HomeMy WebLinkAbout0583 MAIN STREET (HYANNIS) - Health 583°Main-Street(Hyannis)
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Massachusetts Department of Environmental Protection - ---
I100281223R2
., % -,F_ BWP AQ 04 (ANF-001) Asbestos Project#
Project Revision Notification
r-�—oj Project Revision
I; rwI Project Cancellon
X1
A. Asbestos Abatement Description
1.Facility Location:
TOWN OF HYANNIS 583 MAIN STREET P
Instructions 11 All a.Name of Facility b.Street Address or
sections of this form B,ARNSTABLE
must be completed in MA 02601 0000000000
order to comply;;with c.City/Town d.State e.Zip Code f.Telephone
MassDEP notification X X
requirements of 310
CMR 7.15 and g.Facility Contact Person Name h.Facility Contact Person Title .
Department of Labor Work-site Location: ECTERIOR
Standards(DLS)
notification i.Building Name,Wing,Floor,Room,etc.
requirements.of 453 2.Blanket Permit Project Approval,if applicable:
CMR 6.12
Approval ID#
1 3.Non-Traditional Asbestos Abatement Work Practice Approval,
MassDEP Use only if applicable: Approval ID#
Date Received i 3/8/2018 3/8/2018
a.Prcject Start Date(MM/DD/YYYY) b.End Date(MM/DD/YYYY)
2.Submit Original 7-4 N/A
Form To: c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday
.Commonwealth of
Massachusetts
P.O.BoxBoston,IVIA B. Other Project Revisions:
Boston,MA 02211
Note:Temporary
storage of Asbestos
containing waste
material is only,
allowed at the place
of business of aIDLS
licensed Asbestos
contractor or a transfer
station that is
permitted by
MassDEP and
operated in
compliance with Solid
Waste Regulations
310 CMR 19.000
I
Revised: 11/13/2013 Page 1 of 2
Massachusetts Department of Environmental Protection 100281223R2
BWP AQ 04 (ANF-001)
Asbestos Project#
Project Revision Notification
�J Project Revision
L
n
r, Project Cancellation
C. Certification
JIM DOYLE JIM DOYLE
Note:Contractor must "I certify that I have personally 1.Name 2.Authorized Signature
sign this form for DLS examined the foregoing and am PARTNER 3/5/2018
notification purposes familiar with the information
contained in this document and 3.PositioNTitle 4.Date(MM/DD/YYYY)
all attachments and that,based 7813372117 NESM,LLP
on my inquiry of those 5.Telephone 6.Representing
individuals immediately 850 WASHINGTON STREET WEYMOUTH
responsible for obtaining the 7.Address 8.City/Town
information, I believe that the MA 02189
information is true,accurate, and
complete. I am aware that there 9•State 10.Zip Code
are significant penalties for
submitting false information,
including possible fines and
imprisonment.The undersigned
hereby states that I have read the
Commonwealth of
Massachusetts regulations
governing asbestos abatement
(453 CMR 6.00 promulgated by
the Department of Labor
Standards and 310 CMR 7.15
promulgated by the Department
of Environmental Protection),
and that I am aware that this
permit application or notification
shall not be deemed valid
unless payment of the
applicable fee is made."
Revised: 11/13/2013 Page 2 of 2
Massachusetts Department of Environmental Protection 100281223R1
BWP AQ 04 (ANF-001)
Asbestos Project#
Project Revision Notification ProjectRevision
rj Project Cancellation
C�
A..Asbestos Abatement Description e'a
1.Facility Location: ro
TOWN OF HYANNIS 583 MAIN STREET
Instructions 1.All a.Name of Facility b.Street Address
sections of this form BARNSTABLE
must be completed in MA 02601 0000000000
order to comply with c.City/Town d.State e.Zip Code f.Telephone
MassDEP notificaton X X
requirements of 310
CMR 7.15 and g.Facility Contact Person Name h.Facility Contact Person Title
Department of Labor Worksite Location: DCTERIOR
Standards(DLS) .
