PLUMBINGFeeDTg
ain
Native e T Water
;.?
"0*.•"
•
w
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
C
In consideration of the issuance to me of this permit I agree to perfo
pertaining thereto and in strict conformity with the plans, drawings, sta
In accepting this pe it I assume responsibility for all work done by eith
ACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
DATE
MIT N? 6906
Architect
Contractor
or Builder
Legal Lot -
Description
Address of
Building
This permit is . nted to the contractor of bid: nwtned above "' qq onstru the building or to install the equij Jent or device described in the appli-
cation herefor in strict compliance with all ordinances pertaining thereto an: with iron�ekstanding that the work willlae performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to an approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are than ed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above ass s •onsib' " or a thorough knowledge of the sad
regulations pertaining to the work covered hereby whether shown on the p1.,: or draw ' . eflts or speci£ica 'oils and that ?
Signe ity for work done by his agents, servants or employees. 1 , ' / t , r '
rmed under this Permi
' Subdi-
vision
Va13ie of
Pr.ject
BY
Contractor's
e No
Amt. o
Permi
PE '
J O
ork covered hereunder in compliance with Allot with . ' ne
or specifications submitted to the proper autho l4liami
yself, my agent, servant oripmployee.
1 944
AUTHORITY
BUILDING r
ELECTRICAL
PLUMBING
Owner of
Building
Architect •�_ - _ _ .
Contractor �. I
or Builder
Legal
Description
Address of
Building
This permit granted to the contractor or builder named above to construct the building or to install the equipment or evice described in the appli-
cation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans ,: = ithout authorization. A further condition which this
permit is granted is the understanding that the contractor of builder named e as + _ ®risibility for a thorough knowle a . c . , '• s � ettE.'. and
regulations pertaining to the work covered hereby whether .'shown on the pla o _ e statenients or ±:; "ficatio s ,• g respon-
sibility for work done by his agents, servants or .employees.
In consideration of the issuance to me of this permit I free to
pertaining thereto and in strict conformity with the plans, drawin
In accepting this permit I assume responsibility for all work don
NT A BUILDER
MIAMI SHORES VILLAGE, FLORIDA
DATE
ERMIT N? 6944
under this Permit
BY
sP:a" OR
B
+lhe work covered hereunder in compliance with
ents or specifications submitted to the propel' authories
myself, , . gent, servant .r . ployee.
Contractor's
L' e se No
ami`
AUTHORITY
194
g.
• PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Vol /q Job Address //,6 ,�/ f 51 Folio
Legal Description
Owner/Lessee / Tenant R I /E- y Master Permit # 8 J
Owner's Address //cif ,JE � � Phone 13? ---- _ cFpt
Contracting Co. b-)A//M Address / 7f -4Q1 703e 7
Qualifier � rE SS# Phone
State # Municipal # Competency # Ins. Co. 1/0)g - 726
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
Square Ft. t7°
Estimated Cost (value)( �Q
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I
certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
Signer . e of owner and/or
-hie/44J 75
Condo Pre e
a te
FEES: PERMIT ,� • RADON
APPROVED:
Zoning B ding
Mechanical Plumbing
Notary as to Owner and/or Condo President Date
My Commission Expires:
Historically Designated: Yes No
Address
Address
Address
Signal. Contractor or Owner=
Notary as to Contractor or Owner - Builder
My Co
`' — SAN A M MO
* COMMISSION NUMBER
''' CC401261
7 " _5P 4 MY COMMISSION .cYa
./
C.C.F. ,. NOTARY �' TOTAL DUE
Electrical
Date
Date
Engineering
STATE OF FLORIDA PERMIT.#
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID
ONSITE SEWAGE DISPOSAL SYSTEM. FEE PAID
CONSTRUCTION PERMIT RECEIPT #
Authority: Chapter 381, FS & Chapter 10D-6, PAC
CONS,RUCTION PERMIT F
[ T New System [ xisting System [
4 4 :
lding Tank
[ Repair [ Abandonment [ Otber(Specify)
APPLICANT: JC ! n 4 ' 4 AGENT: L010 (// l ef C420. i 6,1 212
PROPERTY STREET ADDRESS: � , U � 144
LOT:
PROPERTY ID #:
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
BLOCK: SUBDIVISION:
TT
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6, FAC
REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS
EXPIRE ONE YEAR FROM THE DATE OF ISSUE. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY
PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A
BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH
MODIFICATIONS MAY RESULT IN THIS- RgRMIT BEING MADE NULL AND VOID.
