NCC230477_Contact Update Record_20240209

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 2/9/2024 9:40:44 AM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC230477
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2023-0477
Original NOI No.* 127651
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Town of Rolesville
Project Name South Main Street Improvements and Burlington Mills Road Realigmmnet(U-6241)
Address 9412 S. Main Street to 200 N. Main Street(Bus.401), Rolesville, NC
County Wake
Latitude 35.9238
Longitude -78.4567
Date COC Issued* 02/17/2023
Prior Rescission Date This field will populate only if COC has already been rescinded.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
(6) Yes
Billing Email [e-mail]
NEW Billing Email [e-mail]
Billing Telephone No. 919-556-3506
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Kelly Arnold
Individual(Previous)
First Name(New)* Eric
Last Name(New)* Marsh

NEW Legally Reflects any revisions above
Responsible Eric Marsh
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing P.O. Box 250,0, Rolesville, NC 27571-9602
Address(Previous)
NEW Permittee Street Address
Mailing Address* P.O. Box 250
Address Line 2
City State/Province/Region
Rolesville NC
Postal/Zip Code Country
27571-9602 USA
Permittee Street 502 Southtown Circle,0, Rolesville, NC
Address(Previous) 27571-9602
NEW Permittee Street Street Address
Address* 502 Southtown Circle
Address Line 2
City State/Province/Region
Rolesville NC
Postal/Zip Code Country
27571-9602 US
Change Requested Mical McFarland (Town of Rolesville)via Modification request submitted 2/8/2024.
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 02/09/2024