NCC211861_Contact Update Record_20240923

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 9/23/2024 10:57:56 AM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC211861
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2021-1861
Original NOI No.* 48423
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Orissa Holding, LLC
Project Name Independence Townes
Address 2933 Matthews Indian Trail Road,Stallings, NC
County Union
Latitude 35.0990
Longitude -80.6820
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Prior Rescission Date This field will populate only if COC has already been rescinded.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? No
Yes
Billing Email [e-mail]
Billing Telephone No. 704-815-5780
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Ty Matthews
(Previous)
Site Contact Title
(Previous)
Organization Impact Development
(Previous)
First Name(New)* Michael

Last Name(New)* Foess
NEW Site Contact* Reflects any revisions above
Michael Foess
NEW Site Contact Executive Manager
Title
NEW Organization Montrose 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 704-815-5780
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 10721 Tradition View Drive,0,Charlotte, NC
Address(Previous) 28269-1418
NEW Site Contact Street Address
Mailing Address* P.O. Box 644
Address Line 2
City State/Province/Region
Cornelius NC
Postal/Zip Code Country
28031 us
Change Requested Joe Childress(Orissa Holding, LLC)via Modification request submitted 9/22/2023.
by:* Address information was not included on the document uploaded and was obtained
from an NC Sec of State website Business Entity search.
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 09/23/2024