NCC216201_NOI 72513 Payment Verification_20211206

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 11/4/2021 8:24:36 PM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 11/5/2021 8:15:51 AM (Review - Construction NOI 72513)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 11/4/2021 8:25 PM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: November 8, 2021 5:00
PM 11/4/2021 8:25 PM
Submit by Evans, Shaundra M 12/6/2021 8:20:12 AM (Payment Verification for NCC216201)
F Jeff Carter
• Evans, Shaundra M assigned the task to Evans, Shaundra M 12/6/2021 8:19 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: December 17, 2021 5:00
PM 11/5/2021 8:16 AM

5 A7
Payment •
NORTH CAROLINA
Envlrmmm(af Quafhy
Project Name
Gastonia CFA
Lot Numbers
(If listed on the eNOI)
NA
NC Reference No.*
NCG01-2021-6201
Certificate of
NCC216201
Coverage (COC) No.*
Invoice Date
11/5/2021
Initial Invoice No.
NCC216201-2021
Initial Fee
$ 100.00
Invoice Due Date
12/5/2021
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*
• Payment Received.
Payment NOT RECEIVED.
Payment Status
PAID
Date Payment
12/6/2021
Received *
(Or, if not received, date rejected for no payment)
Method of Payment*
• electronic
check
Other
ePayment
606137492
Transaction Number*
NOI Tracking No.
72513
Tracking ID referenced upon submittal
This is an Express
• No
Review Project
Yes
Project Tracking ID
NCC-GASTO-2021-Gastonia CFA