NCC193261_Contact Update Record_20210331

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Selkane, Aziza 3/31/2021 12:20:12 PM (Contact Changes Submitted)

•
Certificate of NCC193261
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
NC Reference No. NCG01-2019-3261
Original NOI No.* 19764
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new CDC required)
314 Field Street LLC
Project Name
Capital Motor Sales
Address
316 Field Street, Cary, NC
County
Wake
Latitude
35.7912
Longitude
-78.7747
Date COC Issued*
01/07/2020
Prior Rescission
This field will populate only if COChas already been rescinded.
Date
Which Contacts
f Billing Only
Have Changed?*
r Legally Responsible Individual Only
f Site Contact Only
r BOTH Legally Responsible Individual and Site Contact
Has Billing Contact
Choose'Yes'torevise Billing Contact details.
Changed?
F No
r Yes
Billing Email
Billing Telephone
No.
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Steve Gillooly
Individual
(Previous)
First Name (New)* Steve
Last Name (New) * Gillooly

NEW Legally Fbflects any revisions above
Responsible Steve Gillooly
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee 9196129885
Telephone No.
(Previous)
NEW Permittee 9196129885
Telephone No.*
Permittee Mailing 232 East Chatham Street, 0, Cary, NC 27511
Address (Previous)
NEW Permittee Street Address
Mailing Address* PO Box 1866
Address Line 2
City
State / Province / Region
Cary
NC
Fbstal / Zip Code
Country
27512
USA
Permittee Street 232 East Chatham Street, 0, Cary, NC 27511
Address (Previous)
NEW Permittee Street Address
Street Address* 316 Field Street
Address Line 2
city
State / Province / Region
Cary
NC
Postal / Zip Code
Country
27513
USA
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Steve Gillooly
(Previous)
Site Contact Title Member/Manager
(Previous)
Organization 314 Field Street LLC
(Previous)
First Name (New)* Steve
Last Name (New) * Gillooly
NEW Site Contact* Reflects any revisions above
Steve Gillooly

NEW Site Contact Member/Manager
Title
NEW Organization 314 Field Street LLC
This field is not required on the NOI form and nay not pre -populate.
Site Contact Email [e-mail]
(Previous)
NEW Site Contact [e-mail]
Email*
Site Contact 9196129885
Telephone No.
(Previous)
NEW Site Contact 9196129885
Telephone No.*
Site Contact Mailing 232 East Chatham Street, 0, Cary, NC 27511
Address (Previous)
NEW Site Contact Street Address
Mailing Address* PO Box 1866
Address Line 2
City
State / Rovince / Fbgion
Cary
NC
Fbstal / Zip Code
Country
27512
USA
Change Requested Steve Gillooly
by: * Include any additional correspondence records in the Fbpository 00Cfolder.
Additional Information for this update to contact information:
Addional
Explanation
(Optional)
Date * 03/31 /2021