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FP{O7C
(Rev. 1.1.2015)
a Relurn 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 oare.. 10122J2026
Application is hereby made for inspeclion of smoke detecto6 and carbon monoxide alarms as required by
Massachusetts General Law, Chapter 148, Seclions 26F, 26F1l2 and 527 CMR 1:00 Sectaon 13.7.
NOTE: SUBMIT APPLICATION TO LOCAL FIRE DEPARTf,ENT HEADQUARTERS
Location of Property 762 West Yarmouth Rd
Owner of Propedy Bonnie Lewis
Number of Dwelling Units Signature of Applicant
lnspection/Testino completed on 1012212026 By:t/7^.
Fee: (M.G.L. Chapte|i48 Sec. 104)$50.00 Fire Chief
itole: Any certificate issued in ac@rdance with provisions of M.G.L. Chapter 148, Sections 26F, 26Fl/2 expires sixty (60)
days after issuance by head of the Fire Oepartment.
FIRE DEPARTT{ENT'S COPY
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Yarmouthport