NCC191449_Contact Update Record_20210928

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Selkane, Aziza 9/28/2021 1:48:15 PM (Contact Changes Submitted)

Certificate of NCC191449
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
NC Reference No. NCG01-2019-1449
Original NOI No.* 14983
Project information associated with this permit (cannot change):
Permittee Listed Organizaitoncannot bechanged (new 000required)
POGO Development, LLC
Project Name Lynchford Pointe Subdivision
Address NC 96, O'Neals Township, NC
County Johnston
Latitude 35.6349
Longitude-78.2890
Date COC Issued* 08/19/2019
Prior Rescission This field will populate only if 00Chas already been rescinded.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
Billing Telephone
No.
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Brad Gordon
Individual
(Previous)
First Name (New)* Brad
Last Name (New) * Gordon

NEW Legally Fbflects any revisions above
Responsible Brad Gordon
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee 919 427-3736
Telephone No.
(Previous)
NEW Permittee 919 427-3736
Telephone No.*
Permittee Mailing 125 Colonial Drive, 0, Clayton, NC 27527
Address (Previous)
NEW Permittee Street Address
Mailing Address* 276 Benning Circle
Address Line 2
City State / Rovince / Plegion
Clayton NC
Fbstal / Zip Code Country
27527 US
Permittee Street 125 Colonial Drive, 0, Clayton, NC 27527
Address (Previous)
NEW Permittee Street Address
Street Address* 276 Benning Circle
Address Line 2
City
State / Rovince / Region
Clayton
NC
Fbstal / Zip Code
Country
27527
US
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Brad Gordon
(Previous)
Site Contact Title Owner
(Previous)
Organization
POGO Development, LLC
(Previous)
First Name (New)*
Brad
Last Name (New) *
Gordon
NEW Site Contact*
Reflects any revisions above
Brad Gordon

NEW Site Contact Owner
Title
NEW Organization POGO Development, LLC
This field is not required on the NOI form and nay not pre -populate.
Site Contact Email [e-mail]
(Previous)
NEW Site Contact
Email*
Site Contact
Telephone No.
(Previous)
[e-mail]
919 427-3736
NEW Site Contact 919 427-3736
Telephone No.*
Site Contact Mailing 125 Colonial Drive, 0, Clayton, NC 27527
Address (Previous)
NEW Site Contact
Mailing Address*
Street Address
276 Benning Circle
Address Line 2
City
Clayton
Fbstal / Zip Code
27527
State / Rovince / Fbgion
NC
Country
us
Change Requested Leah Gordon
by: * Include any additional correspondence records in the Fbpository 00Cfolder.
Additional Information for this update to contact information:
Addional
Explanation
(Optional)
Date * 09/28/2021