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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,26F112
Soulh Yarmouth oare 10t22J2026
tFP{}07C
(Rev. 1.1.2015)
City or Town
Application is hereby made for inspeclion ofsmoke detectors and carbon monoxide alarms as required by
I\Iassachusetts General Law, Chapter 148. Seclions 26F, 26F1l2 and 527 CMR 1:00 Sectton 13.7.
NOTE: SUaMI APPLICATION TO LOCAL FIRE DEPART ENT HEADQUARTERS
Location of Property 45 Seth Lane
Owlrer of Property Jill& Chris Larsen
Number of Dwelling Units Signature ofApplicant
lnspection/Testing completed on 101222026 By:
Fee: (M.G.L. Chapter 148 Sec. 10A)$50.00
Notc: Any certificale issued in accordance with provisions of M.G.L. Chapter 148, Sections 26F, 26F1l2 expires sixty (60)
days afrer issuance by head of the Fire Deparlment.
FIRE DEPARTTIENT'S COPY
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Fire Chiet