HomeMy WebLinkAbout0105 WHITE MOSS DRIVE /� l2Y�e /t/ass d�.
�0* Town of Barnstable *Permit
P Expires 6 months from issue dote
Regulatory Services Fee
9c� ;6J& Thomas F. Geiler, Director
pTFD"`A�� Building Division
Q,,1^�
Tom Perry, CBO, Building Commissioner `s
200 Main Street, Hyannis, MA 02601,
www.town.barnstable.ma.us
office" SO06-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number_ 0 31-QQL(- 01 y
Property Address 05 UDV1 14 c H(25S
o
residential Value of Work , 50o Minimum fee of S25.00 for worst under S6000.00 �Jt /0 P'
duca•►¢
Owner's Name a Address TO b Y-) n__j0�15
105 l.J In 1 f_ H o s S Dr. 5 4o n 5 CL-I t LLS
Contractor's Name Telephone Number
Home Impreverricnt Contractor License# (if applicable)
Construction Supervisor's License 4 (if applicable)
❑Workman's Compensation Insurance 64%-PRE.SS PERMIT
Check one: SEP 2 d �009
I am a sole proprietor
X I am the Homeowner TOWN OF BAR❑ I ka: ;Yorker's Compensation Insurance NSTAB1,
Insurance Company Name
Workman's Comp. Policy 11
Copy of Insurance Compliance Certificate must be on tile.
Permit Request.(clieck box)
Rc-it3vf(SiiiNpiii�uiu sh:,-igles) Ali Constructions debris will be taken t0 rJ� �, r `-"^"
U Re-roof(not stripping. Going over existing layers of roof)
LJ Re-side
Replacement Windows. U-Value (maximum .44)
*where required; Issuance orihis permit does not exempt compliance with Other town department regulations,i.e.Historic;Conservation,etc.
*"Noie: P operry O::^er 1„ust sign Property O„r,er Letter of Permission.
t r « n _ r �, r _,, « , >d
uiiic rvVi2nt I--ontla0t0rS L1Canse tx �,viuuuct SLipervistors �iCense is Iequi, .
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Q:\WPFII ES\t=nh.rvtS\Fxpress\EXPRESSP RMIT.DOC
Revisc06O4O9
The Commonwealth of Massachusetts
Department of Industrial Accidents
4�E Oil
Office of Investigations
600 Washington Street
Boston, MA 02111
iuwm inass.gov/dia
`vvoricers' C ampensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address: 111-1 7—/J
City/State/Zip: lylfaxxone #: 7;?,5'6�c7-,:;KZ2
Are you an employer?Check the appropriate box: Type of project(requited):
1.❑ I am a employer with 4. ❑ I aura general contractor and I
employees(full and/or part-time).
* have hired the sub-contractors 6. ❑ New construction
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
shipand have no employees These sutb-contractors have
8. [] Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp, insurance comp. insurance.$
5. We are a corporation and its 10.0 Electrical repairs or additions
required.] � ❑ p
3. I am a homeowner doing all work officers have exercised their 1 I.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.[rRoof repairs
insurance required.] t c. 152, '3'1(4),and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
*Any applicant that checks box HI must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
+Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. if the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins. Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine ttp to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the D1A for insurance coverage verification.
1 do hereby certify a lr,r he pain and penklties of perjury that the information provided above
�is-true and correct.
Signature: _ Date: ,r y
Phone'#:
Official use`only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
P i
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
'. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire,
express or implied, oral or written." f
An employer is defined as"an individual,partnership, association,corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual, partnership,association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with•the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees;a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations itr (city or
town),"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for fixture permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves.etc.)said person is NOT•-required to complete this affidavit:
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 4-24-07
Fax # 617-727-7749
www.mass.gov/dia
THE Town of Barnstable
OF Tp�
Regulatory Services
ST,� Thomas F. Geiler,Director
y MASS.
�A 1639. ,0� Building Division
lFD MA'I a
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: S e-104. ?_ I Z0 o Cj ?
los LOCATION: 1.05 LA—)h WIOS r 4�ox ns-�O,bl 2 NC7il t6n s Mt BLS
number {� street village . I
"HOMEOWNER O
-- Jh n f)0_0Q 1 S 5D -yZO'Z9/U 7 5M-7 757
-
name home phone# work phone#
CURRENT MAILING ADDRESS: D• EJ Q�C 10416
MansYons N/U-s mQ. oZan y 8
city/town state zip code
The.enrrent exemption for"homeo amers"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to
be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner..Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit (Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
. require ts. ..
Slin
atureof, ome
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with die
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section.109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You rnay care t amend and adopt such a form/certification for use in your community.
Q:\WPFILES\FORMS\homeexempt.DOG
�1►,E To,,, Town of Barnstable
Regulatory Services
• IARNSTABLE,
y mass. Thomas F. Geiler,Director
Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner lust
Complete and Sign This Section
If Using A Builder
as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building permit application for.
(Address of Job)
Signature of Owner- Date
Print Name
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
Q:FORMS:OWNERPERMISSION
id }
Assessor's offioe (1st floor): _ d D Z-/ oFTNEtO
Assessor's map and lot number ... ... ' r'" ....V................
Board of Health ,(3rd floor): J !n
Sewage Permit number ...................� ...�.: ..o . �C� — I 3 41 V �' L Bas33TsnLE,
NAB.Engineering Department (3rd floor): S- rJ ooe, 39•
%
House number ....................................................... .............• ' 'fpYpTd•
APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only'
TOWN -OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ......1',.. lVGI�..� ............................................
TYPEOF CONSTRUCTION ............... ........ ......................................................................
. QQ//
........................' 1 ........19....0.E
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies fo�r� Ja'rpermit according to the following information:
Location .........�i .1.....�.......... ..... �n`�5.... .�..!!G........M•��!�J` ( ....... .� ,
Proposed Use �1�/%� nn L I `� .................................................
Zoning District ....... .. .....................................................Fire District ........M 15W/US �1.4G4S
�1 p Q..................................................................
Name of Owner /!l/`=+=!`•� �r�'/`- ` G�`/�.-.T........Address ..... 7�dX �1�,
r
Name of Builder ..... .. ...................Address ....... ?.F' !. ...........................................................
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms .............Foundation ......p0(J/L�I� !OMC g? ...........
n I
Exlerior 4.Aa5...........Roofing ..........�9'•ft ..... 7............................
Floors ..�I.L�"/(;./�/.(...'.. �..��1G�...................Interior ............ .�.C.iT jLC
Heating "� .................Plumbin' --- �y,—
�� g ......... .......711. .....................................................
Fireplace vl(_ ................................................................Approximate Cost�. ...:�. ?..................................................
Definitive Plan Approved by Planning Board ---- U-:--17.
-------19 �O_ . Area ..........................................
Diagram of Lot and Building with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH
� X e__ 0-
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ... �` ...�` ..
v /j
Construction Supe,rvisor's License .........ice/�I.......
GREENBRIER CORP. A=03J---3Q0.43-Qd11-005-012
�o
No 3 N)3123 3.,.Pe it for ..:1L.ES f: .rY ............
Single Family Dwelling
Location .Coto*#3I 10y5.,.White Moss Drive
Marstons Mills
Owner .......Greenbrier................................
Type of Construction ......Frame
............................:..................................................
Plot ........................:... Lot ..:.............................
Permit Granted .....•r•ebruary 13 , ••19 8 7
Date of Inspection ....................................19
Date Completed ......................................19
a
TOWN OF BARNSTABLE 3043.2
Permit No. .................
FFBUILDING DEPARTMENT
D°8�3� I TOWN OFFICE BUILDING Cash
' HYANNIS,MASS.02601 Bond X
CERTIFICATE OF USE AND OCCUPANCY
Issued to GREENBRIER• CORP.
Address lot #31 105 White Moss Drive, Marstons Mills
USE GROUP FIRE GRADING OCCUPANCY LOAD
THIS PERMIT WILL,NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
•
.........: .........., 19......37....... ....................
�-
Building Inspector
��.,� °•, TOWN OF BARNSTABLE
BUILDING DEPARTMENT
= rAUST = TOWN OFFICE BUILDING
rua
i639' HYANNIS, MASS. 02601
�o cur r.
r '
MEMO TO: Town Clerk
FROM: Building Department +°
DATE:
An Occupancy Permit has been issued for the building authorized by
Building Permit #.... �.? . ....... _....._......_.......... ...._......_ ......
issuedto ...... -/' ........ .....( ....z............. ...................... ...... ._..__. . »_... __._....... _ .___
Please release the performance bond.
r
TOWN OF BARNSTABLE, MASSACHUSETTS BUILDING PERMIT
NA 22
DATE 19 PERMIT 1`
APPLICANT ADDRESS
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO (_) STORY - DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) DISTRICT
(NO.) (STREET)
BETWEEN AND
. (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE FT, WIDE BY FT. LONG BY FT, IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS:
AREA OR PERMIT
VOLUME ESTIMATED COST $ FEE
(CUBIC/SQUARE FEET)
OWNER
BUILDING DEPT.
ADDRESS BY
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR
PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY. NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP-
PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED
FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIRED FOR PERMITS ARE REQUIRED FOR
ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ELECTRICAL, PLUMBING AND
1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
MINAL INSPECTION
TI 70 LATHE FINAL INSPECTION HAS BEEN MADE.
