NCC223231_NOI 105003 Payment Verification_20220920

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/8/2022 2:13:22 PM (NCG01 NOI Submission)
Approve by Clark, Paul B 9/13/2022 2:54:55 PM (Review - NOI 105003 Antioch Church Road Lots 4-7)
• Clark, Paul B reassigned the task to Clark, Paul B 9/8/2022 4:01 PM
• The task was assigned to Broussard, Brooklyn C by round robin distribution 9/8/2022 2:13 PM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 13, 2022 5:00
PM 9/8/2022 2:13 PM
by Workflow 9/13/2022 2:55:12 PM (Workflow Start Event)
Submit by Holloman, Tevye L 9/20/2022 11:00:59 AM (Payment Verification for NCC223231)
F Hilliard Engineering PLLC
• Holloman, Tevye L assigned the task to Holloman, Tevye L 9/20/2022 11:00 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 25, 2022 5:00 PM
9/13/2022 2:55 PM

5 A7
Payment •
NORTH CAROLINA
Envlrmmm(af Quafhy
Project Name
Antioch Church Road Lots 4-7
Lot Numbers
(If listed on the eNOI)
4,5,6,7
NC Reference No.*
NCG01-2022-3231
Certificate of
NCC223231
Coverage (COC) No.*
Invoice Date
9/13/2022
Initial Invoice No.
NCC223231-2022
Initial Fee
$ 100.00
Invoice Due Date
10/13/2022
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
9/20/2022
Received *
(Or, if not received, date rejected for no payment)
Method of Payment*
electronic
check
Other
Check Number*
2794
NOI Tracking No.
105003
Tracking ID referenced upon submittal
This is an Express
• No
Review Project
Yes
Project Tracking ID
NCC-JOHNS-2022-Antioch Church Road Lots 4-7