HomeMy WebLinkAbout26F Sep 2026,s aTk V"*^.rrr"r/il "/ o //rur"t am ,A
.glV,t, t'7;,,,,,(//n"-rt/,
FP{07C
(Rev.1.1.2015)
a Return completed application toi
City or Town Oate:09123t2026
Application is hereby made for inspec'tion ofsmoke delectors and carbon monoxide alarms as required by
lllassachusetts GeneralLaw, Chapter 148. Seclions 26F,26F112 and 527 CMR 1:00 Section 13.7.
NOTE: SUBMIT APPLICATION TO LOCAL FIRE DEPARTITENT HEADQUARTERS
Location of Property 11 Marigold RD
Owner of Property JOHN SERIJAN
Number of Dwelling Units Signature of Applicant
09t2312026 By:,Vlu
Fee: 1M.G.L. Chapter 148 Sec. 10A)$50.00 Fire Chief
Note: Any cedificate issued in accordance with provisions of M.G.L. Chapter ,|48, Sections 26F, 26F112 expnes sixty (60)
days after issuance by head ofthe Fire Department.
FIRE DEPARTI'ENT'S COPY
a
!-
APPLICATION FOR CERTIFICATE OF COMPLIANCE
FOR SMOKE DETECTORS AND CARBON MONOXIDE ALARMS
M.G.L. CHAPTER 148, SECTIONS 26F,26F1N
lnspection/Teslrng completed on: