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10135 SW Inez St
CITYOF TIGARD _ SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2000-00207
13125 SW Hall Blvd., Tigard, OR 97223 1503) 639-4171 DATE ISSUED: 7/25/00
SITE ADDRESS; 10135 SW INEZ ST PARCEL.: 2S111BC-0700
SUBDIVISION: TIGARDVII_LE HEIGHTS ZONING: R-3 5
BLOCK: _—LOT: 010 _ _�iJURISDICTION: TIG
TENANT NAME:
USA 1':0: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS: 1
TYPE OF USE: SF WO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection. Paid $8,000.00 fee for reimbursement district#13 on 7/25/00. DLH
Owner: -
HALL, JANET M FEES— _- -
10135 SW INEZ Type By Date Amount Receipt
TIGARD, OR 97224 PRMT BLD 7/25/00 $2,300.00 0003961
INSP BLD 7/25/00 $35.00 0003961
Phone: Total $2,335.00
Contractor: ^
Phone.
Reg #:
Required Inspections
Sewer Inspection
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires
180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not
guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given,the installer
shall prospect 3 feet in all directs is from the distance given. If not so located, the installer shall purchase a"Tap and
Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling(5"46-19x7.
Issued by: �r � �-�',- Permittee Signatuke:
Cell (503)6394175 by 7:01 P.M. fur an inspection needed the next business day
/ CITY OF TIGARD _ PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2003-00270
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 6!13/03
'SITE ADDRESS: 10135 SW INEZ ST
PARCEL: 2S 111 BC-00700
SUBDIVISION: Tl( RDVILLE HEIGHTS ZONING: R-3.5
_ BLOCK: _ LOT: 01--f _ JURISDICTION: TIG _
— CLASS OF WORK: OTR GARBAGE DISPOSALS: — MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREV";i RS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER. FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install irrigation backrlow preventer. _
Owner: ------------FEES _ - ------�
— Description Date Amount
MCBRIDE HALL, JANET M —
10135 SW INEZ I AXI 9%0 State Tax 6/1310::; $2.90
TIGARD, OR 97224 1I'LUMBI Permit Fee 6/13/03 $36.25
Total $39.15
Phone : 503-639-0030 - ----- —
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone : RP/Backflow Preventer
Final Inspection
Rpg#:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is riot started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Issued By: �, % Permittee Signature: ��
Call (503) 639•4175 by 7:00 P.M. for an inspection needed the next business day
Bu710mg r 1Xtures
Plumb.:ng Permit Application ' ' USP ONLY,
FFICE
ReceivedPlumbing
Date/B : 3 Permit NoA LM;)UD3 -d7e'
Ci of Ti al(i Planning Approval Sewer
`J g Date/By: Permit No.:
13125 SW I lail Blvd. Plan Review Other
Tigard,Oregon, 97223 Da Permit No.:
Pham ie: 503-6394171 Fax: 503-598-1960 Post-Review Land Use
Internet: www.ci.tigard.or.us rate/Oy: Case No.:
Contact Juris.: See Page 2 for
24-hots hspection Reu.uest: 503-639-4175
Name/Method: _ -7721Supplemental information.
_ TYPE OF WORK FEE*SCHEDULE(for special Information use checklist
New consDemolition Description tlty. Fec(ea.� Total
Add itiotl/alteration_/re lacemenI []Other: New 1-&2-family dwellings
__ MEGORY OF CONCTRUC'TION Includes 100 fl.for each u IlIfy connectli n
I &2-Familydwelling~ m
Comercial/Industrial SFR I bath _ 249.20
- ---�- – - ---- SFR 2 bath 350.00
Acc.S Buildin Multi-Tamil --
- -- -- (3)l-'Ith 399.00 _
Master Builder Other: Each additional bath/kitchen — 45.00
- JOB SITE[NFORMATION and LOCATION Fire s�nl nkler- . R.: Pae 2
Job site address: /O l 3 S Si-0 " /-t `/ 7 2-• Site Utilities
Suite#: Bld //A t.#: Catch basin/area drain 16.60 ---
g�---�-- Dr ell/leach line.'trench drain 16.60
Project Name: —__
Footing drain no.linear A) Page 2 _
Cross street/Directions to job site: 1vlanufactured home utilities 110.00
Manholes — R 16.60
Rain drain connector _ 16.60
Sanitary sewer(no. linear ft.) Page 2 _
Subdivision: _ Lot#: Storni sewer no.linear ft. _ Pae 2
- ----- �- Water service(nn. linear ft.► Page 2
Tax map/parcel #: - --
DESCRIPTION OF WORKAbsotion valve ,._'Fixture or Item
-- —
Backflow prcventer — EP],'
Backwater valve 16.
