The URL can be used to link to this page

Home My WebLink About16-17125 CITY OF ZEPHYRHILLS ,.w � 5335-8TH STREEf � � (813)780-0020 �7 �25 i, BUILDING PERMIT � PERMIT INFORMATION LOCATION INFORMATION Permit Number: 17125 Address: 38309 38307 & 38311 12TH AVE Permit Type: RE-ROOF ZEPHYRHILLS, FL. Class of Work: ROOF REPLACEMENT Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 11-26-21-0010-03400-0131 Improv. Cost: 8,000.00 OWNER.INFORMATION Date Issued: 3/03/2016 Name: FOSTER JOHN D & GLORIA Total Fees: 75.00 Address: 19851 LEONARD RD Amount Paid: 75.00 LUTZ FL 33558-5124 Date Paid: 3/03/2016 Phone: 813-390-0068 Work Desc: REROOF SHINGLE MULTI FAMILY CONTRACTOR S APPLICATION FEES BAYSIDE ROOFING PROFESSIONAL REROOF RESIDENTIAL 75.00 �C� � � ��C/l � � � ' Ins ections Re uired DRY IN ROOF INSP TAPE JOINTS ROOF I SP FINAL � REINSPECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80(2)(c)the local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or first reinspection,whichever is greater,for each such subsequent reinspection. , NOTICE: In addition to the requirements of this permit, there maybe additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management, state agencies or federal agencies. "Warning to owner: Your failure to record a notice of commencement may result in your paying twice for improvements to your properly. If you intend to obtain financing,consult with your lender or an attorney before recording your notice of commencement." Complete Plans,Specifications Must Accompany Application. All work shall be pertormed in accordance with City Codes and Ordinances. NO OCCUPANCY BEFORE C.O. NO OCCUPANCY BEFORE C.O. l^'�� %L'V CONTRACTOR SIGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER � \ r� _;, si�-7aaoozo City of Zephyrhills Permit Application Fax�13-780-0021 Building Department Date Received Phone Contact for Permittln I Owner's Name John Foster Owner Phone Number 8�3-390-0068 Owners Address �9561 Leonard Rd.Lutz,FL 33558 Owner Phone Number Fee Sfmple TiUeholder Name Owner Phone Number Fee Simple TiUeholder Address JOB ADDRESS 38309 12th Ave.Zephyrhills,FL 33542 LOT# �� SUBDIVISION City Of Zephyrhills ppRCEL ID# ��"z6-21-0010-03400-0131 (OBTAINED FROM PROPERTY TAl(NOi1C� , WORK PROPOSED NEW CONSTR ADD/ALT 0 SIGN Q Q DEMOLISH e INSTALL e REPAIR ' PROPOSED USE Q SFR Q COMM Q OTHER TYPE OF CONSTRUCTION Q BLOCK Q FRAME Q STEEL Q DESCRIPTION oP WORK Re-Roof using Certainteed Landmark shingles FL5444-R8 and Peak peel and stick underiayment FL171 6-R1 BUILDING SIZE SQ FOOTAGE 3500 HEIGHT � I QBUILDING $ g,000 VALUATION OF TOTAL CONSTRUCTION QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C. QPLUMBING $ � J '� (� QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION QGAS Q ROOFING Q SPECIALTY 0 OTHER n ( SC� [/ � FINISHED FLOOR ELEVATIONS FLOOD 20NE AREA QYES NO BUILDER COMPANY Bayside Roofing Professionals SIGNATURE �cisr� Y/ N FEE CURREA Y/N Address 5439 Mile Stretch Dr.Holiday,FL 34690 License# CCC1328720 " ELECTRICIAN COMPANY SIGNATURE aecis7� Y/ N FEE CURREP Y/N Address License# PLUMBER COMPANY SIGNATURE REGISTERED Y I N FEE CURRE� Y/N Address License# MECHANICAL COMPANY SIGNATURE REGISTERED Y/ N F�cuwtEn Y/N Address License# OTHER COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address License# 1111111111111111111111111111111111111111111111111111111111111111111 RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-0-W Permit for new consWction, Minimum ten(10)working days after submittal date. Required onsite,ConsWction Plans,Stormwater Plans w/Silt Fence installed, Sanitary Facilities&1 dumpster,Site Work Permit for subdivisionsllarge projects COMMERCIAL Attach(2)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Fortns.R-O-W Pertnit for new consWction. Minimum ten(10)working days after submittal