NCC211293_Contact Update Record (Site Contact)_20220304

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Selkane, Aziza 3/4/2022 7:06:46 PM (Contact Changes Submitted)

Certificate of NCC211293
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2021-1293
Original NOI No.* 46107
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Cotton Custom Homes
Project Name Laurel Ridge
Address 128 Bluffside Court, Pittsboro, NC
County Chatham
Latitude 35.8040
Longitude-79.2120
Date COC Issued * 03/04/2021
Prior Rescission Date This field will populate only if COC has already been rescinded.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 [e-mail]
Billing Telephone No. 9193678615
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Anita Becker
(Previous)
Site Contact Title Office Manager
(Previous)
Organization cotton custom homes
(Previous)
First Name (New)* Blake

Last Name (New) * Terry
NEW Site Contact* Reflects any revisions above
Blake Terry
NEW Site Contact
Title
NEW Organization cotton custom homes
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 9193678615
Telephone No.
(Previous)
NEW Site Contact 956-250-5408
Telephone No.*
Site Contact Mailing 1617 Center Street, 0, apex, NC 27502
Address (Previous)
NEW Site Contact Street Address
Mailing Address* 1617 Center Street
Address Line 2
City
State / Province / Region
apex
NC
Postal / Zip Code
Country
27502
United States
Change Requested Gina Jiampetti by email on 3/3/2022
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 03/04/2022