NCC201060_Contact Update Record_20230421

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 4/21/2023 12:46:31 PM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC201060
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2020-1060
Original NOI No.* 23075
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Beazer Homes LLC
Project Name Roberts Crossing
Address 7021 Roberts Road,Apex, NC
County Wake
Latitude 35.7624
Longitude -78.8861
Date COC Issued* 03/30/2020
Prior Rescission Date This field will populate only if COC has already been rescinded.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? Q No
(.) Yes
Billing Email [e-mail]
NEW Billing Email [e-mail]
Billing Telephone No. [phone]
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible R.Scott Johnson
Individual(Previous)
First Name(New)* Trevor
Last Name(New)* Dalton

NEW Legally Reflects any revisions above
Responsible Trevor Dalton
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 5400 Trinity Rd,Suite 313, Raleigh, NC
Address(Previous) 27607
NEW Permittee Street Address
Mailing Address* 801 Corporate Center Drive
Address Line 2
Suite 330
City State/Province/Region
Raleigh NC
Postal/Zip Code Country
27607 United States
Permittee Street 5400 Trinity Rd,Suite 313, Raleigh, NC
Address(Previous) 27607
NEW Permittee Street Street Address
Address* 801 Corporate Center Drive
Address Line 2
Suite 330
City State/Province/Region
Raleigh NC
Postal/Zip Code Country
27607 United States
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Scott Johnson
(Previous)
Site Contact Title VP Land Development
(Previous)
Organization Beazer Homes LLC
(Previous)
First Name(New)* Trevor
Last Name(New)* Dalton

NEW Site Contact* Reflects any revisions above
Trevor Dalton
NEW Site Contact Director of Land
Title
NEW Organization Beazer Homes LLC
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 [phone]
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 5400 Trinity Road,Suite 313, Raleigh, NC
Address(Previous) 27607
NEW Site Contact Street Address
Mailing Address* 801 Corporate Center Drive
Address Line 2
Suite 330
City State/Province/Region
Raleigh NC
Postal/Zip Code Country
27607 us
Change Requested Trevor Dalton (Director of Land)via Modification request submitted 4/14/2023.
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 04/21/2023