NCC213830_Contact Update Record (Site Contact)_20220610

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 6/10/2022 12:43:37 PM (Contact Changes Submitted)

Certificate of NCC213830
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2021-3830
Original NOI No.* 57208
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Mattamy Homes
Project Name High Grove Oaks Ph 2-8
Address 3528 Wiltree Drive, Fuquay-Varina, NC
County Wake
Latitude 35.6378
Longitude-78.7689
Date COC Issued * 06/28/2021
Prior Rescission Date This field will populate only if COC has already been rescinded.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. 9192333886
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Joseph Conlan
Individual (Previous)
First Name (New) * Joseph
Last Name (New)* Conlan
NEW Legally Reflects any revisions above
Responsible Joseph Conlan
Individual*

Permittee Email
[e-mail]
(Previous)
NEW Permittee
[e-mail]
Email*
Permittee Telephone
9192333886
No. (Previous)
NEW Permittee
[phone]
Telephone No.*
Permittee Mailing
1210 Trinity Road, Suite 102, Cary, NC 27513
Address (Previous)
NEW Permittee
Street Address
Mailing Address*
11000 Regency Parkway
Address Line 2
Suite 110
City State / Province / Region
Cary NC
Postal / Zip Code Country
27518 us
Permittee Street
1210 Trinity Road, Suite 102, Cary, NC 27513
Address (Previous)
NEW Permittee Street
Street Address
Address*
11000 Regency Parkway
Address Line 2
Suite 110
City
State / Province / Region
Cary
NC
Postal / Zip Code
Country
27518
us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact
Tyler Cooper
(Previous)
Site Contact Title
Project Manager
(Previous)
Organization
Wynn Site Development
(Previous)
First Name (New)*
Joseph
Last Name (New)*
Conlan
NEW Site Contact*
Reflects any revisions above
Joseph Conlan
NEW Site Contact
Vice President of Land Development
Title

NEW Organization Mattamy 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 9196510009
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 165 Sommerville Park Road, 0, Raleigh, NC
Address (Previous) 27603-4757
NEW Site Contact Street Address
Mailing Address* 11000 Regency Parkway
Address Line 2
Suite 110
City
State / Province / Region
Cary
NC
Postal / Zip Code
Country
27518
us
Change Requested Joseph Conlan via Modification request submitted 6/7/2022.
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation Company address for legally responsible individual updated as well.
(Optional)
Date * 06/10/2022