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FP{07C
(Rev. 1.1.2015)
.l 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 Yamouthporl oa]c. 09t25t2926
Location of Property
Owner of Property Father James O Leary
Number of Dwelling Units Signatu16 of Applicant
09125t2026
t
lnspection/Testing completed on 8y
Fee: (M.G.L. Chapter 148 Sec. 10A)$50.00
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Application is hereby made for inspection of smoke dete'ctors and carbon monoxide alams as required by
Massachusetts General Law, Chapter 148, Sections 26F. 26F1/2 and 527 CMR 'l:00 Section '13.7-
NOTE: SUBMIT APPLICATIoN To LOGAL FIRE DEPARTMET{T HEADQUARTERS
15 skrpper lane
Fire Chief_
Note: Any certillcate issued in accordance wth provisions of M.G.L. Chapter 148, Sections 26F, 26F1/2 expires sixty (60)
days aner issuance by head of the Fire Department.
FIRE DEPARTMENT'S COPY