NCC216988_Contact Update Record_20211217

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Selkane, Aziza 12/17/2021 10:10:43 AM (Contact Changes Submitted)

Certificate of
NCC216988
Coverage (COC) No.*
Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No.
NCG01-2021-6988
Original NOI No.*
75836
Project information associated with this permit (cannot change):
Permittee Listed
Organizaiton cannot be changed (new COC required)
Oppidan Inc.
Project Name
Cash Corporate Center Lot B
Address
1251 Burma Dr, Apex, NC
County
Wake
Latitude
35.7099
Longitude
-78.8281
Date COC Issued *
12/17/2021
Prior Rescission Date
This field will populate only if COC has already been rescinded.
Which Contacts Have
Billing Only
Changed?*
Legally Responsible Individual Only
• Site Contact Only
BOTH Legally Responsible Individual and Site Contact
Has Billing Contact
Choose'Yes'to revise Billing Contact details.
Changed?
• No
Yes
Billing Email
[e-mail]
Billing Telephone No.
9194279243
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Kirk Matthews
(Previous)
Site Contact Title Vice President
(Previous)
Organization Omega Construction
(Previous)
First Name (New)* Kirk

Last Name (New) * Matthews
NEW Site Contact* Reflects any revisions above
Kirk Matthews
NEW Site Contact Vice President
Title
NEW Organization Omega Construction
This field is not required on the NOI form and may not pre -populate.
Site Contact Email [e-mail]
(Previous)
NEW Site Contact [e-mail]
Email*
Site Contact 3367011100
Telephone No.
(Previous)
NEW Site Contact 3367011100
Telephone No.*
Site Contact Mailing 1100 South Stratford Road, Building C, Suite
Address (Previous) 110, Winston-Salem, NC 27103
NEW Site Contact Street Address
Mailing Address* 1100 South Stratford Road
Address Line 2
Building C, Suite 110
City State / Province / Region
Winston-Salem NC
Postal / Zip Code Country
27103 us
Change Requested Adam Simpson by email on 12/16/2021
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 12/17/2021