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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,26F1N
City or Town West Yarmouth Date 10121t2026
Application is hereby made for inspeclion of smoke detectors and ca6on monoxide darms as required by
Massachusens ceneral Law, Chapter 148, Sedions 26F,26F1D and 527 CMR 'l r00 Seclron 13.7.
NoTE: SUBMIT APPLICATION To LocAL FIRE DEPARTIEI{T HEADOUARTERS
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Location of Property 32 Niagara Lane
Owner of Property Elizabeth O'Callaghan
Number of Dwelling Units Signature of Applicant
lnspection/Testing completed on By:
Fee: (M.G.L. Chapter'148 Sec. 10A)s50 00 Fire Chief
Note: Any certificate issued in accordance with provasions of M.G.L. Chapter 148. Sections 26F, 26F112 exphes sixty (60)
days afler issuance by head of the Fire Department.
FIRE DEPARTTIENT'S COPY
10121t2026 UA-
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