NCC215489_Contact Update Record (Initial)_20211005

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Selkane, Aziza 10/5/2021 4:05:47 PM (Contact Changes Submitted)

•
Certificate of NCC215489
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
NC Reference No. NCG01-2021-5489
Original NOI No.* 67020
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new CDC required)
Sandy Neck BFR, LLC
Project Name
Sandy Neck Subdivision
Address
Cliffdale Road, Fayetteville, NC
County
Cumberland
Latitude
35.0591
Longitude
-79.0503
Date COC Issued*
10/05/2021
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This field will populate only if COChas already been rescinded.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
f Yes
Billing Email
[e-mail]
Billing Telephone
774-487-1626
No.
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Matthew Alfonso
Individual
(Previous)
First Name (New)* Matthew
Last Name (New) * Alfonso

NEW Legally Fbflects any revisions above
Responsible Matthew Alfonso
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee 774-487-1626
Telephone No.
(Previous)
NEW Permittee 774-487-1626
Telephone No.*
Permittee Mailing 4 Noel Henry Drive, 0, Sandwich, MA 02537-
Address (Previous) 1497
NEW Permittee
Mailing Address*
Street Address
4 Noel Henry Drive
Address Line 2
City
Sandwich
Fbstal / Zip Code
02537-1497
State / Rovince / Fbgion
MA
Country
US
Permittee Street 4 Noel Henry Drive, 0, Sandwich, MA 02537-
Address (Previous) 1497
NEW Permittee Street Address
Street Address* 4 Noel Henry Drive
Address Line 2
City
State / F rovince / Region
Sandwich
MA
Fbstal / Zip Code
Country
02537-1497
us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Matthew Alfonso
(Previous)
Site Contact Title Manager/Principal
(Previous)
Organization Sandy Neck BFR, LLC
(Previous)
First Name (New)* Matthew
Last Name (New) * Alfonso
NEW Site Contact* Reflects any revisions above
Matthew Alfonso

NEW Site Contact Manager/Principal
Title
NEW Organization Sandy Neck BFR, LLC
This field is not required on the NDI form and may not pre -populate.
Site Contact Email [e-mail]
(Previous)
NEW Site Contact [e-mail]
Email*
Site Contact 774-487-1626
Telephone No.
(Previous)
NEW Site Contact 774-487-1626
Telephone No.*
Site Contact Mailing 4 Noel Henry Drive, 0, Sandwich, MA 02537-
Address (Previous) 1497
NEW Site Contact
Mailing Address*
Street Address
4 Noel Henry Drive
Address Line 2
City
Sandwich
Fbstal / Zip Code
02537-1497
State / Rovince / Fbgion
MA
Country
us
Change Requested Gina from Crawford Design Company by email on 10/5/2021
by: * Include any additional correspondence records in the Pepository CDC folder.
Additional Information for this update to contact information:
Addional
Explanation
(Optional)
Date * 10/05/2021