3. FINAL INSPECTION BEFORE
OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS PLUMBING,INSPECTION APPROVALS ELECT CAL INSPECTION APPROVALS
1 1
2 2' J 2
a
oX
HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT
OTHER �p BOARD OF FIEALIH
-t987.
WORK SHALL NOT PROCEED UNTIL THE INSPEC. PERMIT W!L L BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON'THIS CARD CAN BE
TOR HAS AFPROVED THE VARIODUS STAGES OF WORK 15 NOT STARTED WITHIN SI,' MONTHS OF DATE THE ARR.A..NnED Furl BY TELEPHONE OR VlhlT TiiN
CONSTRUCTION. PERMIT iS ISSUED AS NOTED ABOVE. NOTIFICATION.
•
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I CERTIFY THAT THE
f
SHOWN ON THIS PLAN IS ����;{ °f
LOCAT''D ON THE GROUND � ►N
�AS INDICATED ,-
Wi C
SFr ISTE�E�
i DATE REGISTERED LAND SURVEYOR
EvY EE DREDGE ASSOCIATES,INC.
CLIENT G�EE�e1 CERTIFIED PLOT PLAN a.
ENGINEERS - LANDSCAPE ARCHITECTS JOB NO.-le 3 't
PLANNERS— LAND SURVEYORS LO•T 3i {s
1,✓H/TF �fe 53
'DV�i. BY
= �.2=t/i' ?�
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689 WEST MAIN STREET �CHKD. BY, ZARnt5TAt3AF_,,•tq
CENTER_S_.I__L_LE__MA_._0._..2632 SHEETOFL _ SCALE=
...... _ yo' DATE= # "
s� 7
Assessor's offioe Ost floor): ,!�� �THE T
Assessor's -7nap and lot number . .—`D 3/ — fJ a L/ rnf o 0 0�♦
Board of Health -(3rd floor): ,'� �Q� ,,-y �J �� - 0 ,5
G 5
Sewage Permit number .. ...... ...... . - '
�V ► 3 V�e�Fja R + Z B eTALLL, i
• f�1iNn
Engineering Department (3rd floor): s— YJ S pt9'tj� ��� COMP o t639• 0�
House number
APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only wlgN AL CODE A
MEwr v�►MONS
TOWN OF BARN +I
BUILDING `INSPECTOR
APPLICATION FOR PERMIT TO ...... ...7 ...!/ !. ..... . ........................................
TYPE OF CONSTRUCTION ...............�V �/ ........ .....................................................................
........................1. . o........19..8.E
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the' following information:
Location .......:.li .'.!:.. 1......rl .... .....!.1/. -.(.V��1,.....l��k:JJ�S ....... �C�4✓............
ProposedUse ....... . ..........................................................................................................
Zoning District ....... ,. .....................................................Fire District .......�.Y(� '/ru/VS ��liGs
AeAo
n /� p . ... .. . ...... .................................
Nome of Owner .... /.`-{;-i' `......4�Qf`-7.........Address .....�.�. :.J�l�....�I
Name of Builder .......4.411111 ............................................Address ....... .........................................................
Nameof'Architect ...................................................................Address ............................:.................................
......................
Number of Rooms ��U!�
......................................................Foundotion ...... .. . . .............. ........ .... .. . .............
Exte lo. ,, ............Roofin r .W./1✓° .�'1 t1"�j�!.��.... Y'!.1.� g ..........�p1./:.7.1.S - l.........��— � ........................
Floors ....i/.L .lL.. 15 !7 J!. ...................Interior ............
Heating ......K�y_-M-2. ..................................Plumbing ........... ... .......................................dGr Fireplace ..... 1 ................................................................Approximate Cost ........... ... .......t.........................................
Definitive Plan Approved by Planning Board - )U-Z-J7-_ 6 ...
------)9�---- . Area ...// �;- ..
..............
.......
Diagram of Lot and Building with Dimensions 'm Fee ..SUBJECT TO APPROVAL OF BOARD OF HEALTH CLc%
X 21 -
-f Y, 22 roc
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction..
Name / G�.� . r ...... ...f '-:.....
t Construction Supervisor's License ......... / .. ....
GREENBRIER CORP.
No 3.0 4 3.2... Perm
it for O.n.e...S.to.ry..........vv
....... .. .. .. .. .. .... ..
Single Family Dwelling
........................................................................
Locotion,*-..L.o.t....#.3.1.........1.0.5...White...Moss -Drive
.................DM) S.t4ns..Mills........................
Owner .......Greenbrier...Cori.. . ..................
.. .... .. .... .. . .. ..
Type of Construction Fram6r--
................:.........................
...............................................................................
Plot ............................. Lot ................................
Permit Granted .......February....1.3.,..I9 8 7
.. ..... . .. .... ..
Date of Inspection ....................................19
Date Completed ..... 19
..............
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