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a Return completed application to:
APPLICATION FOR CERTIFICATE OF COMPLIANCE
FOR SMOKE DETECTORS AND CARBON MONOXIDE ALARMS
M.G.L, CHAPTER 148, SECTIONS 26F,26F1N
oate. 09124t2026
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City or Town
Application is hereby made foa inspection of smoke dotectors and carbon monoxide alams as required by
Massachusetts General Law, Chapter 148, Seclions 26F, 26F112 and 527 CMR 1:00 Section 13.7.
oTE: SUBlrllT APPLICATIoN TO LoCAL FIRE DEPARTIENT HEADQUARTERS
Location of Property 216 Cranberry Lane
Owner of Property Carol Soszek
Number of Dwelling Units Signature of Applicant
09t2412026
Fee: (M.G.L. Chapter 148 Sec. 10A)s50.00
Note: 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 ttle Fire Depadment.
FIRE DEPARTMENT'S COPY
By:rir;
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Soulh Yamouth
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lnspection/Testing completed on:
Fire Chief