NCC230554_Contact Update Record_20240131

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 1/31/2024 12:24:26 PM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC230554
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2023-0554
Original NOI No.* 128594
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Al. Neyer, LLC
Project Name Buckhorn Business Center Phase 2
Address 6501 West Ten Road, Mebane, NC
County Orange
Latitude 36.0732
Longitude -79.2338
Date COC Issued* 03/02/2023
Prior Rescission Date This field will populate only if COC has already been rescinded.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]
NEW Billing Email [e-mail]
Billing Telephone No. 919-816-6227
NEW Billing [phone]
Telephone No. (optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Bob Brooks
Individual(Previous)
First Name(New)* Adam
Last Name(New)* Butcher

NEW Legally Reflects any revisions above
Responsible Adam Butcher
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 4509 Creedmoor Road,Suite 500, Raleigh,
Address(Previous) NC 27612-3813
NEW Permittee Street Address
Mailing Address* 302 W.3rd Street
Address Line 2
City State/Province/Region
Cincinnati OH
Postal/Zip Code Country
45202 us
Permittee Street 4509 Creedmoor Road,Suite 500, Raleigh,
Address(Previous) NC 27612-3813
NEW Permittee Street Street Address
Address* 6501 West Ten Road
Address Line 2
City State/Province/Region
Mebane NC
Postal/Zip Code Country
27302 us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Bob Brooks
(Previous)
Site Contact Title VP Design Build
(Previous)
Organization Al. Neyer, LLC
(Previous)
First Name(New)* Adam
Last Name(New)* Butcher
NEW Site Contact* Reflects any revisions above
Adam Butcher

NEW Site Contact Senior Project Manager
Title
NEW Organization Al. Neyer, 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 919-816-6227
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 4509 Creedmoor Road,Suite 500, Raleigh,
Address(Previous) NC 27612-3813
NEW Site Contact Street Address
Mailing Address* 302 W.3rd Street
Address Line 2
City State/Province/Region
Cincinnati OH
Postal/Zip Code Country
45202 us
Change Requested Adam Butcher via Modification request submitted 1/29/2024.
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 01/31/2024