NCC216226_Contact Update Record_20231201

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 12/1/2023 12:09:59 PM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC216226
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2021-6226
Original NOI No.* 72573
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Gateway Housing, LLC
Project Name John Smith Road Subdivision-Phase 1 -Single Family
Address John Smith Road, Rutherfordton, NC
County Rutherford
Latitude 35.3438
Longitude -81.9661
Date COC Issued* 11/09/2021
Prior Rescission Date This field will populate only if COC has already been rescinded.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
4) Yes
Billing Email [e-mail]
NEW Billing Email [e-mail]
Billing Telephone No. 828-559-9273
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Angela Anderson
Individual(Previous)
First Name(New)* Neil
Last Name(New)* Gurney

NEW Legally Reflects any revisions above
Responsible Neil Gurney
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 135 S Main Street,0, Marion, NC 28752
Address(Previous)
NEW Permittee Street Address
Mailing Address* 74 N.Garden Street
Address Line 2
City State/Province/Region
Marion NC
Postal/Zip Code Country
28752 USA
Permittee Street 135 S Main Street,0, Marion, NC 28752
Address(Previous)
NEW Permittee Street Street Address
Address* 74 N.Garden Street
Address Line 2
City State/Province/Region
Marion NC
Postal/Zip Code Country
28752 USA
Change Requested Destiny Mealhouse(Operations Manager)via Modification request submitted
by:* 11/29/2023.
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 12/01/2023