NCC202247_Contact Update Record_20210723

Action History (UTC-05:00)Eastern Time(US&Canada)
Subrrit by Selkane,Aziza 7/23/2021 2:18:29 PM(Contact Changes Submitted)

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• tactChanges • Construction
is •rm updates permit contact • • • 11/NCG25 COC data record.
Certificate of NCC202247
Coverage (COC) Enter the Certificate of Coverage Nmber(Use capital letters)
No.*
NC Reference No. NCG01-2020-2247
Original NOI No.* 26077
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new CCCrequired)
The Charlotte Mecklenburg Hospital Authority
Project Name Mountain Island FSED
Address 3536 Mt. Holly-Huntersville Road,Charlotte, NC
County Mecklenburg
Latitude 35.3200
Longitude -80.9400
Date COC Issued* 06/01/2020
Prior Rescission This field will populate only if CCChas already been rescinded.
Date
Which Contacts f Billing Only
Have Changed?* r Legally Responsible Individual Only
r Site Contact Only
r BOTH Legally Responsible Individual and Site Contact
Has Billing Contact Choose'Yes'torevise Billing Contact details.
Changed? r No
r Yes
Billing Email
Billing Telephone
No.
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Billie Graham
(Previous)
Site Contact Title Project Manager
(Previous)
Organization The Beck Group
(Previous)

First Name (New)* Ann
Last Name (New)* Purvis
NEW Site Contact* Peflects any revisions above
Ann Purvis
NEW Site Contact Project Manager
Title
NEW Organization Vannoy Construction
This field is not required on the NCA form and rray not pre-populate.
Site Contact Email [e-mail]
(Previous)
NEW Site Contact [e-mail]
Email*
Site Contact 214-497-3316
Telephone No.
(Previous)
NEW Site Contact 704-507-0156
Telephone No.*
Site Contact Mailing 4777 Sharon Road, 0, Charlotte, North
Address(Previous) Carolina 28210
NEW Site Contact Street Address
Mailing Address* 4024 Barringer Drive
Address Line 2
City State/Frovince/f;bgion
Charlotte North Carolina
Fbstal/Zip Code Country
28217 United States
Change Requested Roman G Hinojosa
by:* Include any additional correspondence records in the Pepository 00Cfolder.
Additional Information for this update to contact information:
Addional
Explanation
(Optional)
Date* 07/23/2021