Clothes washer 16.60
-- - --- ----- ---� Dishwasher 16.60
ROIrER_ V OWNERTENANT _ Drinking fountain 16.60
Ejectors/sump 16.60
-�—-� �--�Pct
Name: �'+ ij�F // �I',Cjf j/� �Q�_ Fr ansiontank 16.60
Address: —�; Fixture/sewer cap 16.60
_City/State/Zip: / x`12 p (1 M1 7z Zc� Floor drain/floor sirik/hub 16.60
-- Garbage disposal 16.60
Phone: (!'3 cl Fax: Hose bib _ 16.60
APPLICANT _ CONTACT PERSON Ice maker 16.60
Naine: _ Interceptor/grease trap 16.60
Address: Medical gas-vrlue: S Pae 2
City/State,ZjPrimer _ _ 16.60
-- - -- - - - Roof draincommercial 16.60
Phone: Fax:: _ !�-�—_ —
_ _ - - _- - -_ Sink/basinAat atury 16.60
E-mail: Tub/showcr/slower pan 15.60
_ CONTRACTOR — — -- Urinal 16.60
Business Name: QWater closet - 16.60
Q�� -- - - --- Water heater 16.60
Address: _ _ Other:
City/State/Zip: - Other:
Phone: _ Fax: PlumbingPermit Fees*
CCB Lic. Plumb. Lie.#: — Subtotal 5
/�� �. Minimum Permit Fee$72.50 S
Authorize
Signature: Residential backflow huc mutn Fee 036.25 x �`
---- Plan Review(251,16 of Permit Fee) S
_ State Surcharge 80/.,of Permit Fee) $ r
- -- (Please print name) TOTAL PERMIT FEE $
Notice: This permit application expires If a permit Is nit ubtaiurd within All new commercial buildings require 2 sets of plans with Isometric or
180 days after It has been accepted as Complete. riser diagram for Plan review.
*Fee methodology set by Trl-County Building Ir,rustryy Service Board.
i'\Usts\Permit i'ortnOlnl PermitApp.doc 01/03
1
Plumbing_Permit Aication - City of'I'igard
Page 2 - Supplemental Information
Fcc Schedule: Residential Fire Su ression Systems:
Site Utilities Qty. Fee(ea) Total Square Faotage: Permit Fee:
footing drain-I" 100' 5(NJ 0 to 21000 $115.00 _- -
Footing drain-each additional 100' 46.40 2,001 to 3,600 1160.00
3,601 to 7,200 $2:0.00
Sewer-I st 100' 55.00 7,201 and_g_reater $309.00
Sewer-:.ch additional loll' 46.40
Water Scrylce- Ist 100' 55.00 Medical Gas S stems•
Water Service-each additional 100' 46.40 Valuation: Permit Fee:
Storm&Rain Frain-Isi 100' 55.00 $1.00 to$5,000.00 Minimum fee$72.50 y _
Storm&Rain Drain-each additional 1(H)' 4640 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each
additional$100.00 or fraction thereof',to and
Fixture or Item Qq Fee(ea) Total including$10,000.00.
Commercial Hack Flow Prevention Device 4t,40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
Residential Backflow Prevention Device each additional$100.00 or;rection thereof,to
,minimum permit fcc$36.25 _ 27 55 and including$25,0(10.00. _
Rain Drain,single family dwelling —- 65 25 $25,001.00 to$50,000.00 $379.50 for the first$25,J00.00 and$1.45 for
— each additional$100.01i or fraction thereof,to
Inspection of existing plumbing or and i,icludin $19,0_0r,.00,
specially requested inspections-per hour 72.50 $50,001.00 and up $7-,2.00 for the first$50,000(x)and$1.20 for
Subtotal: each additional$100.00 or fraction thereof.
