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APPLICATION FOR CERTIFICATE OF COTIPLIANCE
FOR SMOKE DETECTORS AND CARBON MONOXIDE ALARMS
M.G.L. CHAPTER,I48, SECTIONS 26F, 26F1N
South Yarmo!th oate.. 09t2512026
tFP{07C
(Rev. 1.1.2015)
City or Town
Application is hereby made for inspeclion ofsmoke detectors and carbon monoxide alarms as requircd by
Massachusetts General Law, Chapter '148, Sections 26F, 26F112 and 527 CMR 1:00 Sectron 13.7.
NOTE: SUBMIT APPLICATION TO LOCAL FIRE DEPARTIENT HEADOUARTERS
Location of Property 21 Captain Small
Owner of Property Roger Gardin€r
Number of Dwelling Units Signaturs of Applicanl
lnspection/Testing completed on 09t25t2026 By:
s50.00
[ote: Any certil]cate issued in accordance with provisions of M.G.L. Chapter 148. Sections 26F. 26F112 expires sixty (60)
days after issuance by head ofthe Fire Oepartment.
FIRE DEPARTTIENT'S COPY
1
Fee: (M.G.L. Chapter 148 Sec. 10A)Fke Chief