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FP{07C
(Rev. 1.1.2015)
a Return completed application to
APPLICATION FOR CERTIFICATE OF COMPLIANCE
FOR SMOKE DETECTORS AND CARBON MONOXIDE ALARMS
M.G.L. CHAPTER,I48, SECTIONS 26F, 26F112
City or Town Dale 09/09/2026
Application is hereby made for inspeclion of smoke detectoG and ca6on monoxide alarms as requiaed by
I\rassachusetts General Law, Chapter'148. Sections 26F, 26F112 and 527 CMR 1:00 Sectron 13.7.
NOTE: SUBMIT APPLICATION TO LOCAL FIRE OEPARTMENT HEAITOUARTERS
Location of Property 16 Liberly Lane
Owner of Property Meegan Moody-Romero and Richard Romero
Number of Dwelling Units Signature of Applicant
lnspection/TestinO completed on 09/09/2026 By:!l^-
Fee: (M.G.L. Chapter 148 Sec. 10A)s50.00 Fire Chief
Nole: Any cedmcate assued in accordance wth provisions of M.G.L. Chapter ,|48, Sections 26F, 26F112 e)Aires sixty (60)
days after issuance by head of the Fire Department.
FIRE DEPARTMENT'S COPY
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