NCC215612_NOI 66981 Payment Verification_20211011

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 9/30/2021 9:08:16 AM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 10/8/2021 8:53:38 AM (Review- Construction NOI 66981)
• Georgoulias, Bethany A reassigned the task to Broussard, Brooklyn C 10/8/2021 8:41 AM
• Georgoulias, Bethany A reassigned the task to Georgoulias, Bethany A 10/8/2021 8:41 AM
• Georgoulias, Bethany A reassigned the task to DEMLR NCG01 NOI Review Team 10/8/2021 8:39 AM
• The task was assigned to Broussard, Brooklyn C by round robin distribution 9/30/2021 9:08 AM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 4, 2021 5:00
PM 9/30/2021 9:08 AM
Submit by Evans, Shaundra M 10/11/2021 9:46:11 AM (Payment Verification for NCC215612)
* Baseline Construction Inc
• Evans, Shaundra M assigned the task to Evans, Shaundra M 10/11/2021 9:45 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 19, 2021 5:00
PM 10/8/2021 8:54 AM

�.• �,+STA7E o�
VerificationPayrmnt
NORTH CAROLINA
Environmental Quvllly
Project Name
Tractor Supply - Elizabeth City, NC
Lot Numbers
(IF listed on the eNOI)
Lot 7
NC Reference No.*
NCG01-2021-5612
Certificate of
NCC215612
Coverage (COC)
No.*
Invoice Date
10/8/2021
Initial Invoice No.
NCC215612-2021
Initial Fee
$ 100.00
Invoice Due Date
11/7/2021
Important: If you change
the choice below to Payment NOT RECEIVED, the application will be rejected, and a COC will
not be issued. This is the ONLY way to reject an eNOI at this step.
Payment Received* IT Payment Received.
f Payment NOT RECEIVED.
Payment Status
PAID
Date Payment
10/11/2021
Received*
(Or, if not received, date rejected for no payrrent)
Method of Payment*
IT electronic
f check
f Other
ePayment
597110190
Transaction
Number*
NOI Tracking No.
66981
Tracking ID referenced upon subrrittal
This is an Express
IT No
Review Project
r Yes
Project Tracking ID
NCC-PASQU-2021-Tractor Supply - Elizabeth City, NC