notification i.Building Name,Wing,Floor,Room,etc.
requirements of 453 2.Blanker:Permit Project Approval,if applicable:
CMR 6.12
Approval lD#
3.Non-Traditional Asbestos Abatement Work Practice Approval,
MassDEP Use Only if applicable: Approval ID#
Date Received 3/8/2018 3/8/2018
a.Project Start Date(MM/DD/YYYY) b.End Date(MM/DD/YYYY)
2.Submit Original 7-4 N/A
Form To: c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday
Commonwealth of
Massachusetts
P.O.Bo B. Other Project Revisions:
MA Boston,,MA02211
Note:Temporary
storage of Asbestos
containing waste
material is only
allowed at the place
of business of a DLS
licensed Asbestos
contractor or a transfer
station that is
permitted by
MassDEP and
operated in
compliance with Solid
Waste Regulations
310 CMR 19.000
Revised: 11/13/2013 Page 1 of 2
Massachusetts Department of Environmental Protection 100281223R1
B W P AQ 04 (ANF-001) .- - -
f Asbestos Project#
Project Revision Notification
�: Project Revision
r, Project Cancellation
C. Certification
JIM DOYLE JIM DOYLE
"I certify that I have personally 1.Name 2.Authorized Signature
Note:Contractor must g
sign this form for DLS examined the foregoing and am PARTNER 2/15/2018
notification purposes familiar with the information
contained in this document and 3.Position/Title 4.Date(MM/DD/YYYY)
all attachments and that,based 7813372117 NESM,LLP
on my inquiry of those 5.Telephone 6.Representing
individuals immediately 850 WASHINGTON STREET WEYMOUTH
responsible for obtaining the 7.Address 8.City/Town
information, I believe that the MA 02189
information is true, accurate,and
complete. I am aware that there 9•State 10.Zip Code
are significant penalties for
submitting false information,
including possible fines and
imprisonment.The undersigned
hereby states that I have read the
Commonwealth of
Massachusetts regulations
governing asbestos abatement.
(453 CMR 6.00 promulgated by
the Department of Labor
Standards and 310 CMR 7.15
promulgated by the Department
of Environmental Protection),
and that I am aware that this
permit application or notification
shall not be deemed valid
unless payment of the
applicable fee is made."
Revised: 11/13/2013 Page 2 of 2
Massachusetts Department of Environmental Protection 100281223
Y BWP AQ 04 (ANF-001) Asbestos Project#
�r Asbestos Notification Form
i Project revision
I Project Cancellation
A. Asbestos Abatement Description
1.Facility Location:
TOWN OF HYANNIS 583 MAIN STREET
Instructions 1.All a.Name of Facility b.Street Address
sections of this form BARNSTABLE
must be completed in MA 02601 0000000000
order to comply with c.City/Town d.State e.Zip Code f.Telephone
MassDEP notification X X
requirements of 310
CMR 7.15 and g.Facility Contact Person Name h.Facility Contact Person Title
Department of Labor Worksite Location: EXTERIOR
Standards(DLS)
i.Building Name Win9,Floor Room,etc.
notification
requirements of 453 2. Is the facility occupied? r a.Yes r%_0 b.No
CMR 6.12
3. Is this a fee exempt notification (city,town, district, municipal housing authority, state facility, or
owner-occupied residential property of four units or less)? r% a.Yes r b.No
,MassDEP Use Only
4.Blanket Permit Project Approval,if applicable:
Date Received Approval ID#
5.Non-Traditional Asbestos Abatement Work Practice Approval,
2.Submit Original if applicable: Approval ID#
Form To:
Commonwealth of
Massachusetts 6.'Asbestos Contractor:
P.O.Box 4062
Boston,MA 02211 NEW ENGLAND SURFACE MAINTENANCE LLP 850 WASHINGTON ST
a.Name b.Address
WEYMOUTH MA 02189 7813372117
c.City/Town d.State e.Zip Code f.Telephone
AC000196 h:Contract Type: r 1.Written r 2.Verbal
g.DLS License#
7. JOSE VILLALTA AS061825
a.Name of Contractor's On-Site Supervisor/Foreman b.DLS Certification#
8 RICHARD K BOWEN AM061044
a.Name of Project Monitor b.DLS Certification#
9 FLI ENVIRONMENTAL INC AA000144
a.Name of Asbestos Analytical Lab b.DLS Certification#
10.
