NCC231137_Contact Update Record (Email Update Only)_20240501

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 5/1/2024 10:17:19 AM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC231137
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2023-1137
Original NOI No.* 136823
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Andrew Stewart
Project Name Stewart Residence-Boy Scout Rd.
Address Boy Scout Rd., Lincolnton, NC
County Lincoln
Latitude 35.4348
Longitude -81.2811
Date COC Issued* 04/01/2024
Prior Rescission Date This field will populate only if COC has already been rescinded.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
* Yes
Billing Email [e-mail]
NEW Billing Email [e-mail]
Billing Telephone No. 704-773-2728
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Andrew Stewart
Individual(Previous)
First Name(New)* Andrew
Last Name(New)* Stewart

NEW Legally Reflects any revisions above
Responsible Andrew Stewart
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 739 Furnace Road,0, Iron Station, NC 28080
Address(Previous)
NEW Permittee Street Address
Mailing Address* 739 Furnace Road
Address Line 2
City State/Province/Region
Iron Station NC
Postal/Zip Code Country
28080 us
Permittee Street 739 Furnace Road,0, Iron Station, NC 28080
Address(Previous)
NEW Permittee Street Street Address
Address* 739 Furnace Road
Address Line 2
City State/Province/Region
Iron Station NC
Postal/Zip Code Country
28080 us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Andrew Stewart
(Previous)
Site Contact Title Owner
(Previous)
Organization
(Previous)
First Name(New)* Andrew
Last Name(New)* Stewart
NEW Site Contact* Reflects any revisions above
Andrew Stewart

NEW Site Contact Owner
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 704-773-2728
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 739 Furnace Road,0, Iron Station, Nc 28080
Address(Previous)
NEW Site Contact Street Address
Mailing Address* 739 Furnace Road
Address Line 2
City State/Province/Region
Iron Station Nc
Postal/Zip Code Country
28080 us
Change Requested Lisa Lackey Stewart via Modification request submitted 4/30/2024.
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 05/01/2024