NCC216526_Annual Fee Payment Record_20230104

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 11/29/2022 1:09:42 PM (Workflow Start Event)
Submit by Holloman, Tevye L 1/4/2023 10:48:03 AM (2022 Annual Fee Payment Verification for NCC216526-2022)
0 Bonnie Donleycott
Holloman, Tevye L assigned the task to Holloman, Tevye L 1/4/2023 10:46 AM
• The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: January 10, 2023 5:00
PM 11/29/2022 1:09 PM

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NORTH CAROLINA
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Certificate of NCC216526
Coverage (COC) No. * This is passed from the workflow when the invoice is filed.
NC Reference COC NCG01-2021-6526
No. *
Permit Status: Active
Year COC Issued 2021
This field will be hidden.
Check previous years for outstanding fees (years that do not apply will be blank):
2020 Fee Status
2021 Fee Status
Project Name*
Project Address*
Permittee *
County
Williams Grove Phase 2
Stoney Hill Church Road, Bailey, NC
WJH LLC
Nash
Invoice No.* NCC216526-2022
This is passed from the workflow when the invoice is filed.
Annual Fee* $ 100.00
Invoice Date* 12/1/2022
This is passed from the workflow when the invoice is filed.
Invoice Due Date* 1/1/2023
This is passed from the workflow when the invoice is filed.
An automated email reminder is sent to the permittee when the invoice is due. Wait until invoice is 15 days overdue
before proceeding to a Notice of Deficiency.
Days Overdue 3
Wait at least 15 days until proceeding to NOD.
Important: If you change the choice below to Payment NOT RECEIVED, the fee status becomes PAST DUE, and the
permittee will receive a Notice of Deficiency.
Annual Fee Payment • Fee Payment Received or Not Applicable.
Received* Fee Payment NOT RECEIVED.
Date Payment 1/4/2023
Received * Or, if WAIVED or NOT RECEIVED, this is the date that status is recorded.

Method of Payment* electronic
check
other
ePayment 669730247
Transaction Number*
Fee Status* PAID
Legally Responsible Dave Hodgman
Person (Orig.)
Original Permittee E- [e-mail]
mail *
CONFIRM Permittee [e-mail]
E-mail * Opportunity to modify problem e-mail address or permittee contact info
Original Site Contact [e-mail]
E-mail *
CONFIRM Site [e-mail]
Contact E-mail* Opportunity to correct problem e-mail address or site contact info
Original Billing E-mail [e-mail]
(If available)
CONFIRM Billing E- [e-mail]
mail Opportunity to correct problem e-mail address or billing contact info
Billing Telephone No. 336-362-6211
Permittee Email for
[e-mail]
30-day Reminder
This is the email for the 30-day reminder if needed (passed from workflow).
Site Contact Email for
[e-mail]
30-day Reminder
This is the email for the 30-day reminder if needed (passed from workflow)
Billing Contact Email
[e-mail]
for 30-day Reminder
This is the email for the 30-day reminder if needed (passed from workflow).
Project Name for 30-
Williams Grove Phase 2
day Reminder
The project name is passed from workflow for the 30-day reminder
Permittee Name for
WJH LLC
30-day Reminder
The permittee is passed from workflow for the 30-day reminder
County for 30-day Nash
Reminder The county is passed from workflow for the 30-day reminder
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date* 1/4/2023