NCC190367_Contact Update Record_20210503

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 5/3/2021 11:07:35 AM (Contact Changes Submitted)

Certificate of NCC190367
Coverage (COC) Enter the Certificate of Coverage Nmber (Use capital letters)
No.*
NC Reference No. NCG01-2019-0367
Original NOI No.* 11313
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new OOC required)
Cleveland Construction, Inc.
Project Name
19-NC17 Corrosion Control and Fuel Cell Hangar
Address
4390 Minuteman Way, Charlotte, NC
County
Mecklenburg
Latitude
35.0000
Longitude
-81.0000
Date COC Issued*
05/24/2019
Prior Rescission
This field will populate only if OOChas already been rescinded.
Date
Which Contacts
f Billing Only
Have Changed?*
f 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?
r No
r Yes
Billing Email
NEW Billing Email [e-mail]
Billing Telephone
No.
NEW Billing [phone]
Telephone No. (Cptional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Will Rawdon
Individual
(Previous)

First Name (New)* Matthew
Last Name (New) * Milstead
NEW Legally Reflects any revisions above
Responsible Matthew Milstead
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee 330-322-4670
Telephone No.
(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 14825 Ballantyne Village Way, Suite A275,
Address (Previous) Charlotte, NC 28277-4285
NEW Permittee
Mailing Address*
Street Address
1800 Cross Beam Drive
Address Line 2
City
Charlotte
Fbstal / Zip Code
28217
Permittee Street 14825 Ballantyne Village Way, Suite A275,
Address (Previous) Charlotte, NC 28277-4285
NEW Permittee Street Address
Street Address* 1800 Cross Beam Drive
Address Line 2
city
Charlotte
Fbstal / Zip Code
28217
State / Rovince / Fbgion
NC
Country
us
State / F rovince / Region
NC
Country
us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact
Robin Sandidge
(Previous)
Site Contact Title
Superintendent
(Previous)
Organization
Cleveland Construction, Inc.
(Previous)
First Name (New)*
Casey

Last Name (New) * Sandidge
NEW Site Contact* Peflects any revisions above
Casey Sandidge
NEW Site Contact
Title
NEW Organization Cleveland Construction, Inc.
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 704-431-3090
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 14825 Ballantyne Village Way, Suite A275,
Address (Previous) Charlotte, North Carolina 28277
NEW Site Contact
Mailing Address*
Street Address
1800 Cross Beam Drive
Address Line 2
City
Charlotte
Fbstal / Zip Code
28217
State / Rovince / Fbgion
North Carolina
Country
United States
Change Requested Matthew Milstead via e-mail on 5/3/2021 (legally responsible individual change
by: form submitted) in response to annual fee invoice.
Include any additional correspondence records in the Fbpository 00Cfolder.
Additional Information for this update to contact information:
Addional
Explanation
(Optional)
Date * 05/03/2021