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Building Permit # 9/1/2015
1 NORTH BUILDINGPERMIT ®��t,Eo ,6"tio z 5 •,°6 0 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#.,. ,w Date Received �,®�"0'?ATE D e 1Pa"�t5 ? _ YSSAC HU54 Date Issued: IMPORTANT: Applicant must complete all items on this page i r / r r r. Y , r r r t 4 A J r l l / � t ! r r S I 7 1 ,c�tlMifFa, i r�°� air qayrymoi� i�rypw a,w�iq� r:;� l r �r e l, ! I /i O,r , ��� „ I � « � , s" o,c D s c' r ;•esl� no I 1 •r y r, J r bl / 1. b �, J1 ��/r llrl�UJ� J lllh/l%/l / , TYPE OF IMPROVEMENT PROPOSED USE Res" ential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Oil ,, al / l d et(ands/, r „/ , ❑ at h d I r / ., , l DESCRIPTION OF WORK TO BE PERFORMED: r, Identification- Please Type or Print Clearly OWNER: Name: hon.G kct`S Phone" Address: L( lrr , / 1 � l f �.�,� 1! � ,• s�or s J�o�, �, o : �e ' :e11 A� .�,��,n ,.r ' 1� ���,l� �x��>�r l� � � „ ,, J, , r , !, ,ll�� ARCHITECT/ENGINEER one: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.001PER S.F. Total Project Cost: $ - L FEE: $ 2. Check No.: Receipt No.: i NOTE: Persons con racting with unregistered contractors do not have access to the guaranty fund -71 Signature of Agent/Qwner Signature of contractor !: tkORT H ' town of ndov ti 0 l { f No. -C'1k� ��K. ver°, ass, C0C"1CNEW'CK *1. 4 04ATED P4¢R.=C S U BOARD OF HEALTH lit P R T LD Food/Kitchen Septic System THIS CERTIFIES THAT „•�,• BUILDING INSPECTOR /.�� Foundation has permission to erect .......................... buildings on ......... ...... .IM ....... ••••••°••••••••••• ® Rough to be occupied as ....... .... ..................... .... . .. ........ Chimney provided that the person accepting this permit shall in every respect conform to the term the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final 024n® ER IT I I 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTIO A Rough Service .. ...... ................................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Islay in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. A ' Federal ID tt RISE EngineeringRI Contractor Registration No MA Contractor Registration No ,1 division orThictsch Engineering CT Contractor Registration No (10 Shawmut Unit#2,C:m»on, tiT<102ti21 CONTRACT T 339-502-6335 FAX 339-502.6345 Page 1 PROGRAM TRISCOtrraACT18ENTERED INTO BETWE&FRISE CMA-HES FNOINEERINO AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW ENCINEERING DATE CLIENT WORK ORDER CER USTOM Amanda Rogers (S56)52Q-4484 05/28/2015 415429 00002 STREET ' SERVICE STREET 486 Wood Lane 486 Wood Lane j( .....,....�.. .. ...__.. __.--- BILLWO CtTY,STATE,ZIP SERVICE CITY.STATE ZIP North Andover,MA 01845 NorthAndover,MA 01845 , 2015 JOB DESCRIPTION r1lR SEALING:Provide labor and materials to seal areas of your hams against ivtictetul,excess air Icakagc. This w rk will be performed in amcert tvth the U5U Of$peClAl IoUl5 rind diatgnastic lcsts tU t154Ufe that your ItUiriC 1Ylll be left tvidl a fi 1 air exchange and indoor ttir quality.Materials to bC used to seal your home can include caulks,foams rued other products. Primatry anus farsealing ineiude air Icakagc to nttfcs,basements,attached garages and other unheated ttreats{windows are not generally addressed.) (8)working hour. At the completion of the weatherization work,and at no additional cost to the homeowner,it final blower door andfor combustion salety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. GIANT CIIIMNEY CIIASE.KITCI-IEN VAULT-KWAIA.S.6"FIBERGLASS IS CUT 14.5"WIDE,JOISTS 20"ON CENTER...EFFECTIVE It VALUE. 