NCC203003_Contact Update Record_20210818

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 8/18/2021 9:14:58 AM (Contact Changes Submitted)

Certificate of NCC203003
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
NC Reference No. NCG01-2020-3003
Original NOI No.* 28207
Project information associated with this permit (cannot change):
Permittee Listed
Organizaiton cannot be changed (new OOC required)
Toll Southeast LP Company, Inc
Project Name
The Point at Lake Castleberry
Address
4213 Green Level West Road, Apex, NC
County
Wake
Latitude
36.0000
Longitude
-79.0000
Date COC Issued*
07/17/2020
Prior Rescission
This field will populate only if OOC has already been rescinded.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. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible David Kelly
Individual
(Previous)

First Name (New)* David
Last Name (New) * Kelly
NEW Legally Reflects any revisions above
Responsible David Kelly
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee [phone]
Telephone No.
(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 2310 T.W. Alexander Drive, 0, Raleigh, NC
Address (Previous) 27617
NEW Permittee
Mailing Address*
Street Address
900 Perimeter Park Drive
Address Line 2
Suite B3
Cty
Morrisville
Fbstal / Zip Code
27560
Permittee Street 2310 T.W. Alexander Drive, 0, Raleigh, NC
Address (Previous) 27617
NEW Permittee Street Address
Street Address* 900 Perimeter Park Drive
Address Line 2
Suite B3
city
Morrisville
Fbstal / Zip Code
27560
State / Rovince / R gion
NC
Country
us
State / Rovince / Region
NC
Country
us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Shawn Harling
(Previous)
Site Contact Title Sr. Land Development Manager
(Previous)
Organization Toll Brothers
(Previous)

First Name (New)* Shawn
Last Name (New) * Harling
NEW Site Contact* Reflects any revisions above
Shawn Harling
NEW Site Contact Sr. Land Development Manager
Title
NEW Organization Toll Brothers
This field is not required on the N01 form and nay 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
2310 T.W. Alexander Drive, 0, Raleigh, NC
Address (Previous)
27617
NEW Site Contact Street Address
Mailing Address* 900 Perimeter Park Drive
Address Line 2
Suite B3
City
State / Frovince / Region
Morrisville
NC
Fbstal / Zip Code
Country
27560
us
Change Requested Garrick Wier with Toll Brothers via e-mail on 8/17/2021
by: * Include any additional correspondence records in the Repository 00Cfolder.
Additional Information for this update to contact information:
Addional Addresses only updated for all contacts.
Explanation
(Optional)
Date * 08/18/2021