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HomeMy WebLinkAboutNCC223464_Contact Update Record (Site Contact)_20230320Action History (UTC-05:00) Eastern Time (US & Canada) Submit by bethany.georgoulias 3/20/2023 1:11:26 PM (Contact Changes Submitted) Certificate of NCC223464 Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters) NC Reference No. NCG01-2022-3464 Original NOI No.* 108551 Project information associated with this permit (cannot change): Permittee Listed Organizaiton cannot be changed (new COC required) LeoTerra Peters Creek, LLC Project Name Peters Creek Storage Address 3775 Peters Creek Parkway, Winston-Salem, NC County Forsyth Latitude 36.0188 Longitude-80.2604 Date COC Issued * 10/06/2022 Prior Rescission Date This field will populate only if COC has already been rescinded. Which Contacts Have Billing Only Changed?* Legally Responsible Individual Only Site Contact Only BOTH Legally Responsible Individual and Site Contact Has Billing Contact Choose'Yes'to revise Billing Contact details. Changed? Q No 0 Yes Billing Email buddy@leoterradevelopment.com NEW Billing Email kat.lyons@leoterradevelopment.com Billing Telephone No. 336-671-1858 NEW Billing (336) 682-1414 Telephone No. (optional) Legally Responsible Individual Contact Information REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES! Legally Responsible Christopher Lyons Individual (Previous) First Name (New)* Christopher Last Name (New) * Lyons NEW Legally Reflects any revisions above Responsible Christopher Lyons Individual* Permittee Email buddy@leoterradevelopment.com (Previous) NEW Permittee buddy@leoterradevelopment.com Email* Permittee Telephone 336-671-1858 No. (Previous) NEW Permittee (336) 671-1858 Telephone No.* Permittee Mailing 110-A Shields Park Dr., 0, Kernersville, NC Address (Previous) 27284 NEW Permittee Street Address Mailing Address* 110-A Shields Park Dr. Address Line 2 City State / Province / Region Kernersville NC Postal / Zip Code Country 27284 USA Permittee Street 110-A Shields Park Dr., 0, Kernersville, NC Address (Previous) 27284 NEW Permittee Street Street Address Address * 110-A Shields Park Dr. Address Line 2 City State / Province / Region Kernersville NC Postal / Zip Code Country 27284 USA Site Contact Information REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES! Site Contact Jim Sandknop (Previous) Site Contact Title Director of Construction (Previous) Organization LeoTerra Development (Previous) First Name (New)* Kat Last Name (New) * Lyons NEW Site Contact* Reflects any revisions above Kat Lyons NEW Site Contact Senior Director of Entitlements Title NEW Organization LeoTerra Development Inc. This field is not required on the NOI form and may not pre -populate. Site Contact Email jim.sandknop@leoterradevelopment.com (Previous) NEW Site Contact kat.lyons@leoterradevelopment.com Email* Site Contact 336-362-1716 Telephone No. (Previous) NEW Site Contact (336) 682-1414 Telephone No.* Site Contact Mailing 110-A Shields Park Dr., 0, Kernersville, NC Address (Previous) 27284 NEW Site Contact Street Address Mailing Address* 110-A Shields Park Dr. Address Line 2 City State / Province / Region Kernersville NC Postal / Zip Code Country 27284 USA Change Requested Jason Cheek via email requesting site contact updates on 3/10/2023. by: * Include any additional correspondence records in the Repository COC folder. Additional Information for this update to contact information: Addional Explanation (Optional) Date * 03/20/2023