The Applicant: Be advised that this notice will be sent to the Agencies checked above as they may have separate jurisdiction for your project. Any questions about the Agencies Regulations & Policy should be addressed to the individual Agency. Your signature acknowledges your receipt of a copy of this notice. 9?5- 4(AerieJ, Igi6 1457/93— APPLICANT TELEPHONE(Pt PA E PRINT) 2 SIGNATURE DATE LICENSED CONTRACTOR'S NAMETELEPHONE(PLEASE PRINT DATE DEPARTt.NOT::.:5.- °UTH' vY ('� PERMIT NO. 'C',�c o°�9J� /cr: 1 TOWN OF DARTMOUTH DATE ISSUED _ °. c Nor_- TOTAL COST . � � APP ,CA I©N FOR a\ syy ,i,'/ -.`i LESS APPLICATION FEE • J884• EUII,.I If4/ r, PERMIT f 4 0 :J V/I: FINAL PERMIT FEE _ 4 , n Ate. LOCATION OF BUILDING 11 ii 01 Number & Street 2O Sn�JQfce Ed ',Lb.!, Li, r 01.1 Zoning District • 02 Cross Streets(between) and 03 Lot Plat 1 904 Subdivision Lot OWNERSHIP COST 05 ❑ Private (individual, corporation, 36 Cost of Improvement non-profit institution, etc.) 36.1 To be installed but not 06 ❑ Public (Federal, State, or local government) included in the above cost TYPE OF CONSTRUCTION 36.2 Electrical 07 ■ New Construction 36.3 Plumbing ' •ddition -3ype of Room(s) 36.4 HVAC 09 i2 • Iteration..(-�IIi&Y1 avt-ct 4tcr(;r 36.5 Other - Specify 10 ❑ Foundation Only example: elevator 3 n, 11 ❑ Demolition (#of units if residential) 37 TOTAL , CO0, L' V 12 ❑ Moving (relo-ation) STRUCTURE STATISTICS 38 ❑ Wood Frame 13 Number of Bedrooms 39 ❑ Masonry (wall bearing) 14 Number of Bathrooms (Total) 40 ❑ Structural Steel Full-Tub 41 ❑ Reinforced concrete 3/4 - Shower 42 ❑ Other- Specify 1/2 - Toilet Only RESIDENTIAL-PROPOSED USE DIMENSIONS 15 ❑ One-Family 43 Number of stories 16 ❑ Two or more families 44 Total square feet of floor area, all floors, Number of units based on exterior dimensions 17 ❑ Garage 18 ❑ Shed 45 Total land area, square feet 19 ❑ Carport 20 ❑ Swimming Pool SEWAGE DISPOSAL In-Ground Above-Ground 21 ❑ Woodstove 46- ❑ Public or private company 22 ❑ Fireplace 47 KPrivate (septic tank, etc.) • 23 ❑ Other- Specify WATER SUPPLY 48 ❑ Public or private company NON-RESIDENTIAL - PROPOSED USE 49 likPrivate, (well, cistern) 24 ❑ Amusement, recreational PRINCIPAL TYPE OF HEATING FUEL 25 ❑ Church, other religious. 26 ❑ Industrial 50 ❑ Gas 27 ❑ Parking Garage 51 KOiI 28 ❑ Service station, Repair garage 52 ❑ Electricity 29 ❑ Hospital, institutional 53 ❑ Coal 30 ❑ Office, bank, professional 54 ❑ Other - Specify 31 ❑ Public utility 32 ❑ School, library, other educational TYPE OF MECHANICAL 33 El Stores, mercantile 55 Will there be central air conditioning? ❑Yes ❑ No 34 ❑ Tanks, towers 56 Will there bean elevator? ❑Yes ❑ No 35 ❑ Other- Specify PARKING PER ZONING BY-LAWS 57 11 Enclosed 58 0 Outside 59 Does this building contain asbestos? ❑ YES ❑ NO If yes complete the following: Name & Address of Asbestos Removal Firm: - ' IDENTIFICATION - To be completed by all applicants PLEASE PRINT 60 Owner (print) c C /t�/,1 t ik sc acc1 NAME fc �MAILI ADDRESS �� TELEPHONE NO. 61 Signature Ai�c4 .euctra- £,� �. DATE i/Dt3/(15 (J,n Builder's 62 Contractor (print) ��_` `" License No. NAME .MAILING DR S/� TELEPHO . 63 Signature Se DATE 64 Architect or Engineer (print) NAME MAILING ADDRESS TELEPHONE NO. 65 Signature DATE CERTIFICATION TO PERFORM WORK 66 I/We hereby appoint NAME ADDRESS as my/our agent for the purpose of applying for and obtaining a building permit for the work to be done described in this application. Signature DATE ADDITIONAL INFORMATION 67 Has A-1 or Determination been issued by Conservation Commission? ❑ YES ❑ NO Submit copy of notification sent to DEQE and the State Dept. of Labor Industries and result of air sample analysis after asbestos removal is complete. 68 Owner or Agent - I certify under peril of the penalties of perjury that the information herein is accurate to the best of knowl my azure, d ��C� l�I DATE /��3/9c Signature + nerorAgent � 69 BOARD OF HEALTH REVIEW 4il,l Ai. �-� DATE /—ZI— Y-S - / Inspector or Aothonzed P1erson COMMENTS: d 3 J�/^ '?s T�/ 70 DPW - WATER Service No. SEWER Service No. To be completed upon issuance of permit- (if applicable) 71 I will post permit and address so as to be visible from street. Signature DATE Owner or Agent 72 I have received list of requir inspections Signature w� eBS-I-C, � /rr i-© DATE )/2-3/i Owner or 73 FOR RESIDENTIAL PROJECTS OTHER THAN NEW DWELLINGS: Are you a Home Improvement Contractor subject to the registration law(780 CMR-6)? YES NO Are you claiming an exemption from the law by homeowner sign-off? YES t/ NO (if yes.submit required signed affidavit) Contractor's Signature: Date PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (780 CMR-6) QUESTIONS or COMPLAINTS? Call or write: Home Improvement Contractor Registration One Ashburton Place-Room 1301 Boston,MA 02108 617-72 -859� Owner's Signature: LL-e.� Date: , .L 3 9c 6663/ i -_ ��-�- ..- Rf a { —cry - _tn_ ) 1-7.--11-.4"- fie -.C. 7 -,, , , -.%,* ,1 + SZ fl � '� s ek S 1 I CA NI n % o IN _NI) ._ `_ Li- PIC C-: } .�..hyto11111111140011002101111111100116101010111011 t p p am je in W y, a r M ; roe• w q`p� s` io. to C., S 10 w. � m w. 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