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34-020 (8)
BP-2021-2097 175 TURKEY HILL RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 34-020-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-2097 PERMISSION IS HEREBY GRANTED TO: Project# ROOF Contractor: License: Est. Cost: 36599 070626191093 Const.Class: Exp.Date:08/21/202303/22/2022 Use Group: Owner: WHITING JENNIFER M Lot Size (sq.ft.) Zoning: RR/WP Applicant: ADAM QUENNEVILLE ROOFING & SIDING Applicant Address Phone: Insurance: 160 OLD LYMAN RD (413)536-5955 AWC4007012861 SOUTH HADLEY, MA 01075 ISSUED ON:10/27/2021 TO PERFORM THE FOLLOWING WORK: ROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House # Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: 0 - 3-11 _e Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner /\`- Department use only 1,3�r,,,4, City of Northampton �4 etas of Permit: //, r• 1 Building Department r utfDriveway Permit l ti', 212 Main Street °Cj SeWerfSepti Availability . l Room 10,0 p �6 ter ell Av ilability .,i -� fr' Northampton, MA 0106 ,� lwo Sits of tructural Plans ' phone 413-587-1240 Fax 413=5 2�h . Plotlb�ite Plans ti^,/,q Fc, trier Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: 175 Turkey Hill Rd Florence Ma 01062 Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Richard Whiting Jr 175 Turkey Hill Rd Name(Print) Current Mailing Address: 413-531-4493 see contract Telephone Signature 2.2 Authorized Agent: Adam Quenneville 160 Old LymanRd South Hadley Ma 01075 Name(PrinAir_...,/ Current Mailing Address: 413-536-5955 Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 36,599 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total= (1 +2+3 +4+5) 36,599 Check Number 11. oW 3 � I This Section For Official Use Only Building Permit Number'.l1 - ,R.0 7 sssuu ed: Signature: /< - id. 27- ZOZ 1 Building Commissioner/Inspector of Buildings Date operations.agrs gmail.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: . _ L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW x YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW x YE1-7 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW x YES IF YE has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YEII NO IX IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, gradin excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YE; NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Windows Alteration(s) n Roofing EZ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [JI] Decks [❑ Siding [0] Other[CAI Brief Description of Proposed New roof, remove&replace existing, isntall drip edge, ridge vent, ice and water barrier, pipe boot flashing Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Richard Whiting Jr I, , as Owner of the subject property Adam Quenneville hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. see contract 10/21/2021 Signature of Owner Date Adam Quenneville , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Adam Quenneville Print Name 10/21/2021 Signature of Owner/A ent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Adam Quennville CS 070626 License Number 160 Old Lyman Rd South Hadley Ma 01075 8/21/2023 Addressit, Expiration Date 413-536-5955 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable 0 Adam Quenneville Roofing & Siding Inc 191093 Company Name Registration Number 160 Old Lyman Rd South Hadley Ma 01075 3/22/2022 Addres Expiration Date / Telephone_413-536-5955_ SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes X No 0 .max E rNm ac-%t a it.Gt. �9ACR D AWARD VISA : DISC'.VER ?i 201J WINIJCC 160 Old Lyman Road•South Hadley•MA 01075 We are Licensed 1.800.NEW.ROOF • 413.536.5955 Fully Insured Email:info(a1800newroof.net Website:www.1800newroof.net Factory Trained MA Construction Supervisors Lic.44070626 MA Registration#120982 Factory Certified Installers Member of the Home Builder's Assoc.of Western Mass. CT Registration#575920 Member of the Building&Trade Association P.P.0 38710 Proposal Submitted To: Date: 10/18/21 Phone#'s: C: 413-531-4493 Richard Whiting Jr H: W: Street: 175 Turkey Hill Rd Email: City,State,Zip Code: Special Requirements: Florence, MA 01062 PROPOSAL FOR: GARAGE OTHER COOP�' RECOVER Layers: (1 R 3 4 Plywood Included: Yes o 3 ❑ Tear off SLATE or SHAKES COMPLETE ROOF PROTECTION SYSTEM: ,FJ-'"-We shall acquire appropriate permits for all work Home exterior and landscaping to be protected ,..13-"Strip existing roofing to existing decking with full inspection DO NOT DO: --Er All project waste shall be removed by dumpster(dumpster for contractor use only) -tr Install Ice&Water Barrier at all eaves 3' .Ileys,chimneys,pipes and skylights Install(151b.fel VTR nderlaymen over remaining decking area ,E-'Install Metal drip edge at eaves and rake f 5") et,brown) -2'Install manufacturer's starter shingle on all eaves and rake edges /' Install new pipe boot flashing/vent accessories ;a—install ridge ve ' - now Count 'Cobra rolled/4'Baffled/Roll Shingles: GAF Shingles Color: WEATHERED WOOD GAF Ridge cap shingles Warranty Options: 17 We guarantee our workmanship for full years 0 GAF System Plus Warranty E GAF Golden Pledge Warranty Chimney Options: l J Lead Counter Flashing O Water Seal&Tuckpoint O Rubberized Crown CD Cricket CD Mason needed(customer provided) Additional material and labor charges may apply. $165 per q Deteriorated existing decking will be replaced at piece usedand dimensional lumber at$15 per linear ft., after full inspection. Customer Initials: We propose hereby to furnish materials and labor—complete in accordance with above specifications for the sum of: Total Due:($ 36,599 ) ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions arc Down Payment:($ 20,000 ) satisfactory and are hereby accepted.You are authorized to do work as specified. 2nd Paym nt at Start Job:($ Payment will be 1/3 down at signing,1/3 at sta of job,an balance dud 165 9 Balance Due U on Corn lotion:($ , ) upon completion,0/ 8/21 f�S 5 4 'i / t 1 1 Date: Signature: / f Date: 10/18/21 Estimator:(Print Name) Joe Sno ek p (Sign Name) 413-221-4329 ATTENTION HOMEOWNERS:Please cover all personal belongings in the attic,garage or storage areas due to the possibility of roofing debris or dust coming in through cracks of the wood.Adam Quenneyjlle Roofln Twill not be responsible for debris or dust in the attic or storage areas. Customer Initials: ''tt r T, ` T { ■r'7d 3 fl �y �EVE!�£ � '� i y Y �`.� .ti V E.Eli 160 Old Lyman Road e South Hadley, MA 01075 W';+1bV.tS(.0r}ewroQt.iIcc 41.'i-5?,C _95S Ini,:la"i.817O11ewwro!.iT.Ili?I Please keep all children, family, friends and pets away from materials, equipment,work vehicles and all other job site tools from the time it is placed on the property until the work is 100% complete and debris removed. If the weather forecast calls for rain, each day it rains, work will be delayed on your home. We do not remove more shingles than we can replace to avoid potential interior damage to your home. Do not loan your tools or equipment to installation crews . Some properties may have gutter protection that may need to be removed prior to roof installation by initial installer to prevent warranty issues . In the case that the homeowner doesn 't get them removed or don't want initial installer to remove them Adam Quenneville Roofing