9160 SW EDGEWOOD STREET ADDRESS:
i Arecords\microflm\targets\building.Hoc
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Lino (Rec-O-Phone): 639-4175 Business Phone: 63T4- 71
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Ap dwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bld
Plbg. Underfloor Rain Drain Flaming Iurnb
Alarm Water Line Insulation Mec
Underflr, Insul. Shear Wall Gyp. Bd. �
Date Requested:___ Time: AM PM
Address:— - �
�'
Builder: --2Permit #:M �> O33
THE FOLLOWING CORRECTIONS ARE REQUIRED:
I7PFIOVED
for: Date:L�
DISAPPROVED _APPROVED SUBJECT TO ABOVE
__Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE Y
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639 4171
inspection:__ 1 X,(
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Inns-ullat�icn� Mech.
Unoerflr. Insul, Shear Wall <!TF o_� -Elect.
Date Requested:_ f' Time: AM PM
Address:
Builder: Permit
+rM-5
'SHE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector:_ Date:_
VED _DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (RecO-Phone): 639-4175 Business Phone: 61
Inspection:
Footing Susp, Ceiling Sprink. Rough-in A r/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line nsu a io -fdech
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: l 'j Time: AM PM
Address: t-)
Permit #y%71
THE FOLLOWING CORRECTIONS ARE REQUIRED: /^
TPPRInsp ,tor: / Date��OVED DISAPPROVED _APPROVED SUBJECT TO ABOVE
—Call For Reinsp.
7L_
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:— q- �j
Footing Susp. Ceiling Sprink. Rough-i1 n04ppr/Sdwlk
Foundation Plba. Underslab ech. RouRou Fireplace
Post/Beam Suuct. Plbg. Top OutE ec. ough it ! FINAL:
Post/Beam Meci�. San. Sewer Gas Line -Bldg.
Plba. Underfloor Rain Drain Q amines Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Heauested: ( d �jZ` �_Time:—_AM PM
Address:`
Permit
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector: — _ Date:
ROVED DISAPPROVED APPROVED SUBJECT TO A30VE
_____Call For Reinsp.
Community Development ELECTRICAL PERMIT APPLICATION c/
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # W
Permit # 11'4IS-
Phone (503) 639-4171 Date Issued /U_-aF 9s:
CITY AI:TIGARD FAX k-503) 684-7297 Issued by _f_ �;,,qtr
TDD No. (503) 684-2772
Inspection (503) 639-4175
Job Address:Address:+ 4. Complete Fee Schedule Below:
Name of Development A Number of Irtrpectione per permit allowed
Address_ l (r�.�r CI_ Service included Items Gost(ea) Sum
laity/State/Zipf �► _� — Is. Residential-per unit 4
1000 rKl It or late $11000
Name or name of business Ern eddAhere f It nn
( )_._—_�+�.-.-� — porton thereof $2500 1
Commercial Re_ dential�l
Un,.!--4 Energy —� 19500 L
Each Manurd Home,r Modular
Dwelling sermis of feeder $6600
2a. Contractor Installation only: 4b.Services or Feeders
Installation.alteration,or relocation 2
Electrical
`Contractor L ► e 201 amps or leas 00 2
Address V• 201 amps to 400 am $80ps $80 00 2
1 401 am to iOU am pe512000
Ci Z
-I T 2ae mS � w
Phone No, Aeq-725A Over 1000 amen or voMe $34000 2
Contractor's License No. _ ,;, �` Reconneri only $6000
Contractor's Boald Reg. No. 4C.Temporary Services or Feeders
J inntallatron nhorabon,or rawkwAtion 2
Signature of SuRr. Elec'n ✓re-,- 200 amps nr lens $5000 2
License No. '� Phone NO.�gq--7:+ 7 201 empin to BW wripe ,10600
-, 401 amps to 800 amps 11100 f)D
Over 600 Amps to 1000 voMe
2b. For owner Installations: neo mob-above
4d.Branch(Circuits
Print Owner's Name. New,alterntion or extension per panel
Addressn)The fee for branch nmAa With
purchaaa or awy"& IWdor Aare.
