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APPLICATION FOR CERTIFICATE OF COMPLIANCE
FOR SMOKE DETECTORS AND CARBON MONOXIDE ALARMS
M,G.L. CHAPTER 148, SECTIONS 26F,26F112
South Yarmouth Date 10/01/2026
IFP{x)7C
(Rev. 1.1.2015)
City or TowIr
Application is hereby made for inspection oI smoke detectoE and carbon monoxide alarms as required by
lllassachusetts General Law, Chapter'148, Sections 26F. 26F112 and 527 CMR 1:00 Section 13.7.
NOTE: SUBMIT APPLICATION TO LOCAL FIRE DEPARTMENT HEADQUARTERS
Locatioh of Property 29 bass nver d
ban
Number of Owelling Units Signature of Applicant
lnspection/Testing completed on 10101t2026
Fee: (M.G.L. Chapter 148 Sec. 10A)Fire Chief
Nolet Any cedifcate issued in accordance with provisions oI M.G.L. Chapter 148, Sections 26F, 26F12 expires sixty (60)
days afler issuanc€ by head of lhe Fire Department.
FIRE DEPARTI{ENT'S COPY
Owner of Property
By:
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