NCC210832_Contact Update Record_20240814

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 8/14/2024 8:42:22 AM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC210832
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2021-0832
Original NOI No.* 43107
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Pine Gate EPC, LLC
Project Name Pelham Substation
Address Old US HWY 29, Pelham, NC
County Caswell
Latitude 36.4727
Longitude -79.4868
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Prior Rescission Date This field will populate only if COC has already been rescinded.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? No
Yes
Billing Email [e-mail]
NEW Billing Email [e-mail]
Billing Telephone No. 8284121619
NEW Billing [phone]
Telephone No. (optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Fuller Connor
Individual(Previous)
First Name(New)* Rick
Last Name(New)* Backus

NEW Legally Reflects any revisions above
Responsible Rick Backus
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 130 Roberts Street, 0,Asheville, NC 28801-
Address(Previous) 3129
NEW Permittee Street Address
Mailing Address* 405 Fairview Road
Address Line 2
Suite 30
City State/Province/Region
Asheville NC
Postal/Zip Code Country
28803 us
Permittee Street 130 Roberts Street, 0,Asheville, NC 28801-
Address(Previous) 3129
NEW Permittee Street Street Address
Address* 405 Fairview Road
Address Line 2
Suite 30
City State/Province/Region
Asheville NC
Postal/Zip Code Country
28803 us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Adam Pinkston
(Previous)
Site Contact Title Project Manager
(Previous)
Organization Blue Ridge Power
(Previous)
First Name(New)* Rick
Last Name(New)* Backus

NEW Site Contact* Reflects any revisions above
Rick Backus
NEW Site Contact VP Project Execution
Title
NEW Organization Blue Ridge Power
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 [phone]
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 105 Fairview Road, Suite 30,Asheville, North
Address(Previous) Carolina 28803
NEW Site Contact Street Address
Mailing Address* 105 Fairview Road
Address Line 2
Suite 30
City State/Province/Region
Asheville North Carolina
Postal/Zip Code Country
28803 USA
Change Requested Sean Anderson(VP, Project Development)via email on 8/5/2024. Rick did not
by:* provide a telephone number on the form,so Sean's number was entered.
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 08/14/2024