NCC230804_Contact Update Record (Site Contact)_20240301

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 3/1/2024 8:20:47 AM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC230804
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2023-0804
Original NOI No.* 132908
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Dare County
Project Name Dare County EMS#7 Med Flight
Address 1078 Driftwood Drive, Manteo, NC
County Dare
Latitude 35.9199
Longitude -75.6921
Date COC Issued* 03/29/2023
Prior Rescission Date This field will populate only if COC has already been rescinded.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. 252.475.5891
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Franki Joyner
(Previous)
Site Contact Title Construction Administrator for Architect
(Previous)
Organization Oakley Collier
(Previous)
First Name(New)* Dustin

Last Name(New)* Peele
NEW Site Contact* Reflects any revisions above
Dustin Peele
NEW Site Contact Project Manager
Title
NEW Organization Dare County
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 252.937.2500
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 109 Candlewood Road,0, Rocky Mount, NC
Address(Previous) 27804-2141
NEW Site Contact Street Address
Mailing Address* P.O. Box 1000
Address Line 2
City State/Province/Region
Manteo NC
Postal/Zip Code Country
27954 us
Change Requested Dustin Peele via email on 3/1/2024
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 03/01/2024