City _._ _T__ State Zip Fad,branch circuit $500
Phone No. b)The,fen for brarrh warns withotH
The installation is being made on property I own which is purchaso of"rvke or Arador Ara. -oV
'
F„at hranr:h mrcun $1500
not intended for sale, lease or rent. Each additional breach circum $500
C-4ner's Signature _ 4e. Miscellaneous
(Service or feeder not included)
3. Plan Review section (if required): Foch pump or irrigation mrcle $4000
c Fadi sign or outline lighting $1000
Signal cimud(n)or a limned energy ?
Please check appropriate Item and enter fee in section 50. panel,nnerntion or extension $4000
4 or more residential units in one structure Minor LnMln(10) $10000
�Y Service and leader 225 amps or more
System over 600 volts nominal 4f.Each ableaddiIn a inepe a ab over
Classified area or stricture containing special occupancy the allowable in any of the above
as dr,rrriberi in N E.0 Chapter 5 Per inspect on $35 DO
Per hour $..500
In Plant $55 00 _
S,tbmit 2 sets of plans with application where any of the above �—
apply. Not required for temporary construction services. 5. Fees:
NOTICE 5a. Enter total of above fees $ �ot,_
5Y�Surcharge(05 X total loos) $ _
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotai $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF 5b. Enter 25%of hne A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required(Sac 3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal
COMMENCED ❑ Trust Account w g
Balance nue $ 7 vZs~ l
,6(4 <<af,�y ✓rm�T -07M s 7- 9- 6 3�7
LJIY OF IMARD HL1.,E.11-If UF-- PAYMV.NJ RkCE I PT NO. 149
CHRIK AMOUNT 1. r-1
(,LAHKI PRUL GOSH f-)MUUN r a 000(a I
ADDRE-SS x 9160 SW kutikWOOD DN 1 E r 10/e6/95
I
')R
81JIA D I V Vii I UN
9
Of. PflAYMENT (4mtj(1141 PfAiD PURVIUSL 4A 1-114YMI--N1 HMONI P$IAO
TR I CAI, PF.RM I T
1f)(011. AMULINT PAID o 7.
CITY OF i IG'ARD BUIt_DING INSPECTION NOTICE
Inspection Line (Rec-O-Phonr, IQ-4175 Business Phone: 63944
Inspection:
Footing Susp. Ceiling rink. Flough-in A Sdwlk
Foundation Plbg, Underslab Mach. Rough-in Fireplace
Post/Beam Struct. &,c.. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Insulation -Meeh.
Underflr. Insul. Shear Wall Gyp. Bd. -Eleni.
Date Requested: Zime AM PM
Add�� res11s:
1(3�tikier:l� _ U Permit q �-� 33�
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector: Date!0 J� �
L*PfT6VED —DISAPPROVED _APPROVED SUBJECT 17 ABOVE
Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec O Phono): 639-41 75 Business Phone: 639 41
f,1 �
Inspection:
Footing Susp. Ceiling prink. Rough-in Appr/
Foundation Plbg. Underslab Mech. R(,ugh in Fireplace
Postl3eam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Postr'Beam Mech. San. Sewer Gas Line Bldg.
�Ibg. Un ea�laDr� amain Drain Framing Plumb.
Alarm c� ter Line Insulation -Mech.
Underllr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: �� �ll� ` Time: AM PM
Address:
Builder: Permit #:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector: Date:,,
"APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
__Call For Heinsp.
,,t
CITY OF TIGARD BUILDING TION NOTICE '
Inspectbn Line (Rec-O-Phone): 639-4175 Business Phone: 639-
4171 /
Inspection: I C L_
Footing Ceihn
P g Sprmk. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
PosT3eamS rut cf.—_)Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plug. Underfloor Rain Drain F ramin
g -Plumb.
Alarm Water Line I-isulation
-Mech.
Underfir. Insul, Shear Wall
Gyp. Bd. -Flert.