3/6/2018 3/6/2018
a.Project Start Date(MM/DD/YYYY) b.End Date(MM/DD/YYYY)
7-4. N/A
c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday
11.What type of project is this?
r a.Demolition r, b.Renovation r— c.Repair r' d.Other-Please Specify: EXTERIOR
Revised: 11/13/2013 Page 1 of 4
Massachusetts Department of Environmental Protection 100281223
BWP AQ 04 (ANF-001) -
1 ' Asbestos Project#
Asbestos Notification Form
r Project Revision
r Project Cancellation
A.Asbestos Abatement Description: (cont.)
12.Abatement procedures(check all that apply):
f a.Glove Bag r, b.Encapsulation rl c. Enclosure r-j d.Disposal Only r e.Cleanup
r; f.Full Containment rl g.Other-Please Specify:
13.Jab is being conducted: r a.Indoors r7; b.Outdoors
14 a.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or
encapsulated:
4
1.Unear Feet(Lin.Ft.) 2.Square Feet(Sq.Ft.)
b.Boiler,Breaching,Duct, c.Transite Pipe 4
Tank Surface Coatings 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft.
d.Pipe Insulation e.Transite Shingles
1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft.
f. Spray-On Fireproofing g.Transite Panels
1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft.
h.Cloths,Woven Fabrics i.Other-Please Specify:
1.Lin.Ft. 2.Sq.Ft.
j.Insulating Cement
1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft.
15.Describe the decontamination system(s)to be used:
AS REQUIRED
16.Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)
(g):
AS REQUIRED
17.For Emergency Asbestos Operations,the MassDEP and DLS officials who evaluated the emergency:
a.Name of MassDEP Official b.Title of MassDEP Official
c.Date of Authorization(MM/DD/YYYY) d.Waiver#
e.Name of DLS Official f.Title of DLS Official
g.Date of Authorization(MM/DD/YYYY) h.Waiver#
18.Do prevailing wage rates as per M.G.L.c. 149,§26,27 or 27A—F apply to this r a.Yes r b.No
project?
Revised` 11/13/2013 Page 2 of 4
i
Massachusetts Department of Environmental Protection
1002oject
BWP AQ 04 (ANF-001) Asbestos Project#
Asbestos Notification Form Project Revision
Project Cancellation
B. Facility Description -
1.Current or prior use of facility: EXTERIOR
2.Is the facility owner-occupied residential with 4 units or less? r7' a.Yes V b.No
3 TOWN OF HYANNIS 583 MAIN STREET
a.Facility Owner Name b.Address
HYANNIS MA 02601 0000000000
c.City/Town d.State e.Zip Code f.Telephone
4.X X
a.Name of Facility Owner's On-Site Manager b.Address
1 X MA 00000 0000000000
c.City/Town d.State e.Zip Code f.Telephone
5 RODERICK CONSTRUCTION CO 516 RIVER ROAD
a.Name of General Contractor b.Address
MARSTON MILLS MA 02648 0000000000
c.City/Town d.State e.Zip Code f.Telephone
X
g.Contractor's Worker's Compensation Insurer
X 1/1/2019
h.Policy# i.Expiration Date(MM/DD/YYYY)
6.What is the size of this facility? 0 0
a.Square Feet b.#of Floors
C. Asbestos Transportation & Disposal
1.Transporter of asbestos-containing waste material from site of generation:
[` a.Directly to Landfill or r. b.To Temporary Storage Location/Transfer Station
NEW ENGLAND SURFACE MAINTENANCE,LLP 850 WASHINGTON STREET
c.Name of Transporter d.Address
Note:Temporary
storage of Asbestos WEYMOUTH MA 02189 7813372117
containing waste e.City/Town f.State g.Zip Code h.Telephone
material is only
allowed at the place
of business of a DLS 2.If a temporary storage location/transfer station is used,list name of transporter of asbestos containing
licensed Asbestos I waste material from temporary storage location/transfer station to final disposal site:
contractor or a transfer p n' g p
station that is
permitted by REDTECHNOLOGIES 10 NORTHWOOD DRIVE
MassDEP and a.Name of Transporter b.Address
operated in
