NCC210566_Contact Update Record (Address Only)_20240205

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 2/5/2024 4:38:44 PM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC210566
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2021-0566
Original NOI No.* 42030
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
SGRM, Inc.
Project Name Heritage Glen-Phase 5C
Address Tradition Drive,Village of Alamance, NC
County Alamance
Latitude 36.0262
Longitude -79.4929
Date COC Issued* 02/02/2021
Prior Rescission Date This field will populate only if COC has already been rescinded.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? 0• No
0 Yes
Billing Email [e-mail]
Billing Telephone No. 336-227-9231
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Kristin Foust
Individual(Previous)
First Name(New)* Kristin
Last Name(New)* Foust
NEW Legally Reflects any revisions above
Responsible Kristin Foust
Individual*

Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 1851 South Main Street,0, Graham, NC
Address(Previous) 27253-4705
NEW Permittee Street Address
Mailing Address* P.O. Box 699
Address Line 2
City State/Province/Region
Alamance NC
Postal/Zip Code Country
27201 us
Permittee Street 1851 South Main Street,0, Graham, NC
Address(Previous) 27253-4705
NEW Permittee Street Street Address
Address* 4990 S. NC 62
Address Line 2
City State/Province/Region
Burlington NC
Postal/Zip Code Country
27215 us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Kristin Foust
(Previous)
Site Contact Title Vice President
(Previous)
Organization SGRM, inc.
(Previous)
First Name(New)* Kristin
Last Name(New)* Foust
NEW Site Contact* Reflects any revisions above
Kristin Foust
NEW Site Contact Vice President
Title
NEW Organization SGRM, inc.
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 336-227-9231
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 1851 South Main Street,0, Graham, NC
Address(Previous) 27253-4705
NEW Site Contact Street Address
Mailing Address* 1851 South Main Street
Address Line 2
City State/Province/Region
Graham NC
Postal/Zip Code Country
27253-4705 US
Change Requested (Address/Phone Update Only)Kristin Foust via email on 2/1/2024
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 02/05/2024