Fixture Work:
Are you capping,nerving or •ep:acing existing fixtures". If
"yes",please indicate work performed by fixture. Failure to
accurately report fixtures could resuft fn increased sewer fees*.
uantlt u FixtureWork Performed Comments regarding fixture work:
Fixture Type: Replace
New Moved Existing Ca d --
fiaptistry,Fonl
Bath -Tub/Shower _
-Jacuzzi/Whirlpool -
Car Wash -Each Stall
-Drive Thru
Cuspid r/Water Aspirator - -_-- -� -
Dish%asher -Commercial
-Domestic
Drinking Fountain - --`-
E e Wash ----
Floor Drain/sink .2"
.4"
Car Wash Droni *Note! If the fixture work under this permit results in an
Garbage -Domestic
Disposal -Commercial increase of sews r EUtIs,a sewer permit will be Issued and
-industrial -- fees assessed for the sewer increase must be paid before the
Ice Mach./Reffi .Drains plumbing permit ctln be Issued.
Oil Separator Gas Station
Rec.Vehicle Dump Station
Shower -hang
-Stall
Sink -Bar/Lavatory
-Bradley
-Commercial
-Service
Swimming Pool Filter
Washer-Clothes
Water Extractor
Water Closet-Toilet —_
Urinal
Other Fixtures: _
is\DsLa\Permit Forma\PlmPermitAppPg2.doc 01103
Co i Y OF TIGARD 24-Hour
BUILDING r ( Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST _ -__
� Gp BLIP ----
Received _—Date Requested AM_ __ PM --- -__ BLIP _--_
Location MEC
Contact Person Ph(. ) ____ . _._-_ PLM _ '�L>^ a. -76
Contractor Ph( _ SWR —
BUILDING TenarNOwner ('0 _ 1 !'S 3 _ - ELC -__-
Footing
Foundation ELC
Gess:
Ftg Drain ELF!
Crawl Drain
Slab Inspectior. Notes: SIT
Post&Beam
Shear Anchors U - - -
Ext Sheath/Shear
Int Sheath/Shoe,
Framing - —
Insulation
Drywall Nailing -- -- ---
Firewall
Fire Sprinkler — - ---
Fire Alarm
Susp'd Ceiling — --- -----
Roof Ile' /j
Other: -
Final -
PASS PART FAIL -
PLUMBING
Post&Beam
Under Slab
Rough-In
Water Service ------
Sanitary Sewer
Rain Drains - --
Catch Basin/Manhole
Storm Drain —--
Shower Pan
Other: 6 — -
ct
PA _ PART FAILIf
�.—
CHANICAL
Post& Beam
R(,uhh-In —
G-aF,Line
Smoka Dampers -- —---- - --- --- __ _
Final
PF 3S PART FAIL --------- - --- -
EL ECTFRICAL
Se.vice -----� -� ----�
Roigh-In
UG/Slab
Low Voltage
Fire Alarm
Final El Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
_PASS PART FAIL
SITE [ ] Please cal for reinspection RE: —_ _ _ Unable to Inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Date_ - --V -- Inspector
l 'Other:Ci.rlal _
----- DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIT_
CITY, OF TIGARDPLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2000-00293
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DArE ISSUED:
SITE ADDRESS: 1013' ' N INEZ ST PARCEL: 25111 BC-007,10
SUBDIVISION: TIGA�;UVILL_E HEIGHTS ZONING: R-3.5
BLOCK: LOT: 019 _ _ JURISDICTION: TIG
CLASS OF WORK: U GARBAGE DGSPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: 1 00' OF SEWER LINE
Owner: ---FEES ^_
Type By Date Amount Receipt
HALL, JAN!:-:T M --- p
10135 SW INEZ PRMT RCP 8/9/00 $50.00 0004373
TI CARD, OR 97224 5PCT RCP 8/9/00 $4.00 0004373
_ Total $54.00
Phone 1:
Contractor:
MICHAEL_ + CO PLUMBING
P O BOX 23008
TIGARD. OR 97281
REQUIRED INSPECTIONS
Phone 1: 639-3189 Sewer Inspection
Reg #: LIC 000678
PLM 26-333PB
This permit is issued subject to the regulaW'111 c,ntained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans
This permit will expire if k, ork is not started within 180 days of issuance, or if work is suspenoed for more
than 180 days. ATTEN 'I Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080.
