0000 COLUMBUS SQUARE - Street Files FCOLUMBUS.SQ
Commonwealth of Massachusetts
\!. Department of Fire Services - Office of State Fire Marshal
City of Salem - Fire Prevention Bureau
" 29 Fort Ave. Salem, MA 01970 (978) 745-7777 C lr
APPLICATION FOR CERTIFICATE OF COMPLIANCE �C
FOR SMOKE DETECTORS AND CARBON MONOXIDE ALARMS
M.G.L. CHAPTER 148,
Sections: 26F, 26F1/2 - Res. Smoke& CO Detectors
City of Salem Permit: FA-17-411 Application Date: 6/29/2017
Application is hereby made for inspections of smoke detectors and carbon monoxide alarms as required by Massachusetts General Law,
Chapter 148, Section 26F,26F1/2 and 527 CMR 31,et seq.
NOTE: SUBMIT APPLICATION TO SALEM FIRE RESCUE HEADQUARTERS
Property Location 5-U3 COLUMBUS SQUARE Salem, Ma.
by TAUBENECK JANE
DBA /
c)
Phone: Email:
Inspection/Testing completed on: ' 6/29/2017 By: Z4
Inspector
Fee(MGL C 148, Sec 10A): $50.00 Fire Chief
Chief,Salem Fire Department
Note:Any certificate issued in accordance with provision of M.G.L.Chapter 148,Sections 26F,26F1/2 expires sixty(60)days after issuance by head of Fire
Department.
Fire Department's Copy