NCC221350_Contact Update Record (Site Contact)_20241105

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 11/5/2024 9:16:27 AM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC221350
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2022-1350
Original NOI No.* 86269
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Toll Southeast LP Company, Inc.
Project Name Forestville Village
Address Old Knight Rd.&Forestville Rd.,Knightdale, NC
County Wake
Latitude 35.8060
Longitude -78.4769
Date COC Issued* 10/23/2024
Prior Rescission Date This field will populate only if COC has already been rescinded.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]
Billing Telephone No. 602.596.0100
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact David Rexroad
(Previous)
Site Contact Title Land Development Manager
(Previous)
Organization Toll Brothers
(Previous)
First Name(New)* Antonio

Last Name(New)* Ray
NEW Site Contact* Reflects any revisions above
Antonio Ray
NEW Site Contact
Title
NEW Organization Toll Brothers
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 704.576.9620
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 900 Perimeter Park Dr.,Suite B3, Morrisville,
Address(Previous) NC 27560
NEW Site Contact Street Address
Mailing Address* 900 Perimeter Park Dr.
Address Line 2
Suite B3
City State/Province/Region
Morrisville NC
Postal/Zip Code Country
27560 USA
Change Requested Janet Boucher(Sr. Land Development Administrator)via email on 11/4/2024.
by:* Mailing address kept the same.
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 11/05/2024