NCC204878_Contact Update Record_20211006

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Selkane, Aziza 10/6/2021 9:32:27 AM (Contact Changes Submitted)

Certificate of NCC204878
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
NC Reference No. NCG01-2020-4878
Original NOI No.* 34310
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new OOC required)
Cole Mill Hotel, Inc.
Project Name
Cole Mill Road Hotel
Address
1206 Cole Mill Road, Durham, NC
County
Durham
Latitude
36.0240
Longitude
-78.9560
Date COC Issued*
10/29/2020
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This field will populate only if COChas already been rescinded.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
r 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 434-822-2161 Ext 323
Telephone No. (Optional)
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Dennis Hall
(Previous)

Site Contact Title Senior Project Manager
(Previous)
Organization Daly Seven, Inc. - New Construction
(Previous)
First Name (New)*
Chris
Last Name (New) *
Mitchell
NEW Site Contact*
Reflects any revisions above
Chris Mitchell
NEW Site Contact
Senior Project Manager
Title
NEW Organization Daly Seven, Inc. - New Construction
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
336 788 9444 ext 301
Telephone No.
(Previous)
NEW Site Contact
336 788 9444 ext 301
Telephone No.*
Site Contact Mailing
3810 North Elm Street, Suite 202, 0,
Address (Previous)
Greensboro, NC 27455
NEW Site Contact Street Address
Mailing Address* 3810 North Elm Street, Suite 202
Address Line 2
aty
State / Frovince / Region
Greensboro
NC
Fbstal / Zip Code
Country
27455
USA
Change Requested Tamra Mason
by: * Include any additional correspondence records in the Repository CDC folder.
Additional Information for this update to contact information:
Addional
Explanation
(Optional)
Date * 10/06/2021