NCC221350_Contact Update Record_20241104

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 11/4/2024 1:10:57 PM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC221350
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2022-1350
Original NOI No.* 86269
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Toll Southeast LP Company, Inc.
Project Name Forestville Village
Address Old Knight Rd.&Forestville Rd.,Knightdale, NC
County Wake
Latitude 35.8060
Longitude -78.4769
Date COC Issued* 10/23/2024
Prior Rescission Date This field will populate only if COC has already been rescinded.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. 919.321.4800
NEW Billing 602.596.0100
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Dan Rossi
Individual(Previous)
First Name(New)* Chad
Last Name(New)* Fischer

NEW Legally Reflects any revisions above
Responsible Chad Fischer
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee 602.596.0100
Telephone No.*
Permittee Mailing 900 Perimeter Park Drive, Suite B3,
Address(Previous) Morrisville, NC 27560-8725
NEW Permittee Street Address
Mailing Address* 900 Perimeter Park Drive
Address Line 2
Suite B3
City State/Province/Region
Morrisville NC
Postal/Zip Code Country
27560-8725 us
Permittee Street 900 Perimeter Park Drive, Suite B3,
Address(Previous) Morrisville, NC 27560-8725
NEW Permittee Street Street Address
Address* 900 Perimeter Park Drive
Address Line 2
Suite B3
City State/Province/Region
Morrisville NC
Postal/Zip Code Country
27560-8725 us
Change Requested Janet Boucher(Sr. Land Development Administrator)via Modification request
by:* submitted 10/24/2024.
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 11/04/2024