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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
YaEhouthport Dat€:10t0212026
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Application is hereby made for inspeclion of smoke detectors and carbon monoxide alarms as required by
Massachusetls Geneml Law Chapter 148. Sections 26F, 26F'l/2 and 527 CMR 1:00 SectDn 13.7.
NOTE: SUBMIT APPLICATIOI{ TO LOCAL FIRE DEPARTI{Ei{T HEAT OUARTERS
Location of Property 50 Ancient Way
Owner oI Property Wall Family Real Estate Trust
Number of Dwelling Units Signature ofApplicant
lnspection/Testing completed on 10t02J2026 By:
Fee: (M.G.L. Chapter 148 Sec. 10A)s50.00
l{ole: Any cedificate issued in accordance wlth provisions of M.G.L. Chapter 148, Sections 26F, 26Fll2 expires sixty (60)
days aner issuance by head of the Fire D€padment.
FIRE DEPART ENT'S COPY
FP{D7C
(Rev. 1.1.2015)
1
Fire Chief