20 ABBOTT STREET - Street File ¢, o
w�3 City of (Salem,MassachusetUs CIIGCK# so.
Fee Due
FIRE DEPARTMENT - FIRE PREVENTION DIVISION Inspection
N te:
i
A 29 Fort Avenue w
Salem, Massachusetts 01970-5232 Time lo•
APPLICATION FOR CERTIFICATE OF COMPLIANCE Closing Date:
��3oP l5
To: HEAD OF FIRE DEPARTMENT C'rOne Family Dwelling
❑ Two Famlily Dwelling
❑ Condominium Unit #
Application is hereby made for inspection of smoke detectors and carbon monoxide alarms as required by Massachusetts
General Law. Chapter 148 Sections 26F, 26171/2 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 20 A4,- 0 Y lreo-er
Owner of Property {— /�efjan 1- ► I p,
Date rti;ication: ��(�ll' �
� Owner or Agent
Bye y✓c G� °12�17 i!3 - 17 7 7
Phone
Note Any certificate issued in accordance with provisions of M.G.L. Chapter 148 Sections 26F. 26F1/2 expires
sixty (60) days after issuance by head of the Fire Department.