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FP{07C
(Rev.1.1.2015)
a Return completed applicalion to:
APPLICATION FOR CERTIFICATE OF COMPLIANCE
FOR SMOKE DETECTORS AND CARBON MONOXIDE ALARMS
M.G.L. CHAPTER,I48, SECTIONS 26F, 26F1N
City or Town Date 0910912026
Application is hereby made for inspeclion of smoke detectors and carbon monoxide alarms as required by
Massachusetts General Law, Chapter 148, Sections 26F, 26F1l2 and 527 CMR 1i00 Section 13.7.
NOTE: SUBI$lT APPLICATION TO LOCAL FIRE DEPARTUENT HEADQUARTERS
Locaton of Property 481 Buck lsland Road unit 48
Owner of Property Gary&Elizabeth Damiecki
t
Number of Dwelling Units Signature of Applicant
lnspection/Testing completed on 0s/09/2026 By:,r'p
Fee: (M.G.L. Chapter 148 Sec. 10A)s50.00
Note: Any cedificate issued in accordance with provisions of M.G.L. Chapte||48, Sections 26F, 26F12 expires sixty (60)
days after issuanc€ by head of the Fire Department.
FIRE DEPARTMENT'S COPYJ-
Fire Chief