date. Required onsite,Construction Ptans,Stormwater Plans wl Silt Fence installed, Sanitary Facilities 8 1 dumpster.Site Work Permit for all new projects.All commercial requirements must mee[compliance SIGN PERMIT Attach(2)sets of Engineered Plans. ••'•PROPERTY SURVEY required for all NEW construction. Directions:• Fill out application completely. Owner&Contractor sign back of application,notarized If over y2500,a Notice of Commencement is requlred. (AIC upgredes over$7500) " Agent(for the contractor)or Power of Attomey(for the owner)would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (copy of contract required). Reroofs if shfngles Sewers Service Upgrades A/C Fences(PlotlSurvey/Footage) Driveways-Not over Counter if on public roadways..needs ROW � ' r` -:. ' ' NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed"restrictions" which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any applicable deed restrictions. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or contractors to undertake work,they may be required to be licensed in accordance with state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the intended work,they are advised to contact the Pasco County Building Inspection Division—Licensing Section at 727-847- 8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the"contractor Block"of this application for which they will be responsible. If you,as the owner sign as the contractor,that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco County. TRANSPORTATION IMPACTIUTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings,change of use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and 90-07,as amended. The undersigned also understands,that such fees,as may be due,will be identified at the time of permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to receiving a"certificate of occupancy"or final power release. If the project does not involve a certificate of occupancy or final power release,the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact fees are due,they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances. CONSTRUCTION LIEN LAW(Chapter 713,Florida Statutes,as amended): If valuation of work is$2,500.00 or more,I certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's Protection Guide"prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other than the"owner",I certify that I have obtained a copy of the above described document and promise in good faith to deliver it to the"owner"prior to commencement. CONTRACTOR'SIOWNER'S AFFIDAVIT. I certify that ail the information in this application is accurate and that all work will be done in compliance with all applicable laws regulating construction,zoning and land development. Application is hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has commenced prior to issuance of a permit and that all work will be pertormed to meet standards of all laws regulating construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other government agencies may apply to the intended work,and that it is my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to: - Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands,Water/Wastewater Treatment. - Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses. - Army Corps of Engineers-Seawalls,Docks,Navigable Waterways. - Department of Health & Rehabilitative ServiceslEnvironmental Health Unit-Wells, Wastewater Treatment, Septic Tanks. - US Environmentai Protection Agency-Asbestos abatement. , - Federal Aviation Authority-Runways. I understand that the following restrictions apply to the use of fill: - Use of fill is not allowed in Flood Zone"V"unless expressly permitted. - If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a "compensating volume"will be submitted at time of permitting which is