NCC202862_Contact Update Record_20210706

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Georgoulias, Bethany A 7/6/2021 9:18:55 AM (Contact Changes Submitted)

Certificate of NCC202862
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
NC Reference No. NCG01-2020-2862
Original NOI No.* 27901
Project information associated with this permit (cannot change):
Permittee Listed Crganizaitoncannot bechanged (new OOCrequired)
H&M Bedford LLC
Project Name
The Highlands at Bedford -Phase Four
Address
US Hwy 401 & Bedford Drive, McLaughlin, NC
County
Hoke
Latitude
35.0376
Longitude
-79.1302
Date COC Issued*
07/14/2020
Prior Rescission
This field will populate only if COChas already been rescinded.
Date
Which Contacts
f Billing Only
Have Changed?*
f Legally Responsible Individual Only
f 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
NEW Billing Email [e-mail]
Billing Telephone
No.
NEW Billing [phone]
Telephone No. (Cptional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Pat McKee
Individual
(Previous)

First Name (New)* Pat
Last Name (New) * McKee
NEW Legally Reflects any revisions above
Responsible Pat McKee
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee 910-475-7100
Telephone No.
(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 109 Hay Street, Suite 301, 0, Fayetteville,
Address (Previous) NC 28301
NEW Permittee
Mailing Address*
Street Address
4208 Six Forks Road
Address Line 2
Suite 810
Cly
Raleigh
Fbstal / Zip Code
27609
Permittee Street 109 Hay Street, Suite 301, 0, Fayetteville,
Address (Previous) NC 28301
NEW Permittee Street Address
Street Address* 4208 Six Forks Road
Address Line 2
Suite 810
city
Raleigh
Fbstal / Zip Code
27609
State / Rovince / R gion
NC
Country
United States
State / Rovince / Region
NC
Country
United States
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Pat McKee
(Previous)
Site Contact Title Member/Manager
(Previous)
Organization H&M Bedford LLC
(Previous)

First Name (New)*
Pat
Last Name (New) *
McKee
NEW Site Contact*
Reflects any revisions above
Pat McKee
NEW Site Contact
Member/Manager
Title
NEW Organization H&M Bedford LLC
This field is not required on the N01 form and nay not pre -populate.
Site Contact Email [e-mail]
(Previous)
NEW Site Contact [e-mail]
Email *
Site Contact 910-475-7100
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 109 Hay Street, Suite 301, 0, Fayetteville,
Address (Previous) NC 28301
NEW Site Contact
Mailing Address*
Street Address
4208 Six Forks Road
Address Line 2
Suite 810
city
Raleigh
Postal / Zip Code
287609
State / Frovince / Region
NC
Country
United States
Change Requested Patrick McKee via e-mail on 7/2/2021
by: * Include any additional correspondence records in the Repository CDC folder.
Additional Information for this update to contact information:
Addional
Explanation
(Optional)
Date * 07/06/2021