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City or Town Soulh Yarmouth Date:09t2412026
Application is hereby made for inspeclion of smoke deteclors and carton monoxide alarms as required by
lrassachusetts General Law, Chapter 148, Sections 26F, 26F112 and 527 CMR 1:00 Section 13.7.
NOTE: SUBMIT APPLICATIOiI fO LOCAL FIRE DEPARTI{El{T HEADQUARTERS
Location of Property 10 Daisy Lane
Owner of Property Francesca Ruini
Number of Dwelling Units Signature of Applicant
09124t2026
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Fee: (M.G.L. Chapter 148 Sec. 10A)$50.00 F,re Chief
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FP{07C
(Rev. 1.1.2015)
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
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lnspection/Testing completed on:By:
Note: Any certificate issued in accordance with provisions of M.G.L. Chapter 148, Sections 26F, 26F1l2 expires sixty (60)
days after issuance by head ofthe Fire Department.
FIRE DEPARTTIIENT,S COPY