5680.00 AiR SEALING ADDER: (2)working hours. S 174A0 DAMMING:Provide labor and materials to install tt 12"layer of R-38 unfaced fiberglass balls to(30)square feet rot damming; purposes. %LSO ATTiC FLAT:Provide labor and materials to install a 10"layer of R-35 Class 1 Cellulose added to(644)square rest of open attic space. GIANT CHIMNEY CHASE.KITCREN VAULT KWALLS.6"t'IBERGLASS IS CUT 14.5"WiDE,JOISTS 20"ON CENTER—EFFECTIVE R VALUE, S946.68 Ftti EXISTING INSULATION:Slash the vapor barrier,flip,or rc-position(644)square fe.1 of insulation in the attic arca. $161.00 KNEEWALLS:Provide labor and materials to install 2" FSK faced scrttf-rigid fiberglass board insulation to(118)square feet of knecwali area. $413.00 ATTIC ACCESS:Provide labor and materials to insulate the back ar(i)attic Intel,with 2"rigid'Thermax board.Weaifierstrip the perimeter. $60.00 VENTiLATION:Provide tabor and materials to install ventilation chutes in(30)rafter bays to maintain air flow. $60,00 RISE Engineering will apply all applicable,etigiblc incentives to This cantrall You will only be billed the Net amount. Currently, r calendar year,and an incentive of 100%for the for eligible measures,Columbia Gas offers 75%incentive,not to exceed$2,000 Pe Air Seating measures up to the first$680 and an additional 5340 if savings are Justified by the auditor, For tite safety and health of your homes indoor air quality,we will be conducting a blower door diagnostic of the available air flow in your home both before the work is begun,and after lite wcathenzation Work is complete.We will also conduct a full assessment of Ire combustion snrety of your heating system and Water heater."Ibis has a value of$90 and is at no cost to you. 'fatal allowable weatherization incentive is$3,110• $90.00 I 1 ' Federal IO# RISE Engineering RI Contractor Registration No MA Contractor Registration No A division otThielseh Engineering CT Contractor Registration NO 60 Shtawraut Unit#2,Canton,.%IA 02021 CONTRACT 339.502-6335 FAX 3311-502.6345 Page 2 PROGRAM THIS CONTRACT Is ENTERED INTO BETWEEN RISE ENGINEERINGCMA-HES ENGINEERING AND DESCRBEDG THE CUSTOMER POR WORK AS CUSTOMER PHONE DATE CLIENTm WORK ORDER Amanda Rogers (856)520-4484 05/28/2015 415429 00002 SERVICE STREET BILLING STREET 486 Woad Lane 486 Wood Lane ; . SERVICE CITY,STATE,YIP BILLINO CITY,STATE,ZIP I i 1 —"'" '• North Andover,MA 01845 North Andover,MA 01$84,5( 9045-1 .JOS DESCMPTiON {i,, U Total: X2,6 2.18 Program incentive: $2,095.89 Customer Total: $546.29 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Five Hundred Forty-Six&291100 Dollars $546.29 UPON FINAL IMS P THIN AND PROV BY ISE ENGIN IND.CUSTOMER AGREES TO REMIT AMOUNT DUE LN PULL UIMREST OF i%VALL HE CHARGED MONTHLY OH ANY UNPAID DALAN AFTERS 5,8 R R FORT T It7FORMATiON ON OUARANTEES,RIGHTS OF RECISION,SCHEOULPA AND CONTRACTOR REGISTRATION. DO OT SIGN THIS CONTRACT IF THERE ARE ANY a K SPACES AUTHO KED IGNATU engl fig US ER ACCEPTANCE NOTE:THIS CONTRACT MAY BE VATHORAYIN BY US IF NOT EXECUTED WITHIN DATEOFACCEPTANCE _ __._...