NCC230592_Contact Update Record_20240801

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 8/1/2024 11:33:54 AM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC230592
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2023-0592
Original NOI No.* 129278
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Pine Gate Renewables
Project Name Apex Solar
Address 209 Pony Barn Road, Fallston, NC
County Cleveland
Latitude 35.4219
Longitude -81.4795
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Prior Rescission Date This field will populate only if COC has already been rescinded.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. [phone]
NEW Billing [phone]
Telephone No. (optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Ben Catt
Individual(Previous)
First Name(New)* Philip
Last Name(New)* Dierickx

NEW Legally Reflects any revisions above
Responsible Philip Dierickx
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 130 Roberts Street, 0,Asheville, NC 28801-
Address(Previous) 3129
NEW Permittee Street Address
Mailing Address* 105 Fairview Road
Address Line 2
Suite 30
City State/Province/Region
Asheville NC
Postal/Zip Code Country
28803 us
Permittee Street 130 Roberts Street, 0,Asheville, NC 28801-
Address(Previous) 3129
NEW Permittee Street Street Address
Address* 105 Fairview Road
Address Line 2
Suite 30
City State/Province/Region
Asheville NC
Postal/Zip Code Country
28803 us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Preston Brooms
(Previous)
Site Contact Title Construction Manager
(Previous)
Organization Blue Ridge Power
(Previous)
First Name(New)* Adam
Last Name(New)* Travis

NEW Site Contact* Reflects any revisions above
Adam Travis
NEW Site Contact Project Manager
Title
NEW Organization Blue Ridge Power
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 407-552-6305
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 105 Fairview Road suite 30,0,Asheville, NC
Address(Previous) 28803-2307
NEW Site Contact Street Address
Mailing Address* 105 Fairview Road
Address Line 2
Suite 30
City State/Province/Region
Asheville NC
Postal/Zip Code Country
28803-2307 us
Change Requested Sean Anderson(VP, Project Development)via email on 7/30/2024. (Note Pine Gate
by:* Renewables is the upstream owner of Blue Ridge Power.)
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 08/01/2024