Application for the Installation of a Retail Propane Tank Exchange Site at a Retail Store

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Section A: Registration Information
Applicant's Name

Phone Number

Location Owner/ Operator

Installation Address:

Phone Number

Email Consent

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Select one of the following:

Complete the following information (section 1 through 7) per B149.2-10
1. Propane Quantity
Total quantity of propane stored, lbs(kg) (6.5.2.6.1)
2. Cabinet Design
Storage cabinet design (6.5.1.1) (check all that apply
3. Cabinet Location
Click Green + Button to select cabinet location, number and size of cylinders in each cabinet
4. Signage
Confirm that the following signage will be prominently displayed
5. Clearances from (6.5.6.1, 6.5.1.8, table 6.3). Indicate feet or NA
Indicate below distance from Nearest building(s) (Minimum 0 ft non-combustible wall or for one cabinet against a combustible wall)

Indicate below distance from adjoining property line that may be built upon (minimum 10 ft)

Indicate below distance from public through fares or sidewalk not associated with the business (min. 0 for 500 lbs, 15 ft for over 500 lbs total

Indicate below distance from adjoining property line of high occupancy or public gathering buildings (min 25 ft)

Indicate below distance from building opening (minimum 3 ft)

Indicate below distance from mechanical air intake(minimum 10 ft)

Indicate below distance from electrical wiring/equipment (table 7.6) (minimum 5 ft up to 1000 lb or 15ft over 1000lb total)

6. Clearances from Containers (6.5.1.10) Indicate feet or NA
Indicate belowdistance from other flammable compressed gas containers (minimum 3 ft)

Indicate below distance from containers or dispensers for flammable and combustible liquids, or oxidizing, corrosive, or toxic gases (minimum 20 ft)

7. Building Wall Construction
Indicate below if building wall is constructed of OTHER than concrete or masonry material, list materials used from the interior of the building to the exterior

8. Upload Drawings:

Total Amount: $250.00

Payment Method
Credit Card Information

Billing Information