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FP{07C
(Rev. 1.1.2015)
a Return completed applicalion to
APPLICATION FOR CERTIFICATE OF COMPLIANCE
FOR SMOKE DETECTORS AND CARBON MONOXIDE ALARMS
M.G.L. CHAPTER 148, SECTION S 26F, 26F112
City or Town South Yarmo!th Date. o9/18/2026
Application is hereby made for inspection of smoke detectors and carbon monoxide alarms as required by
Massachusetts General Law, Chapter 148. Sections 26F,26F112 and 527 CMR 1:00 Section '13.7.
NOTE: SUBillT APPLICATION TO LOCAL FIRE DEPART ENT HEADQUARTERS
Location of Property 15 Buckwood dr
t
Owner of Property Paige Hyney
Number of Dwelling Units Signature of Applicant
lnspection/Testing completed on 09t1at2026 By
Fee: (M.G.L. Chaptel 148 Sec. 10A)$s0.00
Nole: Any certificate issued in accordance with provisions of M.G.L. Chapter 148, Sections 26F, 26F112 expires sixty (60)
days after issuance by head of the Fire Department.
FIRE DEPARTiIENT'S COPYF
1
Fire chief
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