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a Return completed application to:
APPLICATION FOR CERTIFICATE OF COMPLIANCE
FOR SMOKE DETECTORS AND CARBON MONOXIDE ALARMS
M.G.L. CHAPTER 148, SECTIONS 26F,26F112
Date. 09/09/2026
tFP{07C
(Rev. 1.1.2015)
Cily or Town
Application is hereby made for inspection of smoke detecloB and carbon monoxide alarms as rcquired by
Massachusetts General Law, Chapter 148, Seclions 26F, 26F'112 and 527 CMR 1:00 Section 13.7.
NOTE: SUBItIIT APPLICATION TO LOCAL FIRE DEPARTI{ENT HEADQUARTERS
Location of Property 481 Buck lsland Rd, UNIT'16D
Patrick Baker
Number of Dwelling Units Signature of Applicant
lnspection/Testing completed on By:
Fee: (M.G.L Chapter 148 Sec 10A)s50 00 Fire Chief
Note: Any certificate issued in accordance with provisions of M.G.L. Chapter 148, Sections 26F. 26F112 expires sixty (60)
days after issuance by h€ad ofthe Fire Department.
FIRE DEPARTMENT'S COPY
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Owner of Property
09/09/2026