compliance with Solid BLOOMFIELD CT 06480 8603421022
Waste Regulations 310 CMR 19.000 c.City/Town d.State e.Zip Code f.Telephone
Revised: 11/13/2013 Page 3 of 4
i
Massachusetts Department of Environmental Protection 100281223
BWP AQ 04 (ANF-001) Asbestos Project#
Asbestos Notification Form
r' Project Revision
L/ r Project Cancellation
C.Asbestos Transportation&Disposal: (cont.)
3.Name and address of temporary storage location/transfer station for the asbestos containing waste
material:
RED TECHOLOGIES 203 PICKERING STREET
a.Temporary Storage Location Name b.Address
PORTLAND CT 06480 8603421022
c.City/Town d.State e.Zip Code f.Telephone
4.Name and location of final disposal site(asbestos landfill):
MINERVA ENTERPRISES MINERVA
a.Final Disposal Site Name b.Final Disposal Site Owner Name
9000 MINERVA ROAD
c.Address
WAYNESBURG OH 44688 3308663435
d.City/Town e.State f.Zip Code g.Telephone
A Certification
JIM DOYLE JIM DOYLE
"I certify that I have personally 1.Name 2.Authorized Signature
Examined the foregoing and am PARTNER 2/14/2018
familiar with the information
contained�in this document and 3.Position/Title 4.Date(MM/DD/YYYY)
Note:Contractor must 7813372117 NESM,LLP
sign this form for DLS all attachments and that, based
notification purposes on my inquiry of those 5.Telephone 6.Representing
individuals immediately 850 WASHINGTON STREET WEYMOUTH
responsible for obtaining the 7.Address 8.City/Town
information, I believe that the MA 02189
information is true,accurate,and
complete. I am aware that there 9.State 10.Zip Code
are significant penalties for
submitting false information,
including possible fines and
imprisonment.The undersigned
hereby states that I have read the
Commonwealth of
Massachusetts regulations
governing asbestos abatement
(453 CMR 6.00 promulgated by
the Department of Labor
Standards and 310 CMR 7.15
promulgated by the Department
of Environmental Protection),
and that I am aware that this
permit application or notification
shall not be deemed valid
unless payment of the
applicable fee is made."
Revised: 11/13/2013 Page 4 of 4
SENDER:
.o ■Complete items 1 and/or 2 for additional services. I also Wish t0 receive the
w ■Complete items 3,4a,and 4b. following services(for an
H
■Print your name and address on the reverse of this form so that we can return this extra fee): A
card to you.
■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address
` permit. d
y ■Write°Return Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N
■The Return Receipt will show to whom the article was delivered and the date o.
delivered. Consult postmaster for fee.
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:3 5.Received By: (Print Name) 8.Addressee's Address(On y if requested
(W and fee is paid) L
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y PS Form 38 1 December 1994 `•' Domestic Return Receipt
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UNITED STATES POSTAL SERVICE111111 First-Class MailPostage&Fees Paid
USPS
Permit No.G-10 j
• Print your name, address, and ZIP Code in this box • I
q
Pubiie Health Division
Town of Bamstable
PO Box 534
Hyannis, Massachusetts 02601
Fax(508)775-3344
Phone(508) 790-6265
4 I
Z. 548 659 808
Receipt for
Certified Mail
No Insurance Coverrtge Provided
MMDsTATEs Do not use for Inteil-lAonal Mail
POSTAL SERVICE
(See Reverse) 1
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't'(UV om&-Date Delivered
Return Receipt Showing to Whom,
Date,and Addressee's Address
TOTAL Postage iJ �
&Fees G
Postmark or Date
STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE,
CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front).
