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HomeMy WebLinkAboutBuilding Permit #684-11 - 22 BRIGHTWOOD AVENUE 4/11/2011TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Z- ZS �3 Print MAP NO: PARCEL: L� ( 'ZONING DISTRICT: Historic District yesno Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resiggitial Non- Residential ❑ New Building &bne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ I.�ration - No. of units: ❑ Commercial kl�epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other -4 p .,Well ;. �0 Se ® � _ ❑ -.,� ,3Floodplain Wetlands �- ater ❑Wshed District gWater DESCRIPTION OF -4 "A - � � TO BE PERFORMED: iJf V/ CJ Identification Please Type or Print learly) OWNER: Name: Z-/ l/� / �p f% Phone: Address: 61 i CONTRACTOR Name: (//�j jC �"�/� L/C kpp one: Address: & 5--42 A*91nE:?� IA -12 z'/L7�g Supervisor's Construction License: ' 3 :5a Exp. Dater Home Improvement License: /CP / K 04� Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No FEE SCHEDULE. BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $C' GV FEE: $ Check No.: Receipt No.:yo NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Locationen�- l.J at I-"71 000d' . No. Date Of 14OR7h TOWN OF NORTH ANDOVER I L 1. D > Certificate of Occupancy $ c usEt Building/Frame Permit Fee $ I Foundation Permit Fee $ Other Permit Fee $ r TOTAL $ Check # �4f � 1i' v Building Inspector i I� I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING &DEVELOPMENT 11 COMMENTS CONSERVATION Reviewed on � Si nature COMMENTS HEALTH Reviewed on Si nature COMMENTS i I Zonirg Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Si nature & Date Drivewa Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site yes Located 384 Osgood Street Located at 124 Main Street no Fire Department signature/date COMMENTS Dimension Number of Stories: Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section_21 A —F and G min.$1o0-$100o fine Doc: -Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses. ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2008 I p x 04 a :A o. w O o a a a o G U �, w o G w" W o w G w" d a�' ro w w mE d Un v ..0 Un c� :L m c o cj o � cc � L h I� yr c .i •cj p. C m m m c cc �! E a CF ..to; {r_ .20 CO2 v$ u rn I m C : h W C 1: m 3 q G -cc = c N W W 1 :Em. mo nv - H m OR c IA o.c.c .mom Ma O ev '� Z c o c n m y m c W C m � •d� •97:S O C N V •m LU E O m = cm C CL CD;a O = N A •O $` a.=.., m 7� Cosc O w U m � f) Cs Cf) S rel cm C •C N m _ O � Z cm CD J O I , a W O E O Z d Oy o = co cm O•_ CO) 0 'a O COD O O .g m m CD 0 CD CL~ _ ♦_-+ CD 0 cc CD a EL rma o � _ O O .CJ CO) Z C V CO)CL O C _ c y uj uj Y♦ w W 19 W U) :A 7� Cosc O w U m � f) Cs Cf) S rel cm C •C N m _ O � Z cm CD J O I , a W O E O Z d Oy o = co cm O•_ CO) 0 'a O COD O O .g m m CD 0 CD CL~ _ ♦_-+ CD 0 cc CD a EL rma o � _ O O .CJ CO) Z C V CO)CL O C _ c y uj uj Y♦ w W 19 W U) Toman f )!239 UINNYS C( ,—RAQ ., Employer ID # Salesperson(s): Contractor Reg We hereby submit specifications and estimates for: '�,�- `� �',r2C/,vim• /-� ✓1 � , ,:'.-',f � r II �.-� ,�� !