prepared by a professional engineer licensed by the State of Florida. - If the fiil material is to be used in Flood Zone "A" in connection with a permitted building using stem walf construction,I certify that fill will be used only to fill the area within the stem wall. - If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent properties. If use of fill is found to adversely affect adjacent properties,the owner may be cited for violating the conditions of the building permit issued under the attached permit application,for lots less than one(1) acre which are elevated by fill,an engineered drainage plan is required. If I am the AGENT FOR THE OWNER,I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A permit issued shall be construed to be a license to proceed with the work and not as authority to violate,cancel,alter,or set aside any provisions of the technical codes,nor shall issuance of a permit prevent the Building Official from thereafter requiring a correction of errors in plans,construction or violations of any codes. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of permit issuance,or if work authorized by the permit is suspended or abandoned for a period of six(6)months after the time the work is commenced. An extension may be requested, in writing,from the Building Official for a period not to exceed ninety(90)days and wili demonstrate justifiable cause for the extension. If work ceases for ninety(90)consecutive days,the job is considered abandoned. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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. FLORIDA JURAT(F.S.117.03) � OWNER OR AGENT CONTRACTOR/� Subscribed and sworn to(or affirmed)before me this Subscribed andsworn o(or a(�{ned)before me t is bY by� L4Y l ��D�CA Who is/are personally known to me or has/have produced Who is/are personal known to e or has/have produced as identification. as identification. Notary Public Notary Public Commission No. Commission No. Name of Notary typed,printed or stamped Name of Notary typed,printed or stamped : . i uiui iiiii iiuiiiiii iii�iiiii iiiii iiiii iiiii iiiii mi iiii 2�'I fi�27�07 I Re t: 1749905" Ree: 10.00� P DS: 0.00 IT: 0.00 ' itf0"�'10E O��CQAIVL'VI$NCE14�E:Y'T 02J23/2016 eRecording • Permit�lo. - Property Identification No. �ti-zs,z�-oo�o-o3anao��s TFiE C�ERSIQVED hereby gi<<es notic�that improvements wiil be made to certain r�i property,and in accordsnce with Section 713.13 of the Florida Sf,atutes,the fc�llowing inform3tion is provided in the l�TtlTT��COl�IMENC�l9.E1VT. 1. Description of property(legal descripPiota:)��Y*��'��ast 1@ ai bts 13 ti 1516&17 tess nath 12 FT cf bt 17 61oek 34 a) SU'C0L Add1'BSS:38309 12�h Av9.ZepANhuls.PL 39542 2. General description of improvements a�-a� 3. Ovmer Information a) Nc'iR10 821a QdfITfSS:�F�er 19g51 Leonartf Rtl.Wt,FL 33558 b) Name and address af fee simple tit(ehotder(if other than oevner) . c) Interest in propert,v o�,zT 4. Contractor Information a) N2T41e BSit!dCjCIiCSS;Bayeide Raafirg Profassicnals 543b tArke Stratdi�r,kol!day.fL 3e690 b) Telephcme No.:�zr-aaa-�ssa Fax No.(Opt)�vaao-ssa� 5. Surety Informatinn a) Name and address: b) Amount of Bo��: , c} Telephane No.: FaY Ato.(Opt) 6. Lender a} Name and address: _ 7. Identiry of person within the State ofFlorida desi�ated by owrer upon tivhom notices or uther documents may oe served; a) Name and addrass: b) Tetephone No.: Fax No.(Opt) ' 8. In addition to himseif,owner desianates tha fotiowing person to receive a copy of the Lienor's Iv`otice as provided in Scc;tion� 713.13(1)(b),Florida Statutes: a) Name and address: b) Talephune No.: Fae No.