-. -� - - - - - ----•• ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE dDAYS. AS SPECIFIED.PAYMENT Writ.BE EMADCAS OUTLNCD AB ARE AVTffORiZEO TO DO THE WORK OWNER AUTHORIZATION FORM (Owners Name) owner of the property located at 1V (' CC/Cjcrc( Lr�1�- (Property Address) -- (Property Address) hereby authorize {Subcontractor} an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. er's Signature Date � 1 { � .l j .._. ... ,i � r .� � � ,: � �.:�1 i ,,� , �, � 'if �� ' ' �� ��� � �r� � � �� I � '� , ;, � � , � , . � .. , . �, f �. . ... �, The Commonwealth of Mas-wehusetts Department of IndustrialAceidenls twee of Investigations it; I Congress Street,Suite 100 Roslon,,VA 02114-2017 www mass.govldia Workers'Compensation Insurance Affidavit: Builders/ContractoWElectricians/Plumbers Ayolicant Information_ _ Please Print I,eg bly Name Address: � �# City/State/Zip: - 3 Thiene , € 3A 13 ` Are you are employer. Check the appropriate box: 1.® I am a emp}oyer with_ 4. t a a general contractor and! Type of project(required); employees(full andlor part-time).I have hired the sub-contractor; t' e�;`construction 2,0 1 am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employtxv 'These%uli-cofthractors havc g, Demolition working for me in an , employees and have�vorkt:-rs' � y capacity.acit p Y ?T, []Iluilding:tdslitian [No workers'comp.insurance comp,msurance,, required] 5. [ We arc a corporation and its 10.Q Ficctrical repairs or additions 3. 1 arty a homeowner doing all work officers have exercised their I I_[)Plumbing repairs or additions myself No workers`co right of exemption per NA(il. ,, } [ �'• t�®Raofrepairs insurance required]` e. 1:52,y 1(4),and we have no employees.[No workers' M[]Other comp,insurance required] "Any applica t that cheeks box 01 Must aw tilt M theitoctiunbdow mowing their policy information. t Tlcwttm t zexs alio sttbout€his atTidatit indicating they arc doing all wart and ilteri hire outside cantrrixmrs must sttbruit a nein aft davit incl€ra€i€g wch- tC cmtraetors that check this box must stta ltod an additional that shooing she pante of the ith-cono—aetors awl Beate scfi ether or tint the-Ke entities ha.,Y etrtploy=s. If the mttrcttrttta tar have employees,they must provide their wtirki.-m'ci-orp,policy number. /am an employer that is providing awrkers°compensation hmurance for my employees, Below is the policy and job site infomation. Insurance Company Namc: 6. t.a-A I tk A si_w' .Lt Policy 0 or Self-ins.Lic.?t: { 2 to!i 4 t kA.. I?xpiration Date-___V—',_?T3 Job Site:Address: vert1A Attach a copy of the workers'compensation policy deelaration page(showing the policy number and expiration date). Failure to sectuc covtragc as required under Section 25x1 of MGL c. 152 can lead to the imposition of criminal penalties of a line up to S1,500.00 ant/or one-year imprisonment,ai ivell as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250M a day against the violator. Be advised that a copy of this stater mnt may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. /der hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Phone# �� 3193 Official use only. Do trot write in this area,to be completed by city or town of eurt- City or Town: _Permitil,icen Issuing Authority(circle one): 1,Board of health 2,Building Department 3.CitylT'own Clerk 4.Electrical Inspector S.Plumbing Inspector 6>Other Contact Person: W Phone#: A` ® DATE(MMIDD/ `/ CERTIFICATE OF LIABILITY INSURANCE 7/7/zo15 15 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(les) 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). CONTACT NancyUsher PRODUCER NAME:__ .