NCC202384_Contact Update Record (Leg Resp and Site Contact)_20220610

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 6/10/2022 12:56:13 PM (Contact Changes Submitted)

Certificate of NCC202384
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2020-2384
Original NOI No.* 26682
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Mattamy Homes
Project Name High Grove Oaks Phase 1
Address 3528 Wiltree Drive, Fuquay-Varina, NC
County Wake
Latitude 35.6390
Longitude-78.7596
Date COC Issued * 06/15/2020
Prior Rescission Date This field will populate only if COC has already been rescinded.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? U No
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 Bruce Herbert
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 [phone]
No. (Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 1210 Trinity Road, Suite 102, Raleigh, NC
Address (Previous) 27513
NEW Permittee Street Address
Mailing Address* 11000 Regency Parkway
Address Line 2
Suite 110
City
State / Province / Region
Raleigh
NC
Postal / Zip Code
Country
27518
us
Permittee Street 1210 Trinity Road, Suite 102, Raleigh, NC
Address (Previous) 27513
NEW Permittee Street Street Address
Address* 11000 Regency Parkway
Address Line 2
Suite 110
City
State / Province / Region
Raleigh
NC
Postal / Zip Code
Country
27518
us
Site Contact
(Previous)
Site Contact Title
(Previous)
Organization
(Previous)
First Name (New)*
Last Name (New) *
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Patty Harrell -Hilburn
McKim & Creed, Inc.
Joseph
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 919-233-8091
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 1730 Varsity Drive, Suite 500, Raleigh, NC
Address (Previous) 27606
NEW Site Contact Street Address
Mailing Address* 11000 Regency Parkway
Address Line 2
Suite 110
City
State / Province / Region
Raleigh
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
(Optional)
Date * 06/10/2022