(Opt.) 9. Expiration date of Notic�of Commencement{the expiration date is ona year from the date of record'mg un(ess a different date is specified): . WAIB_iidiVG'T�3 fl'�IV�At:A�tY PAYMEN'I'815'�.ADE�3Y T�OWNEEtA�'I'ER TTF�EX�'i�2ATT�N�F TBi�teT��'ICE�� O�IENCEN[ENT AdtE�ONSIIDE�D��d�PER FAYMENTS LTii'd9�;�2 CH[AFTEdB 713,PART 1,SEG`II�L�i 7i3.13, Fi„O�IlDA S'i'r�Tt;TES AI°ID C��i1V 13�.+5UL'g'3Pi Y�I3R]PA�Nti�'Wi�E�d�i IPROVEN�+iV'TS�:O YOUR PI2f3PEdLT]'.A ' NO'I'ICE OF COl°+�IVS��E�E�'T MiiST BE�CORDED Al`+`D TOST��O1N THE,�OB�i'�E BEFORE'i��I�iST INSPECTYOlti.�]`�iJ aNT�ND"LO O�TA��f�APtCfI�iG,��I+tSl7LT Y�iTYi LEPdDlG�2 Ola AN ATT(312Td�:�'BEFaRE COIV��TEIVCI�'��i�l4�Ad�C Q3�Y�CORt)1�iG Y�U�lOTIC]E i3F�ONi:�IEI�TC�:�d�N3'. s�' t!(�'q�; $ma ANN M.DEARNLEY � � ,"-1 co �• 'qro�y p�rypc-Stue af flori0a =• COrtIfI1iS8(011 N ff$Z�74e Sign OF Owner or 4ti�r.er's Amhorize30Ylicer/DireccorlPartneriTdanogcr =1,� My Comm.Expires Jul 17,20f9 �c�d7,w./ s'`��S��' �' � h�N�niP� BOI�fK011�1(�Iplil►J�yAfiil, � YcintNan;e The forzgoing instiument w�.s adcnawledged before me this :t day nf.--� '��ly�y/}�t.��20�[t�,by� :� � . as (ty� oai f suihority,e.g.oHicer,tzustc� tomey in fact)for � ____ _ (name of party on behalFof�vhom�rument a��as execute�. "�� : Personall Kno�va � OR Produced Itlentitic�fion Notary Si ture � r� `� i��i• t�R_,s' f'� . Y ,/� •e —_ P� �� "`�+�--=�- --'�---�.'d' � . Type of identification Pmduced Name(pdnt) �-'� ��° �-d}"��'�! VeriSeation pwsu�rt to Secdan 92.525,Rlorida Sieiule�.Umler penaJtics uf perjtu�,I declare t.hat I havr read fhC fore�,�oing ttnd that the Cacts slated in it a�e hue to the best of my kno�vledge and belief. / - ,I ' t...4'" � �'- Foasss,Toc.�s�om � -.�T-t-+� �V,��.� ' t l�1 r1��:.0 1� s��orr�ra�n sr��neo 1 PAUL,4S.O'NEIL,PhD.PASCO CLERFt&COMPTROLLER 02/23/2016 11:A5 AM 1 of 1 OR BR 9327 pG �� - , � r � ,a�:,,:� ��g��''A';,v'� ..�. � �/.w t��,-c G��e� i ` 5tate Certified I2oofang ao' � r_,,,��.-- ._ 6��y;,t, W.Pasco:727-844-7663(ROOF) &Building Contractor 4��' �� .�,��.. -�cR �M,p�,s Pinellas:727-723-7663(Rooi� Lic.#CCC1328Z20 �� ^��s�"' - I�1lsborough:813-229-7663(RooF} Lic.#CBC1253998 �� ^ �� Hernando:3�2-799-7999 Bondcd&Insured • ��S`� Fa�:727-940-5441 "A Costs�tihnetat To Quality" ��1 � yf�'i"`'� � Email:ba,ysideroofing@live.coen Aeagie`s list. �'�r��'��' r�°µ'�°� www.baysideroofingpros.com �: , � PROPOSALSLB�IITTF,DTO �!`iy+;.•, w� PFiONE i��a.��' �''t::` :':l`^" bATE ��r- SCHN.N:'1' i^ - :. ;i LOCATION ��l C[TV.STATE,Z.IP 1 • t„ 1}.1 :` '>_ EiL1ILV�� • ♦ ��S�!'Q C�r �'?t� '�.Q�'� 1. S�1�GII_,E $..s�§-,` ,� ,,z��;,_ , F!'E NEFEB F SUDdfIT SPGCIFlCdTIO:YS ANU ESTTdf.ITF.S FOR. rua� e�Rt„CHECXAI.LTH.IT•IPPLY rnn Enl�,* , O O;Obtain and pus[loca!roof permits jin ancordancc with local law) O O� Tnstall ne�.v 16'valley nutal in valleys � n.Completely remove exisling roof to b:+re woud O O'�Install nc�c Rashings for all plumbing ntack;and GRV vents,nailed O O�,Thomughly in;put moT deckine ;und sealedµith asphalt roofing cement O O Replace rotten deckino st S'Rw uer shec[piywood ancL�or O �� Install a Class A fungus resutanl shingle,{6 nails per shingle) ..S "' per L.F of decking and all other�voodwork O O'Insrall standard Ridgevenl 1'or attic ventilation :'i3 L.P. O O�,2e-nail enlire roof deckin3 pet Florida buildin�wdz w,%proper fasunecs'0"'3 Instalt Prc mium tti;h Definitiun Sivng(e over vent for attic O O� lnscall a self-adi�ering peel&stick over entirc roof dcck per .,xentilatiun L.F Flurida building codc""`""""`"'" O O� Fland cleau and iuul awny all job related debris to an approved O"•'�' InsGill IS# Layzr(sj 30i?_layet(��felt for muishire Uairicr dispusal f ciliry �and dry-in of roof for a comp(ete water ti�t�y,s�tcm. O �,,Hand cfean and magneticaliy sweep job<ite for nails O UY Ins4�11 New Drip Ed,;e- Namral-Wliite�'3town;Gray-Black-Bei�e O O Cail in all Rooi Inspecuons�yith local pertnitting for added�vatar tighlness,nailzd aiid sealed with asphalt roof cement O�Finn!inspec�ioa�riUi/eaxe on�+er(s)m ensurr romplete aarisjactioa I �� STY'LE S'lYLr �r-1�}"Y!:'�:::;t��„r.1.4,p. � 'COLOR CQLOR �L �fANti�AC7LRGR'S�1'ARReIv'T4' hir\NU'F:ICTGR�'S�.1RR�.