will not be responsible for any cover issues . When installing your roof some debris may fall into the attic. Please remove or cover belongings in attic to avoid damage or dirt. We do not cover or clean the inside of the attic. It is important that you remove all belongings from around the house where debris may fall such as patio furniture, grills, plants, lawn mowers, etc. Please remove any valuables, pictures or items you feel necessary from walls . There will be lots of shaking and vibrating during the project that may jolt them loose. Please remove all vehicles from garage and driveway before we arrive with dumpster and or material. Due to inadequate original construction practices, age of home, humidity/moisture inside the home, the existing sheet rock (drywall) or plaster may be subjected to vibrations associated with a remodeling project that may cause separation of the tape, seams, nail pops, cracking, blemishes or other damage. Additionally popcorn ceiling coatings may fall as a result of a remodeling project. Customer acknowledges that these potential issues are unavoidable and Adam Quenneville Roofing cannot be held responsible. CT 1•IIC tt-575920 MA HIC;t- 1220982 MA CSL tt-070626 r RI Reg.#-36301 City of Northampton ° l` Massachusetts t r r A. *� r� � DEPARTMENT OF BUILDING INSPECTIONS �* - l 212 Main Street •Municipal Building ` Northampton, MA 01060 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: 175 Turkey Hill Rd Florence Ma (Please print house number and street name) Is to be disposed of at: Adam Quenneville Roofing &Siding 160 Old Lyman RD South Hadley Ma (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: Adam Quenneville Roofing& Siding 160 Old Lyman Rd South Hadley Ma (Company Name and Address) Signature of Permit Applicant or Owner ate If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. / gl DATE(MMIDOIYVVY) AC RD CERTIFICATE OF LIABILITY INSURANCE L......--,, 6/24/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 pollcy(ies)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). PRODUCER CONTACT Sarah Prem= NAME; Clayton Insurance Agency, Inc. PHONE (413)536-0804 •FAX a (A C,_No( isles,-,e,e INC,Ne.UP; 1649 Northampton Street Tv4„apramo@claytoninsurance.net 8. O. Box 989 INSURER(S).AFFORDINO COVERAGE NAIC e .. )Holyoke +tea 01041-0989 INSURERA;Nautilus Insurance Company INSURED INSURER B:Arbella Insurance Co. Adam Quenneville Roofing 6 Siding Inc. INSURERC:AIM Mutual Insurance Company 160 Old Lyman Road INSURERD: South Hadley, MA 01075 INSURER E: INSURER F: • COVERAGES CERTIFICATE NUMBER:2021 mL3TER REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICA CEO NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRAG r 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. INSR -'ADQI.'eITSR— POLICYEFF POLICYEXP • LINTS TYPE OF INSURANCE lN'l l Wyn POLICY NUMBER IMMIDO/YYY;Y) tmetoo/VYVYI X COMMERCIAL GENERALUABIUTY EACH OCCURRENCE $ 1,000,000 ENTED A CLAIMS.MADE X OCCUR ePPRREM ES(OVArlfenen $ 100,000 NB/29331S 6/23/202/ 6/23/2022 MED EXP(Any one person) S 5,000 PERSONAL SAOV INJURY 5 1,000,000 GEMLAGGREGATE LIMIT APPLIES PER: CENERAL AGGREGATE S 2,000,000 PRODUCTS CMPIQP AGO- Q X POLICY n day n LOC . S 2,000,000 OTHER. S AUTOMOBILE LIABILITY (EdHr S 1,000,000 ANY AUTO BODILY INJURY(Per person) 3 B ALL.OWNED X AUTOS SCHEDULED AUTOS 1020107895 6/23/2021. 