You may obtain copies of t;iese rules or direct questions to OUNC by calling (503) 246-1987.
Issued (1n
ssued By: I T l C_, AN .�C _ _ Permittee Signature:
Call (503)639-4175 by 7:00 P.M. for an inspectior needed the next business day
CITY OF TIGARD Plumbing Permit Application Plan Check#_�_
1312L 5W HALL BLVD. Commercial and Residential Recd By
TIGA- RD, OR 97223 Dale Recd
(603) 639-4171 Date to P.E.
Print or Type Date to DST q
� � 3
Incomplete or illegible applications will not be accepted Permit# vOe Z fRelatedSVVR# 0 0 7
Called__
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Job Sink 11.50
Address Street Address Suite Lavatory 11.50
! ,,r Tub or Tub/Shower Comb. 11.50
Bldg# Clty/State Zip Shower Only 11.50
Name, Water Closet 11.50
fir,rY h-)"I Raf- Urinal 11.50
Owner Mailing Address Suite Dishwasher 11.50
^1 J 4 1'. "i e e Garbage Disposal 11.50
City/State Zip Phone Laundry Tray 1150
Name Washing Machine 11.50
So Floor Drain/Floor Sink 2" 11.50
Occupant Mailing Address Suite 3" 11.50
4" 11.50
City/State Zip Phone
Water Healer O conversion O like kind 11.50
Name Gas piping requires a separate mechanical permit
1 tC��,B d ('a1 1u nn a,v ° MFG Home New Water Service 32.00
Contractor MallinAddress Suite MFG Home New San/Storm Sewer 32.00
'►r,e, Hose Bibs 11.50
Prior to permit City/Stale Zip Phone Roof Drains 11.50
issuance,a copy - ,n ( r , n'l 7 I .^ ' 11 Drinking Fountain 11.50
of all licenses are Or on Const Cont.Board Lie.# Exp.Dr ee
required If 1 Other Fixtures(Specify) 15.00
expired In COT Plumbing Lie.# Exp.D.to
database
Name
Architect Sewer-tat 100' 138.00 g _
or Mailing Address Suite Sewer-each additional 100' ?2.00
Engineer City/Stele Zip Phone Water Service-1st 100' 38.00_
g Water Service aach additional 200' 32.00
Describe work to bb done: Storm&Rain Drain-1 at 100' 38.00
New O Repair O Replace with like kind: Yes O No O Storrrl&Rain Drain-each additional 100' 32.00
Residential Q Commercial O
Additional descrlptlnn of work. Commercial Back F!^w Prevention Device 32.00 _
Residential Back9ow Prevention Device' 19.00
Catch 6asln 11.50
Are you capping,moving or replacing any fixtures? Insp.of Existing Plumbing or Specially Requested 50.00
Yes O No O inspectionsper/hr
If y::-.,see back of form to indicate work performed by Rain Drain,single family dwelling 45.00
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50
WORK COULD RESULT:N HNCREASED SEWER FEES. QUANTITY TOTAL
I hereby acknowledge that I have read this application,that the Information
given is correct,that I am the owner or authorized agent of the owner,and Isometric or riser diagram Is required H Quantity Total Is >9
that cans submitted are to compliance with Oregon State Laws. 'SUBTOTAL
SlgnAlure of Owner/Agent Dote ) J�
8% SURCHARGE C`(
Contact Person Name Phone
"PLAN REVIEW 26%OF SUBTOTAL
-- Required only 0 fixture qty.total is>9 `
1 BATH HOUSE$178.00 TOTAL 10`4
2 BATH HOUSE$250.00
3 BATH HOUSE$285.00
(This fee Includes all(dumbing flxtures In the dwelling and the first *Minimum permit fee Is$50+8%surcharge,except Residential Backflow Prevention
100 feet of sanitary sewer storm sower and water service d Device.whlcl is$2c.17%surcharge
**All New Commercial Buildings requlle plans with Isometric or user diagram and
plan review
i%dslslrormslplumapp doc 12117M
PLEASE COMPLETE:
Fixture Type — _ Quantity by Work Performed
New Moved Replaced Removed/Capped
Sink — --- --- __ --_
Lavatory
Tub or Tub/Shower Combination
Shower Only
Water Closat
Urinai
Dishwasher
Garbage_ Disposal -
Laundry Room Tray
Washing Machine
Floor Drain/Floor Sink 2"
Water Heater
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
i,:1•.icn„narhiniu,n d•< 171"'
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 l 1
SUP ��--- —
_
_Date Requested ���1 / AM PM -- BI-D -
Location d �J 5 n P - Suite MEC
Contact Person Ph �_� — - LM' 2t✓y _
6161
Contractor _— Ph _ C_-„?4
BUILDING � Tenant/Owner ELC _
Retaining Wall EI_R - -- . -
Footing Access FPS.
