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FP{07C
(Rev. 1.1.2015)
a Retum compleled applicalion to:
APPLICATION FOR CERTIFICATE OF COMPLIANCE
FOR SMOKE DETECTORS AND CARBON MONOXIDE ALARMS
M.G.L. CHAPTER .I48, SECTIONS 26F, 26F112
City or Town South Yarmouth Date 09t04t2026
Application is hereby made for inspection of smoke detectoG and carbon monoxide alarms as required by
Massachusetts General Law, Chapter 148, Sections 26F, 26F1l2 and 527 CMR 1:00 Section '13.7.
NOTE: SUBMIT APPLIcATION To LOCAL FIRE DEP ENT HEADQUARTERS
Location of Property 2'1 Hazelmoor Road
t
Owner of Property BlackRoc Realty G LLC
Number of Dwelling Units re of Applicanl
lnspection/Testing completed on 09104t2026 By
Fee: (M.G.L. Chapter 148 Sec. 10A)s50.00 Fire Chief
Note: Any certilicate issued in accordance with provisions of M.G.L. Chapter 148, Sections 26F, 26F112 expires sixty (60)
days after issuance by head ofthe Fire Department.
FIRE DEPARTMENT'S COPYr
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