NCC231053_Contact Update Record (Emails Only)_20230501

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 5/1/2023 4:16:18 PM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC231053
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2023-1053
Original NOI No.* 136105
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
ALCOA PROPERTIES,LLC
Project Name MURRAY HEIGHTS SUBDIVISION
Address 4808 MURRAY RD,WINSTON SALEM, NC
County Forsyth
Latitude 36.1740
Longitude -80.3030
Date COC Issued* 04/28/2023
Prior Rescission Date This field will populate only if COC has already been rescinded.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 [e-mail]
NEW Billing Email [e-mail]
Billing Telephone No. 336-577-7775
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible ROBERT WEIDL
Individual(Previous)
First Name(New)* ROBERT
Last Name(New)* WEIDL

NEW Legally Reflects any revisions above
Responsible ROBERT WEIDL
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 2806 Reynolda Road,#172,Winston-Salem,
Address(Previous) NC 27106-3102
NEW Permittee Street Address
Mailing Address* 2806 Reynolda Road
Address Line 2
#172
City State/Province/Region
Winston-Salem NC
Postal/Zip Code Country
27106-3102 us
Permittee Street 2806 Reynolda Road,#172,Winston-Salem,
Address(Previous) NC 27106-3102
NEW Permittee Street Street Address
Address* 2806 Reynolda Road
Address Line 2
#172
City State/Province/Region
Winston-Salem NC
Postal/Zip Code Country
27106-3102 us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact ROBERT WEIDL
(Previous)
Site Contact Title MEMBER MANGER
(Previous)
Organization
(Previous)
First Name(New)* ROBERT
Last Name(New)* WEIDL

NEW Site Contact* Reflects any revisions above
ROBERT WEIDL
NEW Site Contact MEMBER MANGER
Title
NEW Organization 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 336-577-7775
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 2806 Reynolda Road,#172,Winston-Salem,
Address(Previous) NC 27106-3102
NEW Site Contact Street Address
Mailing Address* 2806 Reynolda Road
Address Line 2
#172
City State/Province/Region
Winston-Salem NC
Postal/Zip Code Country
27106-3102 us
Change Requested Robert Weidl via email on 5/1/2023(email addresses revised to lower case letters).
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 05/01/2023