-_ - -- -- ------ PHONE (413)536-0804 FAX (413)534-7874 Martin J Clayton Insurance Agency, Inc. (Nc No Ext): _ ---_ —__ LAC,Noi --_ EMAIL 1649 Northampton Street ADORES S:_ ------ -- - - --- P. O. BOX 989 -. INSURERS)AFFORDING COVERAGE NAIC# Holyoke MA 01041-0989 wsuRERA Nationwide-Mutual-Harleysville _ NATIO INSURED INSURERB-_Allied World Natl_Assurance Co. - Gauthier Insulation -INSURER C: 44 ESSEX ROAD INSURERD: - -- INSURERE: IPSWICH MA 01938 1 INSURER F: COVERAGES CERTIFICATE NUMBER:CL157701379 REVISION NUMBER: THIS IS TO CERTIFY THAT 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. - - - -- -- -"" -"- _---- ADDL SUER POLICY EFF POLICY EXP INSR TYPE OF INSURANCE POLICY NUMBER DD YYY MM DD LIMITS LTR X COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE $ 1,000,000 -- _ DAMAGE TO RENTED $ 50,000 000 A CLAIMS-MADE �X]OCCUR P-REMISES�Ea occurrent l - - --_ X GL43487F 7/6/2015 7/6/2016 MED EXP(Anyone person)--$ 5,000 - PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X JECT L- -1 LOC PRODUCTS-,COMP/OPAGG $ 2 000,000 POLICY F . OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY _Lde _accnt)_ $ BODILY INJURY(Per person) $ ANY AUTO -.� -- -- - __-- ALL OWNED _- SCHEDULED BODILY INJURY(Per accident) $ _ AUTOS _ AUTOS -- "---- - - PROPERTY DAMAGE $ NON-OWNED (Pe HIRED AUTOS AUTOS (peraccident)_,_ __—_ __- $ X UMBRELLA LIAB ��OCCUR EACH OCCURRENCE $ _ _ 1,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ _- 1,000,000 r' -_ DED RETENTION BE020792125-194985 10/18/2014 10/18/2015 $ PER OTH- WORKERS COMPENSATION _ STATUTE_ ER-- AND R- _ AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE F NIA A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $ (Mandatory In NH) -- - _ _-__--- -_-_-- If yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CSG, NSTAR AND NATIONAL GRID ARE LISTED AS ADDITIONAL INSURED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MASS SAVE PROGRAM THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CONSERVATION SERVICES GROUP, INC. ACCORDANCE WITH THE POLICY PROVISIONS. 50 WASHINGTON STREET WESTBOROUGH, MA 01581 AUTHORIZED REPRESENTATIVE Daniel Sullivan/MEG ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD M?'d� rdNtbd With pdfFactory trial version www.pdffactory.com 1L/10/2014 1 : 21 :37 PM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE 12,,0/20'14 THIS CERTIFICATE IS ISSUED AS A MATTEII OF IHFORMATIOII ONLY AND CONFERS 110 RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEIIH, EXTENT) OR ALTER THE COVERAGE AFFORDED HY THE I'OLICJES BELOW. THIS CERT1rICATE OF INSURANCE DOES NOT CONSTITUTE A COIITRACT BETWEEN THE ISSUNIG IHSIMER(S), AUTHORIZED IIEPRESE11TA11VE OR PlIODUCEIt,AND THE CERTIFICATE HOU)ER. IMPORTAUT; If the certificate holder If.an ADDITIOfIAL IHSIAM),the poi(cy(les)Mort be endorsed. If 91-M tOGATIO11 IS WAIVED,subject,to the Lefm!; and cundlllons of the pol!cy, certain policies may require an endomomenL. A statement_ on Lhk certificate does not:confer rights to the certiricaLe holderin lieu afsuch endomement(s). ----------_..