NCC216566_Annual Fee Payment Record_20221116

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 10/30/2022 1:35:19 PM (Workflow Start Event)
Submit by Holloman, Tevye L 11/16/2022 8:33:05 AM (2022 Annual Fee Payment Verification for NCC216566-2022)
0 John Gramberg
Holloman, Tevye L assigned the task to Holloman, Tevye L 11/16/2022 8:32 AM
• The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: December 12, 2022 5:00
PM 10/30/2022 1:35 PM

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Certificate of NCC216566
Coverage (COC) No. * This is passed from the workflow when the invoice is filed.
NC Reference COC NCG01-2021-6566
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* Gatehouse Terrace
Project Address* 2321 Old Salisbury Road, Winston-Salem, NC
Permittee* Elam Guilford, LLC
County Forsyth
Invoice No.* NCC216566-2022
This is passed from the workflow when the invoice is filed.
Annual Fee* $ 100.00
Invoice Date* 11/1/2022
This is passed from the workflow when the invoice is filed.
Invoice Due Date* 12/1/2022
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 11/16/2022
Received * Or, if WAIVED or NOT RECEIVED, this is the date that status is recorded.
Method of Payment* electronic
check
other

ePayment 662630638
Transaction Number*
Fee Status* PAID
Legally Responsible John Gramberg
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. [phone]
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-
Gatehouse Terrace
day Reminder
The project name is passed from workflow for the 30-day reminder
Permittee Name for
Elam Guilford, LLC
30-day Reminder
The permittee is passed from workflow for the 30-day reminder
County for 30-day
Forsyth
Reminder
The county is passed from workflow for the 30-day reminder
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date* 11/16/2022