Date Requested:_ �C.' .`-, �� Time: AM __PM
Address:
Permit #:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector:
3
4 -APPROVED —DISAPPROVED _Ac. PROVED SUBJECT TO ABOVE
_Call For Reinsp.
t
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 B.isiness Phone: 639-4171
Inspection,-
4
nspection:
F-0;
oting 5usp. Ceiling Sprink. Rough in Appr/Sdwlk
ou dates Plbg. Underslab Mech. Rough-in Fireplace
Post/Bearn Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post!Beam Mech. San. Sower Gas Line -Bldg.
Plbn - Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. EI t )
Date Request(- -7 Time:—AM PM
Address: C�
U Permit #: LSE 5- D 3.3
THE FOLLOWING iRECTIONS ARE REQUIRED:
Inspector: Date:� s
' �PPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
CITY OF T I GARD MASTER PrRMIT
COMMUNITY DEVELOPMENT DEPARTMENT rt r,m,-r #. . .. . . . . : Tru T^7- -0
13125 SW Hall Blvd.Tigard,Orogot, 97223*6199 (503)639-4171 DATr-' ISSUED.,
Pr'RCEL: 20102DC -17�1617r,37
-:TT!' 09160 TW El)GEW00r) ^37
S30BD I V I I I ONs . . . I EDGE-'WOOD ZONING: n-4, 5
S I-bc 1;. . . .. . . . . . . . L,')T. . . . . . . . . . . . . .
NEI')CIJE ; DWELLING UNITS-0 DAnEMENT. . . , . :0
f7-AS-3 Or' !.-)ORK. 3 ADD BCDRMS;O DATHS:0 GARAGE. . . . . . . . . . ..171 G.
TYP.r. r— 1 11 . . -SF FLOOP PrEnS - --- PCOUTRED
TYPE, OF CONST. :9N FIRST. . . . :77 S f LEFT. . a 0 ft R I GHT., 0 ft
occur-,t-IN(-"/ (-RP. 03 :0 f FRGNIT. :0 ft REEF. 0 f I-
7,T 0 R f F.S� . . . . . . : 1 PINBSM,--NT:0 sof
'4E 7,GHT. . . . . . . . : 1C ft TOTnL-- - --- -.717 f OMOKE DETCC'aRS. :
r�'L.00R L.OAD. - 40 psf VALUE. . . . . . 4979 PA RR TNG SPAXS. . -.0
remarks AvoiTION TO KITCHEN 77 rQ T--r PA H I
PLUMPING
. .. . . . . . : 1 FLOOR DRPINI!7, . . . 0 SAC-t.r LOW
LAVPTORTES. . . . . :0 WATER HEATI.�Rtj. . . :0 TPnPS. . . . . . . . . . . . . . .(A
TUP/51 i0WEPS. . . . :0 1.AlJNDPY Trr,'-!s. . . -o ..,ATTR SPS I NS. . , . . . 70
WA7ER CLOSETS-121 SEWER LINE (ft ) . :0 GREASE TRPE. . . . . . . 10
DISHWP514EPS. . . . : I WOTrR LINE !ft ) . :O OTHER FTXTUr%r.!3. . . . . ;171
GARBAGE DIPP. . . : 1 RAIN bRAIN (ft ) . :(21
Wrc- HINIG 11O.PCI-4, . :0 rF' Q()7:,! DRATN". (11
M7CHnN I COL. FEET -
FUEL. TY17-'r 7, - UNIT I IT11S. it) t A r!0 un t My 3dA 17 P- ",:,-,t
VENTC. . . . . . i2l BPAT $ `r0. 50 JSD 01?/19/95
Mr-1X 111,'OUT.0' BTU VONT erl--I-c 32. 63 rON 09/11/ )5
FURN 100k . . :0 . . . . . . 0 BTOPC A 53 JSD 09/19/95
:-1001-1 0 wnnr,,(, our-*r. - 6 PPRT 00 .JSD Or) 19 95- 1.)Z- 7'-
FLOOR !-URN. . . . :0 CL-13 DRYFRr3, -. 0 r 1.*:35 J c0 D Ql'-) 19/95 �9S x`70,
DOIL.Icr-r) OTHrJ) IJINIT5,0
GAS OUTLETS:O
Pt)UL CLARK
9 1 C,0 SW EnGEWCOD
TIGARD OR 97224
nF,a n e it: f.-3 9 -47 7 0
r'1JNEr
11hicirle #:
Reg 0. . - 000000
A 14. .711 TnTf)t
This pers-I't is iss-led subject to the -qgu)1tiDr.s cc-tp:-,t! in the Rr:.Qu!r7.E1) I I n_N,.—j
-
T Bard Municipal 'ado, State cf Dre. Specialty Coden and all other- I-octing Tnsp Gyp Boarc; Ins p
applicable laws. P11 work will be lane it accov-dan:e with approved round atior I n s p Rain drain insp
pllins. ?his pervit will typir@ if wei-k is not stai6lid viitlhio, H't P00:/Be'.Am Water L.Ine lt,,rsp
Jays A I f -e S? day". Plumb Final
PI.-M'/U 71'J'.- f 10 G ruilding r. iriAl
r' V,1 1.1 M!-I out Ei�r,� inr CantrcjZ
n u I at i n n T p
rail fev- iriTpeutiaTi 639-417-,
• Penait#: 3 S - 0-3-35
Address:
Issued by: Date:
~-- --
1
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construcdon Contractors Board to sign the
following statement before z building permit can be%ssued. This statement is required
