NCC222359_Contact Update Record_20240627

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Tev.Holloman 6/27/2024 9:37:21 AM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC222359
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2022-2359
Original NOI No.* 95089
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
ADAMS PLACE PROPERTIES,LLC
Project Name ADAMS PLACE PHASE 2
Address 10250 REVOLUTION COURT,CHARLOTTE, NC
County Mecklenburg
Latitude 35.3390
Longitude -80.7380
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Prior Rescission Date This field will populate only if COC has already been rescinded.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
4) Yes
Billing Email [e-mail]
NEW Billing Email [e-mail]
Billing Telephone No. 9106123633
NEW Billing 910-251-5030
Telephone No. (optional)
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact KEITH MACCONOCHIE
(Previous)
Site Contact Title
(Previous)

Organization TRIBUTE CONSTRUCTION
(Previous)
First Name(New)* Kent
Last Name(New)* Tanner
NEW Site Contact* Reflects any revisions above
Kent Tanner
NEW Site Contact Construction Manager
Title
NEW Organization TRIBUTE CONSTRUCTION
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 336-212-0044
Telephone No.
(Previous)
NEW Site Contact 910-612-8148
Telephone No.*
Site Contact Mailing 10 S CARDINAL DRIVE,0,WILMINGTON,
Address(Previous) NC 28403
NEW Site Contact Street Address
Mailing Address* 332 Military Cutoff Rd.
Address Line 2
City State/Province/Region
WILMINGTON NC
Postal/Zip Code Country
28405 USA
Change Requested Kiehli Gore, I&D Support Specialist,via email on 6/26/24
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 06/27/2024