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(Rev. 1.1.2015)
City or Town
a Retum completed application to:t
APPLICATION FOR CERTIFICATE OF COMPLIANCE
FOR SMOKE DETECTORS AND CARBON MONOXIDE ALARMS
M.G.L. CHAPTER 148, SECTIONS 26F,26F1N
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Application is hereby made for inspection ofsmoke detectors and carbon monoxide alarms as required by
I\rassachusetts GeneralLaw, Chapter 148, Sections 26F,26F112 and 527 CMR 1:00 Secton 13.7.
NOTE: SUBMIT APPLICATION TO LOCAL FIRE DEPARTMENT HEADQUARTERS
Location of Property 59 Swan Lake Road
Owner of Property Karyn Morris-Devine
Number of Dwelling Units Signature of Applicant
lnspection/Testing completed on 10121t2026 By vk
Fee: (M.G.L. Chapter 148 Sec. 10A)s50 00 Fire Chief
Note: Any cerlificate issued in accordance with provisions of M.G.L. Chapter 148, Seciions 26F, 26F1l2 expires sixty (60)
days afrer issuance by head of the Fire Department.
FIRE DEPARTIITENT'S COPY
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