for residential building, ;Ic,:triral, mechanical, and plumbing permits. Licensed
architect and ergineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 313:
5q1. 1 own, reside in, or will reside in the completed structure.
2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon comple,:on.
❑ 3A. My general contractor is
(Name) Contractor rcgis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
� OR
® 3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with t%c Constructicn Contractors
Board. If I change my mind and hire a general contractor, I will comract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct acid that I have read and do understand the Information
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
4:5 C
(Signature of permit applicant) (Date)
(White copy to issuing agency permit file.,
pink copy to applicant)
Information Notice to Property Owners
About Construction ReEponsibilities
Note: This Information Notice to Property Owners about Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055(5),
If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure,
you can prevent many problems by being aware of the following responsibilities and areas of concern.
EMPLOYER RESPONSIBILITIES:
If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the
construction or improvement of a residential structure,you will,in most instances,be ruled to be an employer and the people
you hire will he employees. As the employer,you must comply with the following:
Oregon's withholding tax law: As an employer,you must withhold income taxes from employee wages at the time employees
a,'e paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more
information,call the Oregon Dept,of Revenue at 94.5-8091.
Unemployment insurance tax: As an employer,you are required to pay a tax for unemployment insurance purposes on the
wages of all employees. For more information,call the Oregon Employment Division at the Department of Human Resources
at 378-3524.
Workers'compensation insurance: As an employer,you are subject to the Oregon Workers'Compensation Law,and xnust
obtain workers'compensation insurance for your employees. If you fail to obtain workers'compensation insurance,you may
he subject to penalties and will be liable for all claim costs if one of your employees is injured on the job. For more information,
call the Workers'Compensation Division at the Department of Consumer and Business Services at 945-7888.
U.S. Internal Revenue Service: As an employer,you must withhold federal incom,;tar from employees'wages. You will be
liable for the tax payment even if you didn't actually withhold the tax. For more in brmation,call the Internal Revenue Service
at 1-800-829-1040.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Codecompliance: As the permit holder for this project,you are responsible for resolving any failure to meet code requirements
that may be brought to your attention through inspections.
Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for
accidents and omissions such as falling tools,paint overspray,water damage from pipe punctures,fire,or work that must be
re-done.
Time to supervise employees: Make sure you have sufficient time to supervise your employees.
Experdse: Make sure you have the expertise to act as your own general contractor,to coordinate the work of rough-in and finish
trades,and to notify building officials at the appropriate times so they can perform the required inspections.