SYSTEM DESIGN:Ag SPEC I�CATIONS
y am '^ -� / -
T [ IGO ] �'GA„�, 7 gi.71 7/ GPD] SZTIC TAJ /AEROBIC UNIT CAPACITY MULTI - CHAMBERED /IN SERIES: [ ]
A [ ] [GALLONS / OPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
N ( ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
K [ ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE I ] PER 24 HRS NO. OF PUMPS: [ ]
D [ 34:0 GUARE FEU/.RIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: ( ] STANDARD [ 1 FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [ i' BED [ ]
N J �
F LOCATION OF BENCHMARK: ��+-
I ELEVATION OF PROPOSED SYSTEM SITE [ ] [I /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
L
D FILL REQ1� L� 12" Qf'If3 1y �fy'Q { §ECN MON REQUIRED: [ ] INCHES
UNDER BO T'TCM OF DRAINFIELD
O SUBMIT BENCI AR BEFORE I'`IBPLCTIr
T THIS PERM) � IS N: T FOR ADDITI N(S)
H -�� INVERT FLFVrATION _
E BOTTOM OF DRAINFIFr_D ELEVATION
R
TITLE:
TITLE:
T111 SEPTIC TANK MIL BE PUMPED AND A SOLID
DIRECTION DEVICE INSTALLED ON THE OUTLET TEE
HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4016 - 0)
APPLICANT
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
3
T emporary /Experimental
CPHU
EXPIRATION DATE: / /, --
Page 1 of 2
nun
> fu!
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM /
SITE EVALUATION AND SYSTEM SPECIFICATIO
''oo t J WE
APPLICANT: Q4 41,4/7/*.j., j AGENT: , • ' 4, D J,t
LOT: Am BLOCK: SUBDIVISION:
'0(4
PROPERTY ID #: n ' [Section /Township /Range /Parcel No. or Tax ID Number]
4' l
TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSO
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMP
PROPERTY SIZE CONFQRMS TO SITE PLAN:
TOTAL ESTIMATED SEWAGE FLOW: �Q
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
BENCHMARK /REFERENCE POINT LOCATION: f
ELEVATION OF PROPOSED SYSTEM SITE IS
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE
SURFACE WATER:
WELLS: PUBLIC:
BUILDING FOUNDATIO
SOIL PROFILE INFORMATION SITE 1
S:
Munsell # /Color Texture
USDA SOIL SERIES:
Depth
I �1
to
to
to
to
to
to
to
to
i
OBSERVED WATER TABLE: INCHES [ABOVE /
ESTIMATED WET SEASON WATER TABLE ELEVATION:
HIGH WATER TABLE VEGETATION: [ ] YES [ ] NO
SITE EVALUATED BY: fJ)41.p
(Stock Number: 5744 - 003 - 4015 -1)
ti
[1,4 [ ] NO NET USABLE AREA AVAILABLE• ACRES
GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
SQFT UNOBSTRUCTED AREA REQUIRED: 3 SQFT
[INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
FT DITCHES /SWALES:
FT LIMITED USE: FT
,e FT PROPER Y LINESg
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [ ] NO 10 YEAR FLOODING? [ ) YES [ ] NO 1
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD, SITE ELEVATION: FT MSL /NGVD
BELOW] EXIS GRADE. TYPE: [PERCHED / APPARENT)
INCHES [ ABOVE / BELOW ] EXISTING GRADE.
MOTTLING: [ ) YES [ ] NO DEPTH: INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION:
DRAINFIELD CONFIGURATION: [ ] TRENCH [ ] [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA:
HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may n t
used)
PERMIT # a 3
SOIL PROFILE INFORMATION SITE 2
-S-
ITEMS.
PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
FT NORMALLY WET? [ ] YES [
PRIVATE: NON- POTABLE: 1/ s FT
FT OTABLF WATER LINES: 44 FT
� 1
Munsell # /Color Texture Depth
- . 4 to ( D
to
to
USDA SOIL SERIES:
to
to
to
to
to
to
DATE: � �✓
INCHES
Page 3 of 3
laNS77.1UCTIONS:
0: Permit tracking nurnher assigned by C:N/11./.
Property owner's fuil name.
Property owner'n legally cuthoriaA
SU3:37.1/7SION: Lot, block, cad auk:division for E1.
177l' 7.10: 27 charactor nu: fo: p (property cpy.r:r.or 7
Check if *---" -4. •••":•-• _ ,
,i! paved ?colic:. :.-c5-cf-we.y c••••".
no_rnally vi,: ain..1:ar, •-• ," ch . .1'S',!.ef3 O.:
7.ecord cwce flow fo.: :
IFAC. aecor ". the r. f.!o•..7 hr.cor' .:••• ••••'" • 4;r- • ,
pe day pe_ 25C2 f.'or .
doe! not er,ucl_ or cN thc; CnV./C.r:1
accord th.:; `Alot of •,...no:;;.:"•:.:.•(••.:.;:
times as !ci•go 75 :lc :::.'"."•••.; • •'
set'ar.cks in f_''.hapt„'... 7.7.12:.52 c co•-
the 'A:cord 'fa:: .
elevation of the p: ". system vit: !n suction cto c. 1:::•. 1 ..013) 'LC;
accord miniraurn. I•ctback which ", • he me :o F•' • :•3 =L
for non cppiic:'.'cle , . 77. 15 • • r
of any public drinking wcil 2,C3 'feel of th£1 c:.:;7311c:7".:r. 10:
ord infe. !eV: , 3ub,joe: "Lo :o c.f..:;cct! to c- - .:ci .
cctual site cievation.
I. AT3i: 0 Boil P - L2O i 11 i Ls "I
cientificaticA JST
cro ":,•/\ !a
.T.'2rnifiqation co_ora
clearl:, ...Jt, z jcIe, - •corr: "7J1\l•' ;
a,cord the dopth of :.. r.":3 of the e;. ".••
appropriate. acco::4 the e tmtt vJc beccol table eievat"on on
historical irt.forrr.tr.t7orl. !rs
accord soil te;:turc or tocciing co for syzIer.
7.f applicr.51e reccre, depth o er:r•c.vciior! ecord "NA" plicch:e.
CC•N::::f.C;JaK.T.ON: Check drainfteici configuration r,-;flui. fock, apeely type.
C-72‘77...?_!A: accord cny r.ddition remarks pertinent to site ":notanation. 1. docEng
3 Signature of evaluator, title, and date of evc.!•.T.tion. ?rofessional cngi7:;(:73 mu cc cli dc.cumonlzt".1
. . . _ .
ON V./Cs.,:::(SHEET 3LEVATION OP SENCMARX /1.11SFELIIENCci FC1r:
I + SHOT:
SITE 1
H.l.
[-] SHOT
STATE OF FLORIDA PERMIT # &re
DEPARTMENT OF ,HEALTH AND REHABILITATIVE SERVICES DATE PAID
ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $
APPLICATION FOR CONSTRUCTION PERMIT RECEIPT #
Authority: Chapter 381, FS & Chapter 10D -6, FAC
APP ICATION FOR: 1
[ ] New System [,..4.1 Existing System [,44 Holding Tank [,J] Temporary /Experimental
[ 'y] Repair [,1(..4 Abandonment [,,V] Other(Specify)
£T Aixt et /6/2 E_
AGENT:
zth9//,4 Avis i,
APPLICANT:
MAILING ADDRESS: / /:/ G ��
TO BE COMPLETED BY APPLIC,INT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE
SITE PLAN SHOWING PERTINENT.FSIURES REQUIRED BY CHAPTER 10D -6, FLORIDA ADMINISTRATIVE CODE.
PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTIQN OR DEED]
LOT: BLOCK:
PROPERTY ID #: ,7A
BUILDING INFORMATION
Unit Type of
No Establishment
1
2
3
4
SUBDIVISION:
PROPERTY SIZE: ACRES [Sqft/43560] PROPERTY WATER SUPPLY: [ 1 PRIVATE PUBLIC
PROPERTY STREET ADDRESS: / /
'46
DIRECTIONS TO PROPERTY: / ,,/Gj J
[ VI RESIDENTIAL
No. of
Bedrooms
3
[ ] Garbage Grinders /Disposals
[ ] Ultra -low Volume Flush Toilets
dJ,4-
[Section /Township /Range /Parcel No.] ZONING:
Building
Area Sqft
APPLICANT'S SIGNATURE: /
HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4015 -1)
[
•
] COMMERCIAL
# Persons
Served
DATE OF
SUBDIVISION:
DATE: g
TELEPHONE: )7 d iFA 0
7
Business Activity
For Commercial Only
[ ] Spas /Hot Tubs [ ] Floor /Equipment Drains
[ ] Other (Specify)
Page 1 of 3
C
to lo?
c
nr.
o ;c
0 : '
Scale:
Notes:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number 95s7 3 g
PART II - SITE PLAN
Each - block represents 5 feet and 1 inch = 50 feet.
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Site Plan submitted by:
Plan Approved
By
ALL CHANGES
HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 002 - 4015 -6)
Not Approved
I
Date
County Public Unit
UST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
Page 2 of 3
Permit No..
Amount of Permit $
STATE OF FLORIDA, }
COUNTY OF DADE.
Owner's Name and Address
Registered Architect and /or En
Employing Plumber's Name
Location and Legal Description Lot_
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors) ________.....
New Building Remodeling ___ _ ..___ Addition
Size Septic Tank_- --- •- ••- - - - - -- _—__Type of Tank_
Feet of Drain Tile_ - - - -. _Dist. Feet of Tank or Drain Field from Well -
Nature of Water Supply: City —Well. ____-__ --- •••Size of Soakage Pit
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)
(Signed)
x / t — /Y Er Street
Date
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be com Meth herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
G
No._1/ d' �� Street -. -- D
91 7
Repair No. of Stories
r
Notary Public, State of Florida
Capacity Cals ............. .- - -.....
O
Plumbing Id tor.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an emr er of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent Supplemen , and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
aster Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the ................. ...... _ ....._ of the above described construction, that be has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by hire stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such minspecdon li mode' necessary by hnproper notice for inspection, or faulty
materials and /a workmanship.
TOTAL
FIXTURES
CLOSETS
BATH
Tues
SS
SHOWERS
LAVA•
TORTE•
SINKS
SLOP
LAUNDRY
Twos T•
URINALS
CATCH
•A•IN
FLOOR
DRAIN
DRINKING
FOUNT'N•
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
G
TRAP
SOLAR
H
DELP
WELL
SPRKLR.
SYSTEM
SWIM'O
POOL
CONTR.
/
LIST
CHECK
Permit No..
Amount of Permit $
STATE OF FLORIDA, }
COUNTY OF DADE.
Owner's Name and Address
Registered Architect and /or En
Employing Plumber's Name
Location and Legal Description Lot_
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors) ________.....
New Building Remodeling ___ _ ..___ Addition
Size Septic Tank_- --- •- ••- - - - - -- _—__Type of Tank_
Feet of Drain Tile_ - - - -. _Dist. Feet of Tank or Drain Field from Well -
Nature of Water Supply: City —Well. ____-__ --- •••Size of Soakage Pit
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)
(Signed)
x / t — /Y Er Street
Date
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be com Meth herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
G
No._1/ d' �� Street -. -- D
91 7
Repair No. of Stories
r
Notary Public, State of Florida
Capacity Cals ............. .- - -.....
O
Plumbing Id tor.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an emr er of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent Supplemen , and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
aster Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the ................. ...... _ ....._ of the above described construction, that be has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by hire stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such minspecdon li mode' necessary by hnproper notice for inspection, or faulty
materials and /a workmanship.
C
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