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FP.O07C
(Rev. 1.1.2015)
t Return completed application to:
APPLICATION FOR CERTIFICATE OF COMPLIANCE
FOR SMOKE DETECTORS AND CARBON MONOXIDE ALARMS
M.G,L. CHAPTER 148, SECTIONS 26F, 26F1l2
City or Town Yarmouthport Date 09t04t2026
Application is hereby made for inspection of smoke detectors and carbon monoxide alarms as required by
Massachusetts General Law, Chapter 148, Sections 26F,26F112 and 527 Ci/R '1:00 Section 13.7.
NOTE: SUBMIT APPLICATION TO LOCAL FIRE DEPARTMENT HEADQUARTERS
Location of Property 864 West Yarmouth Road
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Owner of Property Barbara Healey
Number of Dwelling Units Signature of Applicant
lnspection/Testing completed on 09t04t2026 By vfv
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 expires sixty (60)
days after issuance by head of the Fire Department.
FIRE OEPARTMENT'S COPY
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