-----_._... -------'------"------'---------------'-----------' ----'----'---------'----'---'--------------------- I w BOrkl(-y Msirined Risk Services I Clayton Martin J Ins Agency Inc 1 1649 Northampton SI 'AA, Ne Ex, 600834.4589 ;n'r Na; Ebb)215-811A PO Sox 989 AfZRF$5, P()licyS'ervices U)t}erkiP.yrisk,b)m t kJ N36It5 AiT'UI:UfNG( ::i:vkftAVL• NAJI:n Hai oke MA 01041 E A iN� ( Gauthier Insulation Inc NS u:CRP-------- 1 NS DR ER l PO Box 344 N5 LRER il Ipswich, MA 0193$ IN5 tF2FRF !Nsu.ERr COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CEMIFY THAT THE POMIES OF IRCURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD I DWATED, NOTWITHSTANDING ANY REOUIREMENr,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHK;H THIS CERTIFICATE MAY BE ISSUED OR MY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 13 SUBJECT TO ALL THE TERIAS. EXCLUCIONSAND CXINDITIONS OF SUCHPOLICIES.1-P1fIS SHOWN MAY HAVE BEEN REDUCED BYPAK)CLAIMS. yl' TYt'G OF INSIiRANt:F 4, L'R- INaR YdVU Rol kf,Y NDAlAFR k7 A1fC,DlYYYY) h1Af,ri ni?YYY', II6ATS 6 ErtER AL LIA HILI7Y ( _ S AUTO MO NILE UA6tUTY ! $ WORKERS COWEMa ATION i Y1 c'STrtI U. U7H AND EMPLO YERS'LMOILITY l/N TORY!1x1,'!S F.R AkY PROnRiF.i pRnArtiNER!E%Et:u71vF Y 1 A n;n';c,t�;alt*.cR c+tcCunru� ra:A � WC-20-20-001661-06, 1013012014 x10130/2015 Et'ACV r1 CIDGNI S 500,000 E L,DISCASr..£. - - P: 'YEE 500,1X10 gr:li:Pl X�N 01''SPER&HUNS boP a�..� y 500,DDD '1 IiiSGA -PCL.'Y'_A'.11 S i%I.SI'R!r'iq)N'{{)PC Ar!<)NS I CQC A`IUNS f Vf.l+R'L...(AI[,rl,!•.';OI D t01.Ad d:litn♦I Ra::;rk-Sclrtda;v,A:nn.t:.p,,:n:+te5'i9d1 Coverage FJ2cdntt Category Elect.Status Name State(s}_All EnNtieS/Locations _Officer Exclude Kurt Gauthier MA Gauthier Insulation Inc Officer Include Brittnie Aiello 44 Essex Road Ipswich, MA 01938 CERT F TE OL C ELL ION SHOULDANYOFTHE ABOVE DES(RIBEDPOLICIES BE CAhK,ELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Mass Save Program/Conservation Services Group, Inc At,C.U(;VAPK.E WITHTHE POLICY PR()VISK}rIS. 50 Washington Street West Borough,MA 01581 ignature: ACORD 25(2010105) BRAC 3139 i Office of Consumer Affairs and Business Regulation y� N 10 Park Plaza- Suite 5170 Boston,Massachusetts 02116 Horne Improvement Contractor Registration Registration: 173410 Type: Individual Expiration: 10(112016 Tr# 257812 KURT GAUTHIER ---- __ _�_ _..._. . _._.�.. _ ....... KURT GAUTHIER P.O. BOX 344 _. -_ ____ _.. _.__ ____ _.. IPSWICH, MA 01938 _ _- _ --_—.____..... ........_......... ____. Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card SCA 1 0 24M-05,11 . i`�nrrrt>>rrir rf> r f` %tis'arrtt.:erll Office of Consumer Affairs&Business Regulation License or registration valid for individui use only TOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: cll} F tegistratiow 173810 Type: Office of Consumer Affairs and Business Regulation 1 xpiratian: 4611/2046"11116. Individual 10 Park Plaza-Suite 5170 :'' Boston,MA 02116 KURT GAUTHIER KURT GAUTHIER 44 ESSEX RD f IPSWICH,MA 01938 Undersecretary of va{id w' out signature Massachusetts-De . acard of ent of public Sa Buildingfety,RegufstiOns �"Eak&�PB'�:ECi.6a'rRi. K'n'd.'y,'t 'nda6cis �si+rroa�e.t,,ase=a;e:zCesr lomkh XfA 01 9A r r .. stvxz � Expsr do