HomeMy WebLinkAbout26F Cert 20255-\The Commonw e alth of Mass achusetts
CitylTown o (1/rrrrr,,n t/
FP{07C
(Rev. 1.1.2015)
a Re(urn completed applicationto:
APPLICATION FOR CERTIFICATE OF COMPLIANCE
FOR SMOKE DETECTORS AND CARBON MONOXIDE ALARMS
M.G.L, CHAPTER 148, SECTIONS 26F,26F112
City or Tc,vn West Yarmouth oat'. 1OR0/2025
Application is hereby made for inspection of smoke delectors and carbon monoxide alarms as required by
Massachusetts General Law, Chapter 148, Sections 26F, 26F'l12 and 527 CMR 1:00 Section 13.7.
NOTE: SUBMIT APPLICATION TO LOCAL FIRE DEPARTMENT HEADQUARTERS
Location of Property 11 Moss Road
Owner of Property Debbie Petrowski
Number of Dwelling Units Signature of Applicant
lnspection/Testing completed on 10t30t2025
(lnspector)
Fee: (M.G.L. Chapter148 Sec. 'l0A)$50.00 Fire Chief
Note: Any certificate issued in accordance with provisions of M.G.L. Chapter '148, Sections 26F, 26F'12 expires sixty (60)
days after issuance by head of the Fire Departmenl.
FIRE DEPARTMENT'S COPY
By O\iv^ ):3:
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