NCC223258_Contact Update Record (Site Contact)_20230905

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 9/5/2023 5:13:07 PM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC223258
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2022-3258
Original NOI No.* 105615
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Triple A Homes
Project Name Chapel Ridge
Address 807 Cabin Creek,Pittsboro, NC
County Chatham
Latitude 35.7948
Longitude -79.2293
Date COC Issued* 09/16/2022
Prior Rescission Date This field will populate only if COC has already been rescinded.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
0 Yes
Billing Email [e-mail]
Billing Telephone No. 9498120991
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact David Dail
(Previous)
Site Contact Title Construction Manager
(Previous)
Organization Triple A Homes
(Previous)
First Name(New)* Justin

Last Name(New)* Cook
NEW Site Contact* Reflects any revisions above
Justin Cook
NEW Site Contact
Title
NEW Organization Triple A 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 919-270-1928
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 1013 Green Oaks Parkway, 0, Holly Springs,
Address(Previous) NC 27540
NEW Site Contact Street Address
Mailing Address* 1013 Green Oaks Parkway
Address Line 2
City State/Province/Region
Holly Springs NC
Postal/Zip Code Country
27540 us
Change Requested Laura Peters via email on 9/1/2023.
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 09/05/2023