NCC205663_Contact Update Record (Legally Resp)_20220310

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 3/10/2022 2:45:09 PM (Contact Changes Submitted)

Certificate of NCC205663
Coverage (CDC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2020-5663
Original NOI No.* 38622
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
City of Raleigh (Raleigh Water)
Project Name State Street Basin Water and Sewer Improvements Phase 1
Address Varies - Bledsoe, E.Lee, Bragg, Hoke, S.Person, Garner, McMakin, Sawyer, Gregg,
Ellington, Branch, S.Blount, S.Bloodworth, S.East, Raleigh, NC
County Wake
Latitude 35.7635
Longitude-78.6356
Date COC Issued* 01/29/2021
Prior Rescission Date This field will populate only if COC has already been rescinded.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
NEW Billing Email [e-mail]
Billing Telephone No.
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Robert Massengill
Individual (Previous)
First Name (New)* William

Last Name (New)* Wheeler
NEW Legally Reflects any revisions above
Responsible William Wheeler
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No. (Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing PO Box 590, 0, Raleigh, NC 27601
Address (Previous)
NEW Permittee Street Address
Mailing Address* P.O. Box 590
Address Line 2
City
State / Province / Region
Raleigh
NC
Postal / Zip Code
Country
27602
USA
Permittee Street 222 West Hargett Street, 0, Raleigh, NC
Address (Previous) 27601
NEW Permittee Street Street Address
Address* 222 West Hargett Street
Address Line 2
City State / Province / Region
Raleigh NC
Postal / Zip Code Country
27602 USA
Change Requested William Wheeler, Interim Director of Raleigh Public Utilities Department, via
by: * Modification request submitted 3/4/2022.
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 03/10/2022