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(Rev. 1.1.2015)
a Return completed applicalion lo:
APPLICATION FOR CERTIFICATE OF COMPLIANCE
FOR SMOKE DETECTORS AND CARBON MONOXIDE ALARMS
M.G.L. CHAPTER 148, SECTIONS 26F,26F1N
City or Town Yarmoulhport Date:10t2312426
Application is hereby made tor inspection of smoke detectors and carbon monoxide alaams as required by
Massachusetts Gene.al Law, Chapter 148, Sections 26F, 26F112 and 527 CMR 'l:00 Section 13.7.
NOTE: SUBMIT APPLICATION TO LOCAL FIRE OEPARTMENT HEADQUARTERS
Location of Property 5208 HeatheMood
Owner of Property Judy Johnson
lnspection/Tesling completed on 10123t2026 By:
Fee: (M.G.L. Chapter 148 Sec. 10A)$50.00
Note: Any certificate issued in accordance with provisions of M.G.L. Chapter 148, Sections 26F, 26F112 expires sixty (60)
days after issuance by head ofthe Fire Department.
FIRE DEPARTMENT'S COPY
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Number of Dwellihg Unis 1 Signature of Applicant
Fire Chief_