NCC222830_Contact Update Record_20230803

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Tev.Holloman 8/3/2023 4:02:08 PM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC222830
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2022-2830
Original NOI No.* 101432
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Caliber Development, Inc.
Project Name Patchetts Branch
Address 3208 Joyner Bridge Road, Four Oaks, NC
County Johnston
Latitude 35.3376
Longitude -78.3348
Date COC Issued* 08/09/2022
Prior Rescission Date This field will populate only if COC has already been rescinded.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
(6) Yes
Billing Email [e-mail]
NEW Billing Email [e-mail]
Billing Telephone No. 919 669 1332
NEW Billing 919 669 1332
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Mickey Lamm
Individual(Previous)
First Name(New)* Mickey
Last Name(New)* Lamm

NEW Legally Reflects any revisions above
Responsible Mickey Lamm
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee 919 669 1332
Telephone No.*
Permittee Mailing 2191 Vinson Road,0,Clayton, NC 27527-
Address(Previous) 9278
NEW Permittee Street Address
Mailing Address* 1270 Keen Road
Address Line 2
City State/Province/Region
Four Oaks NC
Postal/Zip Code Country
27524 us
Permittee Street 2191 Vinson Road,0,Clayton, NC 27527-
Address(Previous) 9278
NEW Permittee Street Street Address
Address* 1270 Keen Road
Address Line 2
City State/Province/Region
Four Oaks NC
Postal/Zip Code Country
27524 us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Mickey Lamm
(Previous)
Site Contact Title Registered Agent
(Previous)
Organization Caliber Development, Inc.
(Previous)
First Name(New)* Mickey
Last Name(New)* Lamm
NEW Site Contact* Reflects any revisions above
Mickey Lamm

NEW Site Contact Registered Agent
Title
NEW Organization Caliber Development, 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 919 669 1332
Telephone No.
(Previous)
NEW Site Contact 919 669 1332
Telephone No.*
Site Contact Mailing 2191 Vinson Road,0,Clayton, NC 27527-
Address(Previous) 9278
NEW Site Contact Street Address
Mailing Address* 1270 Keen Road
Address Line 2
City State/Province/Region
Four Oaks NC
Postal/Zip Code Country
27524 us
Change Requested Mickey Lamm requested via email on 8/1/2023
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 08/03/2023