NCC230396_Contact Update Record_20240209

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Tev.Holloman 2/9/2024 11:16:32 AM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC230396
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2023-0396
Original NOI No.* 126878
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
9900 Mount Holly Road Properties LLC
Project Name Mount Holly Apartments
Address 9900 Mount Holly Road,Charlotte, NC
County Mecklenburg
Latitude 35.2925
Longitude -80.9715
Date COC Issued* 02/28/2023
Prior Rescission Date This field will populate only if COC has already been rescinded.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
0 Yes
Billing Email [e-mail]
NEW Billing Email [e-mail]
Billing Telephone No. 910-338-3585
NEW Billing 910-338-3585
Telephone No. (optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Robert Hollis
Individual(Previous)
First Name(New)* Robert
Last Name(New)* Hollis

NEW Legally Reflects any revisions above
Responsible Robert Hollis
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee 910-338-3585
Telephone No.*
Permittee Mailing 332 Military Cutoff Road,0,Wilmington, NC
Address(Previous) 28405
NEW Permittee Street Address
Mailing Address* 332 Military Cutoff Road
Address Line 2
City State/Province/Region
Wilmington NC
Postal/Zip Code Country
28405 us
Permittee Street 332 Military Cutoff Road,0,Wilmington, NC
Address(Previous) 28405
NEW Permittee Street Street Address
Address* 332 Military Cutoff Road
Address Line 2
City State/Province/Region
Wilmington NC
Postal/Zip Code Country
28405 us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Keith MacConochie
(Previous)
Site Contact Title
(Previous)
Organization
(Previous)
First Name(New)* Johnathan
Last Name(New)* Robinette
NEW Site Contact* Reflects any revisions above
Johnathan Robinette

NEW Site Contact
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 3362120044
Telephone No.
(Previous)
NEW Site Contact 828-367-8405
Telephone No.*
Site Contact Mailing 414 Arboretum Drive, Unit 125,Wilmington,
Address(Previous) NC 28405
NEW Site Contact Street Address
Mailing Address* 414 Arboretum Drive
Address Line 2
Unit 125
City State/Province/Region
Wilmington NC
Postal/Zip Code Country
28405 Us
Change Requested Johnathan Robinette, Project Manager,via email on 2/1/24
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 02/09/2024