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FP{07C
(Rev. 1.1.2015)
APPLICATION FOR CERTIFICATE OF COMPLIANCE
FOR SMOKE DETECTORS AND CARBON MONOXIDE ALARMS
M.G.L. CHAPTER 148, SECTIONS 26F, 26F112
City or Town Date. 09/03/2026
Application is hereby made for inspection of smoke detectors and carbon monoxide alarms as required by
l,4assachusetts General Law, Chapter'148, Sections 26F,26F'112 and 527 CMR 1:00 Section 13.7.
NOTE: SUBMIT APPLICATION TO LOCAL FIRE DEPARTMENT HEADQUARTERS
a
4 Aunt Edith's RdLocation of Property
Owner of Property Lance Willsey
Number of Dwelling Units Signature of Applicant
lnspection/Testing completed on 09t03t2026 By
Fee: (M.G.L. Chapter 148 Sec. 10A)$50.00
Note: Any certificate issued in accordance with provisions of M.G.L. Chapter 148. Sections 26F,26F112 exptes sixty (60)
days after issuance by head of the Fire Department.
FIRE DEPARTMENT'S COPYF
a Retum completed applicalion to:
South Yarmouth