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(Rov. 1.1.2015)
a Retum completed application to:
APPLICATION FOR CERTIFICATE OF COMPLIANCE
FOR SMOKE DETECTORS AND CARBON MONOXIDE ALARMS
M.G.L. CHAPTER 148, SECTIONS 26F,26F1N
City or Town Date 08119t2026
Application is hereby made for inspeciion ofsmoke detectors and carbon monoxide alarms as required by
I\rassachusetts General Law Chapter 148, Sections 26F,26F1l2 and 527 CMR 1t00 Section 13.7.
NOTE: SUBMIT APPLICATION TO LOCAL FIRE OEPARTiIENT HEADQUARTERS
Location of Property 36 Waltham Circle
Owner of Property Mary Crowell & Edc Gongola
Number of Dwelling Units Signaturo of Applicant
lnspection/Testinq completed on 08t19t2026 By:
Fee: (M G.L. Chapter 148 Sec. 10A)s50.00 Fire Chief
Noto: Any cedificate issued in accordance with provisions of M.G.L. Chapter 148, Seclions 26F, 26Fll2 epnes sixty (60)
days afier issuance by head of the Fi.s Department.
FIRE DEPARTMENT'S COPY
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