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(R€v. 1.1.2015)
a Retum completed application to:
APPLICATION FOR CERTIFICATE OF COMPLIANCE
FOR SMOKE DETECTORS AND CARBON MONOXIDE ALARMS
M.G,L. CHAPTER,I48, SECTIONS 26F, 26F,,II2
City or Town West Yarmouth oate. 09/30/2026
Application is hereby made for inspection of smoke detectoB and caabon monoxide alarms as required by
I\rassachusetts Gene.alLaw, Chapte||48, Sections 26F,26F112 and 527 CMR 1:00 Section 13.7.
NOTE: SUBI{lT APPLICATION TO LOCAL FIRE DEPARTMENT HEAOQUARTERS
Location of Property 11 Rogra Road
Owner of Property Gregorio, Louis Trst
Number ot Dwelling Units Signature of Applicant
lnspection/Testing completed on 09t3u2a26 By:'Vt-
Fee: (M.G.L. Chapter 148 Sec. 10A)$50.00 Fire Chief
Note: Any certificate issued in accordance with provisions of M.G.L. Chapter 148, Sections 26F, 26F12 expires sixty (60)
days after issuance by head of the Fire Department.
FIRE DEPARTMENT'S COPY
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