0000 ABERDEEN STREET - Street Files Cityof eSaIemAm8aChu(setts �40.60
3 fee Due
FIRE DEPARTMENT - FIRE PREVENTION DIVISION Inspecti n ate:
29 Fort Avenue
Time ll p Q
Salem, Massachusetts 01970-5232
APPLICATION FOR CERTIFICATE OF COMPLIANCE Closing Date:
XOne Family Dwelling
To: HEAD OF FIRE DEPARTMENT ❑ Two Famlily Dwelling
❑ Condominium Unit #
Application is hereby made for inspection of st-loke detectors and carbon monoxide alarms as required by Massachusetts
General Law. Chapter 148 Sections 26F, 26F1/2 and 527 CMR 31. et seq.
Type of Smoke Detector Battery Hardwire Hardwire w/Bat. back-up Heat Combination
Type of Carbon Monoxide Detectors Battery Plug-in W/ Bat. Back-up Combination
Location of Property �, ,���— p;�� S'i
Owner of Property Odu
Date o ' ertification: 4� / ��"�D'
Owner or Aeent
Phone
Note Any certificate issued in accordance with provisions of M.G.L. Chapter 148 Sections 26F. 26F 1/2 expires
sixty (60) days after issuance by head of the Fire Department.