NCC204866_Contact Update Record_20210610

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 6/10/2021 3:21:51 PM (Contact Changes Submitted)

Certificate of NCC204866
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
NC Reference No. NCG01-2020-4866
Original NOI No.* 34315
Project information associated with this permit (cannot change):
Permittee Listed
Organizaitoncannot bechanged (new CCCrequired)
Wake County Board of Education
Project Name
Elementary School 51 Pond Breach
Address
Woods Creek Road, Holly Springs, NC
County
Wake
Latitude
35.6810
Longitude
-78.8830
Date COC Issued*
10/29/2020
Prior Rescission
This field will populate only if CCChas already been rescinded.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 Don Haydon Jr
Individual
(Previous)

First Name (New)* David
Last Name (New) * Neter
NEW Legally Peflects any revisions above
Responsible David Neter
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee 919-588-3577
Telephone No.
(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 111 Corning Road, Suite 190, c/o Facilities
Address (Previous) Design and Construction, Cary, NC 27518
NEW Permittee Street Address
Mailing Address* 5625 Dillard Drive
Address Line 2
City State / Rovince / Fbgion
Cary NC
Fbstal / Zip Code Country
27518 us
Permittee Street 5626 Dillard Drive, 0, Cary, NC 27518
Address (Previous)
NEW Permittee Street Address
Street Address* 5626 Dillard Drive
Address Line 2
City
State / province / Region
Cary
NC
postal / Zip Code
Country
27518
us
Change Requested David Neter, Chief Business Officer/Interim Chief of Facilities and Operations via
by: Modification request submitted 6/9/2021
Include any additional correspondence records in the Repository CDC folder.
Additional Information for this update to contact information:
Addional
Explanation
(Optional)
Date * 06/10/2021