NCC205041_Contact Update Record_20231212

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 12/12/2023 8:28:11 AM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC205041
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2020-5041
Original NOI No.* 35038
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
City of Oxford
Project Name 2018 Water System Improvements
Address Various Locations, Oxford, NC
County Granville
Latitude 36.3070
Longitude -78.5746
Date COC Issued* 12/18/2020
Prior Rescission Date This field will populate only if COC has already been rescinded.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
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 M.Alan Thornton
Individual(Previous)
First Name(New)* W. Brent
Last Name(New)* Taylor

NEW Legally Reflects any revisions above
Responsible W. Brent Taylor
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 506, 0, Oxford, NC 27565
Address(Previous)
NEW Permittee Street Address
Mailing Address* PO Box 1307
Address Line 2
City State/Province/Region
Oxford NC
Postal/Zip Code Country
27565 USA
Permittee Street 300 Williamsboro Street,0,Oxford, NC
Address(Previous) 27565
NEW Permittee Street Street Address
Address* 300 Williamsboro Street
Address Line 2
City State/Province/Region
Oxford NC
Postal/Zip Code Country
27565 USA
Change Requested W. Brent Taylor(City Manager)via Modification request submitted 12/8/2023.
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 12/12/2023