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(Rev. 1.1.2015)
+ Retum completed application to:
APPLICATION FOR CERTIFICATE OF COMPLIANCE
FOR SMOKE DETECTORS AND CARBON MONOXIDE ALARMS
M.G.L. CHAPTER 148, SECTIONS 26F, 26F1/2
City or Town South Yarmouth Date. 09/04/2026
Application is hereby made for inspection of smoke detectors 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 DEPARTMENT HEADOUARTERS
Location of Property
i
Owner of Property Sally Kilgallon Trust
Number of Dwelling Units Signature of Applicant
lnspection/Testing completed on 09104t2026 By:llvr-
$50 00 Fire Chief
Note: Any certificate issued in accordance with provisions ot M.G.L. Chapter 148, Sections 26F, 26F1l2 expires sixty (60)
days afrer issuance by head ofthe Fire Department.
FIRE DEPARTMENT'S COPY
74 Captain York
1
Fee: (M.G.L. Chapter 148 Sec. 10A)