NCC200664_Contact Update Record_20240513

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 5/13/2024 7:45:41 AM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC200664
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2020-0664
Original NOI No.* 22111
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Toll Southeast LP Company, Inc
Project Name Castleberry Estates
Address 816 Wimberly Road,Apex, NC
County Wake
Latitude 35.7640
Longitude -78.9242
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Prior Rescission Date This field will populate only if COC has already been rescinded.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
NEW Billing Email [e-mail]
Billing Telephone No.
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible David Kelly
Individual(Previous)
First Name(New)* Edward B.
Last Name(New)* Pease

NEW Legally Reflects any revisions above
Responsible Edward B. Pease
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 2310 T.W.Alexander Drive,0, Raleigh, NC
Address(Previous) 27617
NEW Permittee Street Address
Mailing Address* 900 Perimeter Park Drive
Address Line 2
Suite 3B
City State/Province/Region
Morrisville NC
Postal/Zip Code Country
27560 us
Permittee Street 2310 T.W.Alexander Drive,0, Raleigh, NC
Address(Previous) 27617
NEW Permittee Street Street Address
Address* 900 Perimeter Park Drive
Address Line 2
City State/Province/Region
Morrisville NC
Postal/Zip Code Country
27560 us
Change Requested Edward B. Pease(Division President)via Modification request submitted 5/7/2024.
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 05/13/2024