�>`' - � _iii,=✓ -, The following scheduled will be adhered to unless circumstances beyond the contractor's control arse: Work scheduled to begin: (Date Contractor Will Be Contra/ Wo; j) Expected Date of Completion: � � (Date When Contracted Work Will Be Sustantially Completed) TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE THE CONTRACTOR AGREES TO PERFORM THE WORK, FURNISH THE MATERIAL AND LABOR SPECIFIED ABOVE FOR THE SUM OF: $ X.At t ✓' *includes all finance charges in this amount* Payments will be made accordin to the following SCHEDULE: $ a, upon signing contract (*Not to exceed 1/3 of the total contract price OR the cost of special order items, whichever is greater*). or upon completion of $ BY or upon completion of $/�f�- upon completion of the contract�(*Law Lforbids demanding full payment until contract is completed to both parties' satisfaction In order to meet the completion schedule, the following material/equipment must be s any deposit or down payment r peciat ordered before the contracted work begins Maw requires that the actual cost of any special equipment or custom made material which must be ordered in advance to meet the completion schedule-): required by the contractor before work begins may not exceed the greater of (a) one-third of the total contractor price a (b) a D O N G T H I CONTRACT to be paid for Identical copies of the contract -should goTto E Rthe o A R ner and thBeLontratc contractor PACES Home Owners Signature: fi _ Contractors Signature: . a: Date: You may cancel this agreement if it has been signed by a pa ~ Date: �",i► main office or branch thereof, provided party thereto at a place other than an address of the seller, which may be his you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of the agreement. �c� 6� 700 Tom Quinn `(Contract (978) 265.2390 �- ''QUINN)S c CONSTRUCTION / S 868 Mammoth Road • Dracut, Massachusetts 01826 Name t I 4dDate Job Name Job Locationf Job Phone �. p (.D4/ Street Address (Not Post Office Box), CitY/Town, State & Zipcode. X44% r Daytime Phone: Evenin Phone: . pe nA�n .sir-� 9 Mailing address (if different from Salesperson(s):/,�__ ��rjContractor R We hereby submit specifications and estimates fa J Employer ID # >;-4 Exp. Date: ti -40 121. 017 79l %ear , ✓ r� �r!r i % �"r.G ,-elz > /_ i ,c..� S i s�"C /a f � J l'-•'i�'- �fr'� Of i /' c'i�' �'--� C�C./��[ �.�?/, ���1��. • �s=1:r=f% /t' lam- e3f 5,��>� .S^ L/,-Zf �''r�..� " e�--.moi mac` ,.• n /, ,, .��a 5 iC i✓ro� r �uS17 S0 " �i�t/t'�t The following scheduled will be adhered to unless circumstances beyond the contractor's contr I arse: Work scheduled ll begin: �/�%?s yr Expected Date of Completion: (Date Contractor Will Be Contracted Work) (Date When Contracted Work Will Be Sustantia y Completed) TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE THE CONTRACTOR AGREES TO PERFORM THE WORK, FURNISH THE MATERIALAND LABOR SPECIFIED ABOVE FOR THE SUM OF: $/ *includes all finance charges in this amount* P y entsS�w1 11 be made accordin to the ifollowing SCHEDULE: $ pon signing contract (*Not to exceed 113 of the total contract price OR the cost of special order it is greater*). P ems, whichever $ BY_� /_ or upon completion of $ By / / or upon completion of r------------_-_---------------------------------------- ------ $ f e' )1C upon completion of the contract (*Law forbids demanding full payment until contract is completed to both parties' satisfaction If In order to meet the completion schedule, the following material/equipment must be special c/1�� any deposit or down payment required by the contractor before work begins may not ceed the greater fof (a) one-third re the O twork he total contractor pr ce or that the actual cost of any special equipment or custom made material which must be ordered in advance to meet the completion schedule*): a to be paid for O N T IGN THIS CONTRACT IF THERE ARE ANY BLANKS PACE Identical copses of the contract should go to the homeowner and the contractor Home Owners Signature: -11-'" �- .. Date: <51/ I ��c//i' Contractors Signature: -T %,�,.a Date:`.i�J/.r You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller, which may be his main office or branch thereof, provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of the agreement. z I From:Bonnie Welch Fax!D:9784549343 i Page 1 of 1 Date :3i32011 11:54 .AM Page:1 of 1 i OP ID- RW CERTIFICATE OF LIABILITY INSURANCE (MMI. DDN, YYY) P��031031111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 978-459-8681 Francis Provencher Insurance 978-454-9343 Agency, Inc. 530 Rogers Street Lowell, MA 01852 NAMEACT PHONE FAX A1C. No Ext : (A/C. No): EMAIL PRODUCER CUSTOMER ID #: QUI NN -1 INSURER(S) AFFORDING COVERAGE NAIC # I DAV" O R- 'v I z- D I v liCBC10000052400 01/13/11 i 01113/12 PR=M!s=S xu-re 50,000 INSURED Quinn's Construction wsURERA: Endurance American Specialty - 868 Mammoth Rd. Dracut, MA 01826 INsuRERe:Commerce Insurance Company 34754 INSURER C INSURER D : - INSURER E : GENERAL AGGREGATE 1 $ 2,000,000 INSURER F : I.IJVCIC fiI�['J l.! -K 11!"1[ [3 1 F- N1111lIk L-1.+' �<-\/IC Ill �1 �Il l�nn fin. THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD. INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I LTR ' TYPE OF INSURANCE IADDL INSR! SUBR POLICY EFF POLICY EXP WVD 1 POLICY NUMBER MP 11DDNYYY c MMIDDIYWY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A _ l X COVVERCOL GEN=RA LA3:: TY I DAV" O R- 'v I z- D I v liCBC10000052400 01/13/11 i 01113/12 PR=M!s=S xu-re 50,000 LA;MS-V,ADE X OCCUR i VIED EX? (A-iyone person) ' $ 5,000 i I ! PERSONAL & ADV;N-URY i $ 1,000,000 1 GENERAL AGGREGATE 1 $ 2,000,000 I—� ^=N'L AGGREGA; E! W1T APPL S ?E3:PRODUCTSi -CO o/ 0 AGG j $ 2,000,000 1. POLICY I! ?RO- I : J -C1 - ! $ AUTOMOBILE LIABILITY i I I COM, BiNED SN GLE LiM1T $ B ANY.AJTO (Ea accident) ! IBBGS68 05/07110 1 05/07/11 1 ALL OWN ED AUTOS i BODILYINJUPY(Perperson) $ 250,000 X SCHEDULED AUTOS 1 BODILY INJURY (Per acadent)j $ 500,000 I PROPERTY DAMAG= X HIR EDAi;TOS G (Peraccident) i$ 250,000 X NON -OWNED AUTOS I $ �! 1 UMBRELLA LIAB !, OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAMS—MADE I 1 ! I o.- , AGGREGAT E $ ! ' DEDJC T 131E I G I I RETEN ;ON $ .WORKERS COMPENSATION ' WC STAT U- I. 'CTH-i TL LT AND EtrI PLOY ERS' LIABILITY Y 1 N I T, ORY I ER i ANY PROPRiETOPJPARTNER1=XrCUT VE j I i EL, EACH ACCIDENT� $ -, OFFiCERN,_V.3ER EXCLUDED? I ;NIA! (Mandatory In NH) i i ! _ �a, . „_` I DiSEASE - EA E LO : _-I $ yes, desc-be unde.- D= ESOR TON OF OPERATIONS delen• DISEASE PY LiA4? I $ E -G- "' - I I I I I I i DESCRIPTION OF OPERATIONS f LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) "CERTIFICATE FOR WORKERS' COMP COVERAGE WILL BE ISSUED DIRECTLY FROM THE COMPANY WITHIN 2 BUSINESS DAYS* Ckr_K I IF1Cl.1� 1 F- H[)I 11F -R f AAIl-CI I ATIIIAI U 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. - AUTHORIZED REPRESENTATIVE nl U 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD RightFax N1-2 3/4/2011 9:02:27 AM PAGE 2/003 Fax Server I ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (MM'DD.YYYY) 03.04:-2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: FRANCIS E. PROVENCHER 530 ROGERS STREET LOWELL, MA 01852 26F9G INSURED QUINN THOMAS DBA QULNNS CONSTRUCTION PHONE FAX (Arc, No, Ext): FAX (A'C, No): E-MAIL ADDRESS: PRODUCER CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE INSURER A: HARTFORD GROtiP INSURER B: INSURER C: INSURER D• NAIC # 868 MAMMOTH RD INSURER E: DRACUT, LTA 01826 INSURER F: COVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED REVISION NUMBER: TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH BY RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF DATE POLICY EXP DATE TYPE OF INSURANCE POLICY NUMBER (MM',DD\YYYV ) (MM,DD;YYYY) LTR INSR WVD LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE OCCUR. DAMAGE TO RENTED $ PREMISES (Ea occurrence) MED EXP (Any one person) S GENTAGGREGATE LIMIT APPLIES PER: PERSONAL && ADV INJURY $ POLICY PROJECT LOC GENERALAGGREGATE $ PRODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE $ ALL OWNED AUTOS LIMIT (Ea accident) SCHEDULE AUTOS BODILY INJURY $ HIRED AUTOS (Per person) BODILY INJURY S NON -OWNED AUTOS (Per accident)PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE DEDUCTIBLE $ RETENTION S $ $ WORKER'S COMPENSATION AND EMPOLYER'S LIABILITY YIN UB-41IGP704-11 01/15:'2011 01;15/2012 +.^.'C STATUTORY LIMITS OTHER WN ANY PROPERITORiPARTN'ERIEXECUTIVE N E. L. EACH ACCIDENT $ 100,000 OFFICERPME'.BER EXCLUDED? N E.L. DISEASE - EA EMPLOYEE S 100,000 oryin NH) G11 yes, d descr,be uns yes, er E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS bear: DESCRIPTION OF OPERATIONS%LOCATIONS!VEHICLES%RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTD G WORKERS CO1,II' COVERAGE. THE WORKERS' CO'NIPE- SATION POLICY DOES NOT PROVIDE COVERAGE FOR QUIiN1 THOMAS. CERTIFICATE HOLDER CITY OF LOWELL BUILDING DEPT. 375 MERRLMACK ST. LOWELL, AZA 01852 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Raman' A}ger r Office of Consumer Affairs and usiness - Regulation 10 Park Plaza - Suite 5170 W.N. ..• Boston,.Massackusetts 02116 Home Improvement ,��,Cnractor Registration =:-- Registration: 121604 Type: Individual Expiration: 5/24/2012 Tr# 293905 QUINN'S CONSTRUCTION THOMAS QUINN MAMMOTH RD."` ---- ' 868 DRACUT, MA 01826 DPS-CA1 a 50M -04/04-G101216 1 T� Office of Consumer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR Registratior3 -121604 Expiratttin _P_? -412D12 Tr# 293905 TYPe i=inalvldual ' QUINN'S CONST,ktf fiOw- THOMAS QWINN- 868 MAMMOTH R: DRACUT, MA 0182(1 ate Address and return card. Mark reason for change. Li Address ❑ Renewal ❑ Employment [j Lost Card License or registration valid for individul use only before the expiration date. If found return to: Office ofConsumerAffairs and Business Regulation 10 Park Plaza - Suite 5170 - Boston, MA 02116 Undersecretary�"� Not valid without signature t.— i = N-11ts. achus tts - Depat nient of Public. Safet% Board of BuiltlinL= Regulations and Standards Construction Supervisor License I - License: CS 39732 i Re$t'rieted to 00 THOMAS J QUINN.. 668 MAMMOTH RD DRACUT MA'0826 Expiration: 3/2512012 Tr#: 18330 Restricted to: 00 i 00- Unrestricted 1G -1 2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for•revocation of this license. 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