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Molalla Fire District

Fire & Rescue Agency Serving South Clackamas County, OR

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Motor Fuel Dispensing Facility Application

If you wish, you can download the PDF version of this form.

"*" indicates required fields

Step 1 of 4

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Applicant & Business Information

Business Name:*

Site Address:*

Street Address: Address Line 2: City: State: Zip:

Business Phone:*

Business Email:*

Applicant Name:*

First Name: Last Name:

Facility & Operational Details

Type of Facility (check all that apply):*

Motor Vehicle Fueling Station (Public)

Private Fueling Facility

Fleet Fueling

Other (specify below)

Please specify "other" fueling facility type:*

Fuel Types Dispensed (check all that apply):*

Gasoline

Diesel

Biodiesel

Ethanol

Compressed Natural Gas (CNG)

Propane (LPG)

Hydrogen

Electric Charging Only

Dispensing Method (check all that apply):*

Attended Station

Unattended (Cardlock)

Mobile Dispensing Unit

Self Service / Full Service

Fuel Storage:*

Above-Ground Storage Tank

Underground Storage Tank

Total Tank Capacity (gallons):*

Number of Tanks:*

Tank Manufacturer:*

Date of Last Tank Inspection:*

Month

Day

Year

Effective December 21, 2016, Ordinance No. 13-01, Molalla Rural Fire Protection District #73 will be administering a $100 flat rate fee for motor fuel dispensing facility plan review. The $100 fee will be collected at submittal and includes the initial inspection and one re-inspection. Payments will need to be mailed or delivered to 320 N. Molalla Ave., Molalla, OR 97038.

Required Attachments

Site Plan:*

Max. file size: 256 MB.

Manufacturer’s Specifications / Cut List:*

Max. file size: 256 MB.

Spill Prevention and Response Plan:*

Max. file size: 256 MB.

Emergency Shutoff Procedures:*

Max. file size: 256 MB.

Copies of DEQ/Environmental Permits:*

Max. file size: 256 MB.

Compliance Acknowledgment

By signing this application, the applicant certifies that the facility will comply with all applicable requirements of the 2022 Oregon Fire Code, including but not limited to sections 23 and 57. Ensure all requested items listed in the checklist are provided including the site plan with the submittal. Upload or hand deliver the completed checklists and site plans.

INCOMPLETE CHECKLISTS / SITE PLANS WILL BE RETURNED. ANY INCOMPLETE PLANS WILL NOT BE REVIEWED; AND YOUR APPROVAL WILL BE DELAYED.

The Molalla Fire District may conduct on-site inspections before approval and reserves the right to revoke permits if the facility is found non-compliant.

Signature*

Your Name
Your Name
Your Name

Date*

Month

Day

Year

Molalla Fire District

320 N. Molalla Avenue
PO BOX 655
Molalla OR, 97038

Phone: 503-829-2200
Fax: 503-829-5794

Business Hours:
Monday – Friday: 8:00 AM – 5:00 PM

Links

City of Molalla, OR
Molalla Police Department
Clackamas County Sheriff's Office
Clackamas 911 (C-COM)
Molalla River School District

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