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FP.,t)07C
(Rev. 1.1.2015)
a Return completed application lol
APPLICATION FOR CERTIFICATE OF COMPLIANCE
FOR SMOKE DETECTORS AND CARBON MONOXIDE ALARMS
M.G.L. CHAPTER 148, SECTIONS 26F,26F112
City or Town Yarmouthport oate. 10t08t2026
14 forest gate
Owner ol Property deirdre mckimmey
Number of Dwelling Units Sighature of Applicant
i:
t
lnspection/Testing completed on By:
Fee: (M.G.L. Chapter 148 Sec. 10A)s50.00
Application is hereby made for inspeclion of smoke detectors and carbon monoxide alams as required by
Massachusetts General Law, Chapler 148. Seclions 26F. 26F112 and 527 CMR 1:00 Section '13.7.
NoTE: sUBillT APPLICATION To LOCAL FIRE DEPARTMENT HEAoOUARTERS
Location of Property
10108t2026
Fire chief
-
Noto: Any cedmcab issued in accordance with provisions of M.G.L. Chapter i48, Sections 26F, 26F1l2 expires sixty (50)
days afler issuance by head of the Fire Depadment.
FIRE DEPARTMENT'S COPY