Foundation -------
Ftg Drain - SGN _
Crawl Drain Ins ti�r�N1CJotes: /,o '
Slabs !-- _ -,�l"Q SIT `------------
Post R. Beam
Ext Sheath/Shear ---- --
Int Sheath/Shear
Framing --
Insulation _ ----1
Drywall Nailing -- _----_- ----_____ —_.---_---
Firewall
Fire Sprinkler --- ----- - ------- - ------ -- --- .
Fire Alann ]
Susp'd Ceiling -- -- -- -
Roof
Mise -
Final -
PASS PART FAIL - ._- ---------._---_--_____-._----�-_PLVM /
Eam
Under Slab T2 Z
I up Out
Water Service -----_--
Rain Drains
�AS
PART FAIL -
_ HANICAL it
Post& Beam -- - - --- ----------- ------ ---
Rough In -
Gas Line ---- -- .. ---- - -- -- -
Smoke Dampers
Final ---- _-- ---- - -_._.-----
PASS PART FAIL
ELECTRICAL ------ _-.._-_-_-_------ - -----_ ------__.----_-----__-_--_- -
Service
Rough In
UG/Slab --- - --- ------- _ -_- --------- --- -------
Low Voltage
Fire Alarm ------ --- ------- -- ------------_ ---- --
Final
PASS PART FAIL ----.. - -- -- -- - ------ --- - --SITE
Hackfill/Grading --- ---- _..------------_--- _-- - --
Sanitary Sewer
Storm Drain I ] Reinspection fee of$_ required before nest inspection Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Unable to inspect - no access
Fire Supply Line [ ] Please call for reinspection RE: -
ADA
Approach/Sidewalk 1 /
Date � � � Inspertar _�!� Ext �1
Other _ - /
Final
PASS PART FAIL 130 NOT REMOVE thiF, inspection record from the job site.
CITY OF T'llGARD BUILDING INSPECTION DIVISION
24-hour Inspection Line: 639-4175 Business Line: 639-4171 -
1 BUP
Date Requested_ "/ C� _— AM —PM / ► � BLD _
Location G� / .3 �� ��� l /7 P � — Suite — MEC
Contact Person Ph PLM Ua Uu�
Contractor Ph SWR _
BUILDING Tenant/Owner �� �IGti� ELC
Retaining Wall ELR
Footing Access
'oundation FPS
rig Drain
""-
Crawl Drain Inspection Notes: SGN ----- —
Slab - - -- -- -- SIT
Post& Beam --------
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
- --------._.-------
Firewall
Fire Sprinkler
Fite Alarm
Susp'd Ceiling -------
Roof
Misc --- - - -
Final
-PASS._ RAFT FAIL -- ---- - - ---- - - --
PLUMBING
---------------
ost& Beam ---- -- - ---_
Under Slab __-
Top Out
Wa3er Se t - -__.__---------
anitarUSewer_ (`
Rain Drains
Final - _--- -- -- -- - - ---_ -------
PASS ART .) FAIL
MECHA --
Post& Beam -- - -- ---- -- ----
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL.
ELECTRICAL
Service.
Rough In
UG/Slab
- ---------- -------------------
Low Voltage
Fire Alarm _-�-- - _-_--
Final
PASS PART FAIL
SITE
Backfill/Grading --�
Sanitary Sewer
Storm Drain [ ]Reinspech.n fee of$— _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ]Please call for reinspection RIF __- [ ]Unable to inspect no access
Fire Supply Line
ADA
Approach/Sidewalk .
Other �— _-- Date r /D Inspector �"` �" - �G.r1 -- Ext
Final
PASS PART FAIL_) DO NOT REMOVE this inspection record from the job site.
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