NCC192597_Contact Update Record_20201217

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany 12/17/2020 7:52:00 AM (Contact Changes Submitted)

Certificate of NCC192597
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
NC Reference No. NCG01-2019-2597
Original NOI No.* 17896
Project information associated with this permit (cannot change):
Permittee Listed
Organizaiton cannot be changed (new OOC required)
Toll Bros. of North Carolina II, Inc.
Project Name
Castleberry Trails
Address
605 Wimberly Road, Apex, NC
County
Wake
Latitude
35.7695
Longitude
-78.9251
Date COC Issued*
11/01/2019
Prior Rescission
This field will populate only if OOC has already been rescinded.
Date
Which Contacts
f Billing Only
Have Changed?*
F Legally Responsible Individual Only
f Site Contact Only
r BOTH Legally Responsible Individual and Site Contact
Has Billing Contact
Choose'Yes'torevise Billing Contact details.
Changed?
r No
r Yes
Billing Email
NEW Billing Email* [e-mail]
Billing Telephone
No.
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible PerryVerille
Individual
(Previous)

First Name (New)* Ted
Last Name (New) * Pease
NEW Legally Peflects any revisions above
Responsible Ted Pease
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee
[phone]
Telephone No.
(Previous)
NEW Permittee
[phone]
Telephone No.*
Permittee Mailing
900 Perimeter Park Dr Suite B3, 0,
Address (Previous)
Morrisville, NC 27560
NEW Permittee
Mailing Address*
Street Address
900 Perimeter Park Dr
Address Line 2
Suite B3
aty
Morrisville
Fbstal / Zip Code
27560
Permittee Street 900 Perimeter Park Dr Suite B3, 0,
Address (Previous) Morrisville, NC 27560
NEW Permittee Street Address
Street Address* 900 Perimeter Park Dr
Address Line 2
Suite B3
city
Morrisville
Fbstal / Zip Code
27560
State / Rovince / Fbgion
NC
Country
us
State / Rovince / FZegion
NC
Country
us
Change Requested Ted Pease via Modification request submitted 12/16/2020 and Garth De Blasio
by: (site contact) via e-mail.
Include any additional correspondence records in the Fbpository CDC folder.
Additional Information for this update to contact information:
Addional Entered Ted's contact information for billing (default).
Explanation
(Optional)
Date * 12/17/2020