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1. If you want this receipt postmarked,stick the gummed stub to the right of the return address
leaving the receipt attached and present the article at a post office service.window or hind it to
your rural carrier(no extra charge).
2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return
address of the article,date,detach and retain the receipt,and mail the article. 0)
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` 3. If you want a return receipt,write the certified mail number and your name and address on a
C return receipt card,Form 3811,and attach it to the front of the article by means of the gummed
ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT
E REQUESTED adjacent to the number.
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4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, M
endorse RESTRICTED DELIVERY on the front of the article. E
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5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If u-
return receipt is requested,check the applicable blocks in item 1 of Form 3811. a
6. Save this receipt and present it if you make inquiry. 105603-93-B-0219
�tNE i
Town of Barnstable A
snxxsreer.E, i Department of Health, Safety, and Environmental Services
y MASS. i^.
16 9.
Public Health Division
P.O. Box 534, Hyannis MA 02601
Office: 508-790-6265 Thomas A.McKean,RS,CHO
FAX: 508-790-6304 Director of Public Health
December 1, 1998
Ragbir Mehta
585 Main Street,
Hyannis, MA 02601
RE: 583 Main Street, Hyannis
NOTICE TO ABATE VIOLATIONS OF THE TOWN OF BARNSTABLE
REGULATION REGARDING FUEL AND CHEMICAL STORAGE SYSTEMS
Our records indicate that you have an underground fuel oil tank located at 583 Main Street,
Hyannis, MA, listed as Parcel 308 on Assessor's Map 114.
This tank is not located in a critical zone of contribution to our public drinking supply wells but is
30 years old or older. You must have your underground tank removed within 30 days from the
receipt of this order letter.
For the removal of the tank you must first obtain a removal permit from the Fire Department. I
have enclosed tank removal information for you.
You may request a hearing before the Board of Health if written petition requesting same is
received within seven (7) days of receipt of this notice.
Sincerely yours,
Thomas . McKean
Director of Public Health
Enclosure: Tank Removal Information
cc: Hyannis Fire Prevention
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HYANNIS DIRE DEPARTMENT
95 HIGH SCHOOL ROAD EXTENSION
HYANNIS, MASS. 02601
RICHARD R. FARRENKOPF
CHIEF Sixohe Oetectvrd Save .&Pej BUSINESS: 775-1300
EMERGENCY: 775-2323
April 27, 1990
Attorney Robert Terry jO
P.O. Box 560
Mashpee, Massachusett fr `' 1 '
Main Sitreet,, t
It has c me to the -. •-�.` •`,, ,;;` -: .;,, C( 1 (�-1 '
I attention of this Department. that:�there,is ann��
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underground tank located ,at this propertA. y. `
Pleas contact thisoffice within five days to verify this �^ 1
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information.**} `r
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Sincere ,.-..-�,._�-
ERIC HUB
1. ` l .` •'
ISieutenarii�
Fire Prevention Officer]]
For: RICHARD R;_�FARRENKOPF.; Chief
Hyannis Fire Dep' rtmer t ' )
f 'A
EH/dl ,�•
C_ , 1 S.
