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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, SECTIONS 26F, 26F112
City or Town South Yarmouth Date. 09/'i 8/2026
Application is hereby made for inspeclion of smoke detectors and carbon monoxide alarms as required by
Massachusetts GeneralLaw, Chapter 148, Sections 26F,26F1l2 and 527 CMR 1:00 Section 13.7.
NOTE: SUBMIT APPLICATION TO LOCAL FIRE DEPARTiIENT HEADOUARTERS
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Location of Property 14 Elm Lane
Owner of Property Courtney Perry
Signature of Applicant
lnspection/Testing completed on 09t18t2026 By:
Fee: (M.G.L. Chapter 148 Sec. 10A)Fire Chief
Note: Any certificate issued in accordance with provisions of M.G.L. Chapter 148, Sections 26F, 26F112 expires sixty (50)
days after issuance by head ofthe Fire Department.
FIRE DEPARTi,IENT'S COPY
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$s0.00