NCC190553_Contact Update Record_20240715

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Tev.Holloman 7/15/2024 2:01:33 PM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC190553
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2019-0553
Original NOI No.* 11900
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Robinson Village Charlotte,LLC
Project Name Robinson Village
Address Brawley Lane,Charltotte, NC
County Mecklenburg
Latitude 35.2430
Longitude -80.6720
Date COC Issued* 04/01/2024
Prior Rescission Date This field will populate only if COC has already been rescinded.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
O Yes
Billing Email
Billing Telephone No.
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Bob Hogan
(Previous)
Site Contact Title
(Previous)
Organization R2 Development
(Previous)
First Name(New)* Chasity

Last Name(New)* Conner
NEW Site Contact* Reflects any revisions above
Chasity Conner
NEW Site Contact
Title
NEW Organization R2 Development
This field is not required on the NOI form and may not pre-populate.
Site Contact Email [e-mail]
(Previous)
NEW Site Contact [e-mail]
Email*
Site Contact 7045769620
Telephone No.
(Previous)
NEW Site Contact 704-999-0945
Telephone No.*
Site Contact Mailing 517 Alcove Road,0, Mooresville, NC 28117-
Address(Previous) 8574
NEW Site Contact Street Address
Mailing Address* 517 Alcove Road
Address Line 2
City State/Province/Region
Mooresville NC
Postal/Zip Code Country
28117-8574 us
Change Requested Chasity Conner, Development Project Administrator,via email on 7/11/24.
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 07/15/2024