�(N **PLEASE NOTi. r
FY,-.THIS DEP mENT .IF 1,OQ0 6l.UNDERGROUND
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PAR ] Real Estate System - General Property Inquiry] Help [ ]
n
Parcel Id: 308 115- - Account No: 220834 Parent :
Location: 585 MAIN ST Neighborhood: HY08 Fire Dist : HY
Devel Lot : Lot Size : . 18 Acres
Current Own: MEHTA, RAGBIR State Class : 322
585 MAIN ST No. Bldgs : 1 Area: 5400
Year Added:
HYANNIS MA 2601
Deed Date : 0150186 Reference : 5075/024
January 1st : MEHTA, RAGBIR Deed MMDD: 0586 Deed Ref : 5075/024
Comments :
Values : Land: 88600 Buildings : 168800 Extra Features :
Road System: 585 Index: 952 (MAIN STREET (HYANNIS) ) Frntg: 73
Index: ( ) Frntg:
Control Info: Last Auto Upd: 050695 Status : C Last TACS Update : 080687
Land Reviewed By: Date : 0000 Bldgs Reviewed By: RW Date : 0086
Tax Title : Account : 385 Taken: 062388 Account Status : PO Hold Status : PO
Cancel [ ].
Press XMT for more data
Next screen [PAR ] Action [ ]
Owners Name I[ ]
Road Index [ ] Road Name [ ]
Parcel Number [308] [116] [ ] [ ] [ ]
PAR ] Real Estate System- General Property Inquiry] Help [ ]
Parcel Id: 308 114- - Account No: 220825 Parent :
Location: 583 MAIN ST HYANNIS Neighborhood: HY08 Fire Dist : HY
Devel Lot : Lot Size : . 35 Acres
Current Own: TERRY, R E & HEALY G B TRS State Class : 340
KINSALE REALTY TRUST No. Bldgs : 2 Area: 4804
P 0 BOX 954 Year Added:
HYANNIS MA 2601
Deed Date : 050184 Reference : 4099/341
January 1st : TERRY, R E & HEALY G B TRS Deed MMDD: 0584 Deed Ref : 4099/341
Comments :
Values : Land: 76400 Buildings : 221400 Extra Features :
Road System: 583 Index: 952 (MAIN STREET (HYANNIS) ) Frntg:
Index: ( ) Frntg:
Control Info: Last Auto Upd: 050695 Status : C Last TACS Update : 011791
Land Reviewed By: Date : 0000 Bldgs Reviewed By: M* Date : 0888
Tax Title : Account : 6032 Taken: 071696 Account Status : PP Hold Status : PP
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NAME OF 0 FENS�, A top Al. . t- -� ME ffrA BAR 6&g1l
TOWN.-OF ADDRESS FEE
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BARNSTABLE CITY,STA .Z' OD j� /1
� SIN 1. /(-�1 /J
T �tHE ( MV/MB REGISTRATION NUMBER
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*RARNNI'ARI.F:. /J1 //'�yr' /)/r//t f�+/�"" j/' w
OFFENS
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OPTED MOR s, I j
NOTICE OF / TIME AND DAT�O�VIOLA(A / P M.)_ON �� 20� LO (/DF VIOLA I� / , / / �� fy�� UJI
0 SIGNA RE Et7FORCING PERSON �yy° �G BEN TIN''D1]PT. ,/�rJ /�B�/AfDG 0r I�\/\ N
VIOLATION �9�C 1,2WG�
0
OF TOWN J H REBY ACKNOWLEDGE ECEIPT OF CITATION X Q
ORDINANCE M Unable to obtain s gsn�arturfe of oaf ender. THE NONCRIMINAL FINE FOR THIS OFFENSE IS $ �1 6/b►
Date mailed f�Fa ! u'
LU
OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL rz
DISPOSITION WITH NO RESULTING CRIMINAL RECORD. ua
REGULATION a
(1)You may elect to pay the above line,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, J
before:The Barnstable Clerk,230 South Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P.O.Box 2430, rZ
Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE.
(2)If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST
BARNSTABLE DIVISION,COURT COMPOUND, MAIN STREET,BARNSTABLE,MA 02630,Attn:21D Noncriminal Hearings and enclose a copy of this
citation fora hearing.
(3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing
to be due,criminal complaint may be issued against you.
❑ 1 HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$
Signature