NCC192967_Contact Update Record_20210202

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Georgoulias, Bethany 2/2/2021 11:20:22 AM (Contact Changes Submitted)

Certificate of NCC192967
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
NC Reference No. NCG01-2019-2967
Original NOI No.* 18902
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new OOC required)
Town of Valdese
Project Name
Main Street Waterline Replacement
Address
Main Street, Valdese, NC
County
Burke
Latitude
35.7447
Longitude
-81.5660
Date COC Issued*
12/03/2019
Prior Rescission
This field will populate only if COChas already been rescinded.
Date
Which Contacts
f Billing Only
Have Changed?*
r Legally Responsible Individual Only
r 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
Billing Telephone
No.
Site Contact
(Previous)
Site Contact Title
(Previous)
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Bryan Duckworth
Public Works Director
Organization
(Previous)
Town of Valdese

First Name (New)* Greg
Last Name (New) * Padgett
NEW Site Contact* Peflects any revisions above
Greg Padgett
NEW Site Contact
Title
NEW Organization Town of Valdese
This field is not required on the NCA form and nay not pre -populate.
Site Contact Email [e-mail]
(Previous)
NEW Site Contact [e-mail]
Email*
Site Contact 828-879-2128
Telephone No.
(Previous)
NEW Site Contact 828-879-2131
Telephone No.*
Site Contact Mailing 102 Massel Avenue Southwest, 0, Valdese,
Address (Previous) NC 28690-2814
NEW Site Contact Street Address
Mailing Address* P.O. Box339
Address Line 2
C7ty
State / Rovince / Fbgion
Valdese
NC
Fbstal / Zip Code
Country
28690
us
Change Requested Seth Eckard; additional contact details provided by Greg Padgett
by: * Include any additional correspondence records in the Pepository 00Cfolder.
Additional Information for this update to contact information:
Addional
Explanation
(Optional)
Date * 02/02/2021