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HomeMy WebLinkAboutNCC191449_Contact Update Record_20210928Action 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Longitude-78.2890 Date COC Issued* 08/19/2019 Prior Rescission This field will populate only if 00Chas already been rescinded.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 leah5959@aol.com (Previous) NEW Permittee leah5959@aol.com 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 leah5959@aol.com (Previous) NEW Site Contact Email* Site Contact Telephone No. (Previous) leah5959@aol.com 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