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FP{07C
(Rev 6/23)
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-Qt 83APPLICATION FOR CERTIFICATE OF COMPLIANCE
FOR SMOKE DETECTORS AND CARBON MONOXIDE ALARMS
M.G.L. CHAPTER 148, SECTIONS 26F,26F1N
City or Town Yarmouth Date 09t23t206
Application is hereby made for inspeclion of smoke deteclors and carbon monoxide alarms as required by
Massachusetts General Law, Chapter 148, Sections 26F, 26F 1D and 527 CMR 1 :00 Section 13.7.
NOTE: SUBMIT APPLICATION TO LOCAL FIRE DEPARTMENT HEADQUARTERS
PLEASE NOTE THAI OT{LY APPLICATIONS WITH ORIGINAL WET SIGNATURES WLL BE ACCEPTED. PIIOTOCOPIES OF APPLICATIONS lYtLL NOT BE PROCESSED.
Location of Property
Owner of Property John Walsh
1 Signature of Applicant
09t23t2026 By Lt. Oliva tVu-
Fee: (M.G.L. Chapter 148 Sec. 10A)$50.00
(tnspecto0
Fire Chief Enrique Arrascue
Note: Any certificate issued in accordance with provisions of M.G.L. Chapter 148, Sections 26F. 26F 12 expires sixty (60)
days afler issuance by head ofthe Fire Department.
FIRE DEPARTMENT'S COPY
'1?t -qto
11 Barnes Lane
Number of Dwelling Units
lnspeclion/Testing completed on: