NCC216660_Contact Update Record (Legally Resp Change)_20230109

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 1/9/2023 1:10:29 PM (Contact Changes Submitted)

Certificate of NCC216660
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2021-6660
Original NOI No.* 74074
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
D.R. Horton - Terramor, LLC
Project Name Haywood Glen Phase 3
Address 1501 Old Knight, St. Matthew's, NC
County Wake
Latitude 35.8183
Longitude-78.4673
Date COC Issued* 12/01/2021
Prior Rescission Date This field will populate only if COC has already been rescinded.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. 919-200-7563
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible
Karl Beyer
Individual (Previous)
First Name (New) *
Tracey
Last Name (New)*
Davis
NEW Legally
Reflects any revisions above
Responsible
Tracey Davis
Individual*

Permittee Email [e-mail]
(Previous)
NEW Permittee tmdavis1 @drhorton.com
Email*
Permittee Telephone [phone]
No. (Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 7208 Falls of Neuse Rd, Suite 201, Raleigh,
Address (Previous) North Carolina 27615-
NEW Permittee Street Address
Mailing Address* 7208 Falls of Neuse Rd
Address Line 2
Suite 201
City State / Province / Region
Raleigh North Carolina
Postal / Zip Code Country
27615 United States of America
Permittee Street 7208 Falls of Neuse Rd, Suite 201, Raleigh,
Address (Previous) North Carolina 27615-
NEW Permittee Street Street Address
Address* 7208 Falls of Neuse Rd
Address Line 2
Suite 201
City State / Province / Region
Raleigh North Carolina
Postal / Zip Code Country
27615 United States of America
Change Requested Tracey Davis (D.R. Horton) via Modification request submitted 1/3/2023.
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 01 /09/2023