Motor Fuel Dispensing Facility Application

Owner - New Information


Facility - New Information


The rules governing motor fuel dispensing facilities are found in Title 41 of the Illinois Administrative Codes, Parts 174, 175, 176 and 177. The rules require that construction of a new motor fuel dispensing facility or modification of an existing facility shall not be commenced until applications and plans are given written approval by the Office of the State Fire Marshal. Facilities are prohibited from opening for business until they have been inspected by an inspector from the OSFM Petroleum & Chemical Safety Division.

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NOTE: Facilities are not approved for fuel dispensing until a final inspection and approval has been granted after an on-site inspection conducted by the OSFM’s Division of Petroleum & Chemical Services (DPCS).

required Facility will be operated as: !
required This Application applies to: !
Permit Number:
!
Number of Dispensing Devices to be Self-Service: 
Number of Dispensing Devices to be Full-Service: 
Number of Dispensing Devices to be Fleet Service: 
Number of Dispensing Devices to Marine Dispensing: 
Number of Dispensing Devices to Unattended for any portion of a 24 hours period: 
required Is Collision Protection provided in accordance with NFPA 58 for any LP-Gas storage cabinets? !
If “Yes” specify: !
required Are any Dwelling Units or Sleeping Areas located at this facility? !
If “Yes” explain and indicate location of sleeping areas on submitted drawings: !
requiredAre Emergency Shutoff Switch/s:
Provided at the Control Station for Attended Facilities? !
Located so that an emergency switch is located at least 20 ft. and not more than 100 ft. from each dispenser? !
Conspicuously marked and easily accessible? !
Interconnected so that activation of one emergency shutoff activates all shutoffs? !
Located at each dispensing island for Unattended and Fleet Facilities? !
requiredAre portable Fire Extinguishers provided as required by regulations? !
requiredAre Fuel Dispensers protected against collision damage? !
Method: !
required Will any buildings on this property or adjacent to this property contain basements located within 20 ft of underground dispensing storage tanks? !
required Are Warning and Instructional Signs posted as required by the rules? !
required Is a method that does not require coin or currency provided for contacting the fire department? ! (Required at all except Marina Motor Fuel Dispensing Facilities)
required Is a Control Station located as required by the rules? !
requiredAre all dispensing devices readily visible from the control station? !
Specify means: !
required For Dispensers > 40 ft. From the control station, is a means provided for the attendant to communicate with persons in the dispensing area? !
requiredUnattended Islands are provided with: !
Fire Suppression System (type: ! ) Fire Detection System
requiredIf Fire Suppression System:
Does the fire suppression system include agent discharge nozzles mounted above dispensers and at or near ground level? !
Does activation of the suppression system automatically activate an emergency shutoff switch? !
Does activation of the fire suppression system automatically sound an alarm notification device audible throughout the dispensing area? !
Does activation of the fire suppression system automatically transmit an alarm to the fire department via an acceptable method? !
requiredIf Fire Detection System:
What is the method of detection? !
Is the fire detection system located below a weather enclosure canopy? ! (Required unless written documentation is submitted indicating that the detection system will operate without a canopy).
Does activation of the detection system automatically activate an emergency shutoff switch? !
Does activation of the detection system automatically sound an alarm notification device audible throughout the dispensing area? !
Does activation of detection system automatically transmit an alarm to the fire department via an acceptable method? !
Are fire extinguishers installed at each dispensing island and at the emergency shutoff switch? !
required Does the facility have the capability to automatically transmit an alarm to the fire department? ! (This is required for all unattended motor fuel dispensing facilities regardless of suppression or detection system alarm transmission).
required Does activation of the emergency switch automatically transmit an alarm to notify the local fire department? !
required Are signs placed at or near each emergency shutoff switch indicating “transmits a fire alarm to the fire department”? !
required What is the method of fuel dispenser activation? ! !
required How are limits on dispensable quantities achieved? !
required Is spill containment provided on docks adjacent to dispensers? !
required Are dispenser nozzles of the automatic closing type without hold-open clips or devices? !

Submitted Plans

! required SUBMITTED PLANS MUST INDICATE: All lot lines and dimensions; Building Locations and Dimensions; Location of all dispensing devices; Location of Control Stations & Emergency Shutoff Switch/s; Fire Extinguisher Locations & Sizes; The Location of any LPG or Flammable/Combustible Liquid Storage Tanks at the Site; LPG cylinder storage cabinets. Insufficient information can be cause for return or denial.
Document name Last Uploaded Attachment
This application does not apply to the installation/modification of underground storage tanks at this facility. A separate application is required for any work involving Underground Storage Tanks.

The submittal of this application is not necessary if a change of business name has occurred at a currently permitted service station or a change of ownership has occurred at a currently permitted service station. If either of these has occurred, please submit a notification form to this office at Division of Petroleum and Chemical Safety, 1035 Stevenson Drive, Springfield IL, 62703.


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        Owner Information
        Corporation, partnership, or other business entity.
        (Must be mailing address)
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        Facility Information
        Name and address where tanks are located.
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