NCC232278_Contact Update Record_20240711

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 7/11/2024 10:35:08 AM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC232278
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2023-2278
Original NOI No.* 152879
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
NSR Maxwell, LLC
Project Name Maxwell Avenue Townhomes
Address 14826 N Old Statesville Rd, Huntersville, NC
County Mecklenburg
Latitude 35.4154
Longitude -80.8427
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Prior Rescission Date This field will populate only if COC has already been rescinded.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
0 Yes
Billing Email [e-mail]
NEW Billing Email [e-mail]
Billing Telephone No. 7049978255
NEW Billing [phone]
Telephone No. (Optional)
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Chuck King
(Previous)
Site Contact Title Land Development Project Manager
(Previous)

Organization North State Development, LLC
(Previous)
First Name(New)* Justin
Last Name(New)* Kirby
NEW Site Contact* Reflects any revisions above
Justin Kirby
NEW Site Contact Development Project Manager
Title
NEW Organization North State Development, LLC
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 7047473730
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 18825 West Catawba Avenue,Suite 250,
Address(Previous) Cornelius, NC 28031-5546
NEW Site Contact Street Address
Mailing Address* 18825 West Catawba Avenue
Address Line 2
Suite 250
City State/Province/Region
Cornelius NC
Postal/Zip Code Country
28031-5546 US
Change Requested Justin Kirby via Modification request submitted 7/9/2024. Updated billing contact as
by:* well since it had been Chuck King.
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 07/11/2024