NCC201094_Contact Update Record_20230418

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 4/18/2023 9:31:35 AM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC201094
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2020-1094
Original NOI No.* 23224
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Shirdi Sai Temple
Project Name Shirdi Sai Temple
Address 2006 State Hwy 218, Indian Trail, NC
County Union
Latitude 35.1629
Longitude -80.5737
Date COC Issued* 03/30/2020
Prior Rescission Date This field will populate only if COC has already been rescinded.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? Q No
4) Yes
Billing Email
NEW Billing Email [e-mail]
Billing Telephone No.
NEW Billing [phone]
Telephone No. (Optional)
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Sonia Bhave
(Previous)
Site Contact Title Superindendent
(Previous)

Organization SRB Designbuild
(Previous)
First Name(New)* Veera
Last Name(New)* Thota
NEW Site Contact* Reflects any revisions above
Veera Thota
NEW Site Contact Responsible Official
Title
NEW Organization Shirdi Sai Temple
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 7043097353
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 10550 Independence Pointe Pkwy, Suite 300,
Address(Previous) Matthews, NC 28105
NEW Site Contact Street Address
Mailing Address* 7013 South Creek Road
Address Line 2
City State/Province/Region
Charlotte NC
Postal/Zip Code Country
28277-4321 us
Change Requested Sonia Rai Bhave(previous site contact,SRB Design Build Corp.)and Veera Thota
by:* via emails on 4/17/2023.
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 04/18/2023