If you have additional questions,write or cal l the Construction Contractors Board(PO Box 14140,Salem,OR 97309-5052,
503/"178-46_21). The Board is located at 7(H)Summer St. NE Suite 300,in Salem.
prop-ownpn,f
1194
CITY (IV 11WARD -- RECEIPT CW PAYMENT REf'h1Pl Nil. p41n4 u�t,.
CHF UK AMOUNT
HAME a CA ARK, HE T TY .1 CASH 0140UN T a W. $Bel
ow.)RE43N t CLARK, PAUL. F PAYMI-N I (441c. A (A4/19/95
91(bo 13W EDGEWOOD 1-33J81.):C V I!:t 1111'4 r
t I(3ARD OR 97,22:3—
PURI ORO' OF PAYMENT AMU(JN'i PAID F)IIF(PL)Sk% LIF PAYMFN1 (4MUI)N I P1111)
NU 7.Ll.)I NO M M13 T95--03134 50. It PLUMBING F'F AM
.0 . HUM.D PER .3. kjo PLAN I..;HEUK C k: S'9. mks
11161A SW FUGF.W0111)
1 i M t r 1L, AMOLIN 1 PAID 38
„ 14
Residential Building Permit Application
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
.:obalte Address: Cl ik,2 0 SW iED6C'.t�[aC1�
Subdivision: (5-d�fW&g d Lot# I f Office Use 0111V
, � g.�� ��' Contact Date ! / Initials
Valuation: r Result
New Construction Only: (Square Fnotage) PlancklRec# '`7- F
Houso: � Garage: Permit # L41-57,
Relssua of
Corner Lot? Y Flag Lot? Y (V,%, Map & TL#
zone
p _
Owner: LAUD- '�2L_ 'T:[ t=LA 04 Plat
Address: q S(� I,�Q[a`[ Approvals F!9quireq
S "12
Planning Setbacks _ Solar L Engineering _
Phone: ( 503 ) 3Q "'c}_ 7 ---Other�-
Contractor: �.. 0 off„ �►'' " a a tome Required
° Z_ E” ' Subcontractors
Address:
Truss Details _
_.�
Other
Phone: �_1 m"T � ? Nates
Contractor's License # _ -'—
(attach copy of current Ore on license_) ��c�ts �" .S� o�� y'•-/z-�'�
Contact Name: f: )Q }! -
��1
Contact Phone �_) .1 Ola
Subcontrartors: J c r; Arch itect/Engineer:
Plumbing: Address.
Mechanical:
(attach copy of current OR Contractor's License)
Phone:
JOB DESCRIPTION: _ /Y 17—/Old '76 �"• 1 T_�(� �.!.�
---
Applicant Signature Applicant Phone number
Received by { ,' �kt� Date Rc -ivecl
Permit# Account Description amount Amt. Pd. Sal. Due -
M5tfj U 33 1 Bldg. Permit (BUILD) -SO-)-T 5!, JP
Pltjmb. Permit (PLUMB) za v p? 4,0
Mech. Permit (MECN)
StatM Tax (TAX)
Bldg: 3 ,
Plumb:
Mech:
Plan Check (PLANCK)
Bldg:
Plumb:
Mech:
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC) _
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT) -
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
Institutional TIF (TIF-IS)
Office TIF (-r1F-0)
Water Quality (WQ:JAL)
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (EPPRMT)
Erosion Planck/USA (ERPL.AN)
Erosion Planck/COT (EROSN)
TOTALS: ,
i
I
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Cl I Y OF 1'I GARD RE U 1 PT OF PAYMlrW W1~C,*H'I PI NI.,. M35:s
UHLIX AMOU1V 1' a 71. 816
l ra�M r t::1.ARK, PAUL. l:Ns1-1 00
If PORES",), r 916171 17W F.I)LiE-WUC)D I lHYMEN S Chi 1 t r 04/11/'+`,
TIC3ORD OR WWI CV'I.X31(IN a
9 72P.3—
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PURI- 113 ' OF r-AYMF:NI AMUONI PAID PURPOSL F), PAYMEN1 (01OLIN 1 f,IH11)
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