NCC205572_Annual Fee Payment Record_20211203

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 11/29/2021 5:37:55 PM (Workflow Start Event)
Submit by Evans, Shaundra M 12/3/2021 10:34:32 AM (2021 Annual Fee Payment Verification for NCC205572-
2021)
0 Sean A Dolle
• Evans, Shaundra M assigned the task to Evans, Shaundra M 12/3/2021 10:33 AM
• The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: January 10, 2022 5:00
PM 11/29/2021 5:38 PM

STA—
NORTH CAROLINA
Environmental Quallty
•
Certificate of
NCC205572
Coverage (COC) No. *
This is passed from the workflow when the invoice is filed.
NC Reference COC
NCG01-2020-5572
No.*
Permit Status:
Active
Year COC Issued
2020
This field will be hidden.
2020 Fee Status
Check last year's fee status
Project Name*
Moriah Multi -Family
Project Address *
3717 Mt Moriah Road, Durham, NC
Permittee*
Harold K Jordan and Co; Inc.
County
Durham
Invoice No.*
NCC205572-2021
This is passed from the workflow when the invoice is filed.
Annual Fee*
$ 100.00
Invoice Date*
12/1/2021
This is passed from the workflow when the invoice is filed.
Invoice Due Date*
1/1/2022
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.
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 12/3/2021
Received * Or, if WAIVED or NOT RECEIVED, this is the date that status is recorded.
Method of Payment* ' electronic
check
other
ePayment 605832717
Transaction Number*
Fee Status* PAID

Legally Responsible Jerry Haugley
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 (If available)
CONFIRM Billing E- Opportunity to correct problem e-mail address or billing contact info
mail
Billing Telephone No
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 This is the email for the 30-day reminder if needed (passed from workflow).
for 30-day Reminder
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date* 12/3/2021