6/23/2022 BODILY INJURY(Per accident) S _ NON-OWNED PROPERTY DAMAGE S X �FIIREDAUT09 X AUTOS -lPef' u 5 100,000/300,000 UNINSA/NOERINS MOTORI0T9 X UMBRELLA LIAB OCCUR I EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE S 5,000,000 DEO RETENTION$ AN1242102 6/23/2021 6/23/2022 S WORKERS COMPENSATION X STATUTE ER , AND EMPLOYERS'UABILITY Y/N ANY PROPRIETORIPARTNER/EXECUTIVE I E.L EACH ACCIDENT 4 1,000,000 OFFICERIMEMBLR EXCLUDED? Y J N I A C (Mandatory in NH) AWC4007012661 4/29/2021 4/29/2022 E.L.DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS belay _ ' E.L,DISEASE..POUCY LIMIT S 1,000,000 _ I DESCRIPTION OP OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If mans speae Is,leaked) B'or Informational Purposes Only CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Adam Quenneville Roofing 6 Siding Inc THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 160 Old Lyman Rd South Hadley, MA 01075 AUTHORIZED REPRESENTATIVE Michael Regan;L'I1T 1/7 / P r- 1 ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS02S(20/401) _ The Commonwealth of Massacnusett v. Department of Industrial Accidents =? Office of Investigations ==a1=7600 Washington Street _ � NNW Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �{ I Please Print Legibly Name(Business/Organization/Individual): Ales\ (�oener k 11� Address: (Go 0 c L e,L City/State/Zip: 5o1)11.\ klOclto (11 r) G[05" Phone#: 'i i 3 -53 C-5 q55— Are you an employer?Check the appropriate box: Type of project(required): l.,K 1 am a employer with 15 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 L❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.4 Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#l must also fill out the section below showing their workers'compensation policy information. 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. Q �1 l vim` ,n5 V✓c+�c L Insurance Company Name: r ' Vacil Policy#or Self-ins.Lic.#: A W C`1OO 1 O l a t ( Expiration Date: d Job Site Address: 115 j V(tc N 1 I► City/State/Zip:t 0(CO(einn O la y 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 up 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby certify under the pa' and penalties of perjury that the information provided above is true and correct. Signature: Date: / d/) 'a i Phone#: 1 3 _ 5 3c - 5 9 5 5- Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Vir Division of Professional Licensure .. ,• ' Board of Building Regulations and Standards Consttipiftg)ttiftilpf rvisor CS-070626 f*pires:08/21/2023 ADAM A QUOINEV 160 OLD LYMtiN el,ir,`"F .'r' 1,. , SOUTH HADLEY 0.'..;. .• .... . ,!. 4 1104l.OP ,V Commissioner &tit Ai P.97L (6904224220~eald olojeadoaduidata Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 • Boston, Massachusetts 02118 Home Improvement-Ccintractor Registration Type: Corporation Registration: 191093 ADAM QUENNEVILLE ROOFING AND SIDING;INC. Expiration: 03/22/2022 180 OLD LYMAN RD. SO.HADLEY,MA 01075 Update Address and Return Card. SCA I 0 20M-05/17 .:: ‘1:.L'''N :::!77Y7Y7N''V/W7NK.73N/ V.P,S117.V:77N7117- f'`.7;N/.1:FS-N7'77::''.S17`.,F7ti: KNIVC77:/; ,•'.:•A, It : -..Asf_. 'ai* _._)12t__ 4\AI: 4,1$... .•Ot'.. '4./;._ ..1,1_*_..1.4_. .k.#1.1.....sifr__...t...*:_ 'kii:_ -4 ._ .-ftl!" _tlo' :.1‘1,_ At‘;'_11.1r...Zi.V?:_....1s.fr'_ ,„.H. ,.....— STATE OF CONNECTICUT 4. DEPARTMENT OP CONSUMER PROTECTION :. . i Zeit known that ,4, ,,?.: , ADAM QUENNEVILLE . 160 OLD LYMAN ROAD SOUTH HADLEY, MA .01075-2632 vK•. I I ;;';,,,,'7 ;:,.'''' I I , ':‘,\•- •'• •V,,',. ,,..... • 1 ' ''' has satisfied the qualifications required by law and is hereby registered as a HOME IMPROVEMENT CONTRACTOR . , Registration # HIC 0575920 ADAM QUENNEVILLE ROOFING ...C.i. ; Effective: 12/01/2020 4/11 4 - Expiration: 11/30/2021 Michelle Seagull.Commlaelomer 0;A.- ; - .--=L-------...;.- ---oil— -— —-- ' - ;A: -orti=-NTra-- ---7- - . ; 7-i --- ; (.'• me ______A.ita • A ,,,41.444,..„4.41......1.....114L—itinagrantall_, t.,.,--141