\�: ' '7'7= PRICE PRICC ^�'1;:'�' Y'i�� V V' �3��> (�.`:r��jt � G'pC But CI�ECJi ALL T77.1TAPPLy �sra :07 O O Obtain and post local roof pennits(in accorclance n�ith local law) O O Install thickness of insulation�v proper fastcners O O Completely remove etistiue rouf ro bam O O tnst:�U mm TPO Root'System _ O O,Therouglily iacpect roof decking , _. _ O .O_Install a maintenance J?'ge rap'sl�ee�instxlleJ��vith hot tar O O Replace rotten dccking at�_per sheet plywood an�br ymanulated finish( ). �_per L.F of dccking end ail othcr�voodwork O O [nstull en parapit walls O O Replace matal,conetete ami(or a}Psum deck at S O O Make proper tie-in to,loped rooF O O Re-nail entirc roof dccking per floiida buildinY code w(proper fhsteners O O Install new cepin�cnp flashings on��alis O O In;tall a sclT=adhering pecl 3c s6ck o�•er er.tirt roof deck per O O Clean azid haul a�vay al I job rclatcd debris to an approved Florida build'uig codo disposal facility O O Install a 7=Ib.(43 lb.basc.heat secured�sith fastzners . O O Hand claan and magnetic¢Ily s�veep job site far naiIs O O Install new Drip Edge-Natuial-White-Brow��-(iray-Black-Bei�e O O Cafl in afl Roof inspcc[iorts�vich local pennitting O U lnstall a modified roof system Smoodi/Granulated O O W"e recommend a tapered roof system for tlic clevation of I O O Install plys of foeretass felt,inst;�ll with hot tar � ponding watez Add O Acccpted O Relused ' � O Ins[all an alumilmm wat ftnuli v O Fina!inspection ivitb Gorne on�ner(sJ w ensure conepfe�e sa[Lsfactian �� d Sll'LE SML• COLOR I,OLOIL FfANUiACRiRER'S MARRANTY A1ANU�ACTUliE2'S V.,VLR.a�"R' PRICL• - PRICE ^g!e,",�,� �(.y''�e,4�j :,� :;}��:..i�»,.:! Ca .-..ib:.r �_i-";fi .ls�•.F i a� �'�� , , o-�-a � Q� Pi%Pi•Upose herebv to fumish material and labor-complete in acwrdance with above specifications,fo the sum to be paid according to the paymenl schedule set:orth below,unlessjab is not completed. -, ,. �—_ ,s ! j r+fq+ p i , n doliars($ . � jrt.:� .f•� �/ ,tt,l4erl''/1ZE:f .'�/ 11JS"f r�I�':�: V�I`4 ......:...�>- Payntent to be made as follows: Down Payment ' Balunce .r��r: r u..ji,�hr �;�; i.r, �� t v r= ,t, ,�.,, .' _ ,.., f,,,, :�: - - A7ethori�ed y.f 1 j, f,�,�r�j`fj`'R� Sl�liRll[/'G' �� af . Y.�i ri All unpaid and outstanding balances hereunder shall be subicct Note:Tlus proposal may be to 9 scrvicc charge of 1.5%per month be�innin;from the due date. ��ithdra�vn by us if not accepted witliin =f�� days. fAcce�tunce of�'YopOSRI •T'he above prices,specifications and TERtY1S AND CONDITIONS ON IZEVERSE SIDE condihons are salis(actory and are h�reby accepted.You are authorized to do the work as cifie ay rill be ade as outlined above. Si�nature� Du1e of.4cceptance� / �� i I W.Pasco:727-844-7663(ROOF) �_. State Certifled Roofing Contractor Pinellas:727-723-7663(ROOF) �� Lic.#CCC1328720 , Hillsborough:813-229-7663(ROOF) - Bonded 8 Insured , Hemando:352-799-7999 �r"��, � Fax#;727-943-5121 • ��/j�% To Whom It May Concern: I� The following are authorized to obtain permits and considered agents for eayside Roofing Professionals,Inc.: Patrick Hloska Sr. Patrick Hloska Jr. , lill Hloska Brian Hloska Andrew Shuhart Lorie Gouge Anybody who is not listed in the above should be removed from obtaining any information on permits. Thank You � / Patrick Hloska Roofing License#: CCC1328720 he forgoing wa1�acknowledged before me this � da of C 20 by �-�e� f�1�t`�S�-� .as �� h� for �5-t4.�C� ` � �Z�/'t./,4,P� �t°C�oG� Signature of Notary Print,Type,Stamp Personally Known�or Produced ID Type of ID Produced ��. R{CHARD H GOUGE S!'�r ru��o L Commission�FF 924Z�0 '-• *= NSy Commission Expires ';;��.,.,�o�;�' Octobet 04, 2019 , ��„��,��`