Fillable APPLICATION FOR RETAIL PETROLEUM OUTLET LICENSE O R (Prince Edward Island Regulatory & Appeals Commission)

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APPLICATION FOR RETAIL PETROLEUM OUTLET LICENSE O R (Prince Edward Island Regulatory & Appeals Commission)

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The APPLICATION FOR RETAIL PETROLEUM OUTLET LICENSE O R (Prince Edward Island Regulatory & Appeals Commission) form is 2 pages long and contains:

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Country of origin: CANADA
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APPLICATION FOR RETAIL
PETROLEUM OUTLET LICENSE
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ALL APPLICABLE QUESTIONS MUST BE ANSWERED
1
NAME OF OUTLET:
2
LOCATED AT: (Street) (Town, Community) (Province) (Postal Code) (Telephone)
P.E.I.
3
OWNER OF OUTLET:
4
OWNER’S MAILING ADDRESS:
5
OPERATOR OF OUTLET:
6
OPERATOR’S MAILING ADDRESS:
7
CURRENT PETROLEUM PRODUCTS LICENSE NUMBER:
8
DESCRIBE OTHER SERVICES PROVIDED AT THIS OUTLET (SERVICE BAYS, C-STORE, RESTAURANT, ETC.):
9
WHAT COMPANY IS YOUR PROPOSED SUPPLIER OF PROPANE:
10
WILL YOU BE SELLING PROPANE THROUGH A CYLINDER EXCHANGE CENTRE:
Yes No If yes, give size of cylinders ___________ litres
11
DO YOU PROPOSE THE STORAGE AND RETAIL SALE OF FILLED PROPANE CYLINDERS (MAXIMUM OF 45.4
KG):
Yes No If yes, give size of cylinders ___________ litres
12
WILL YOU BE FILLING CYLINDERS FROM A DISPENSER: Yes No
If yes, give maximum size of cylinders to be filled ___________ litres Size of bulk propane storage ___________ litres
13
WILL YOU BE FUELING TANKS PERMANENTLY ATTACHED TO MOTOR VEHICLES: Yes No
14
THE FOLLOWING ITEMS MUST ACCOMPANY THIS APPLICATION (NOTE: ONLY ITEM NO. 3 IS REQUIRED FOR
PROPANE EXCHANGE CENTRE APPLICATIONS):
1. A PLAN INDICATING LOCATION OF PROPOSED PROPANE
INSTALLATION IN RELATION TO EXISTING BUILDING(S)
2. A LETTER OUTLINING WHY IT IS CONSIDERED THAT PUBLIC
INTEREST, CONVENIENCE AND NECESSITY REQUIRE THE
LICENSING OF A PROPANE OUTLET IN THE AREA
THE FOLLOWING ITEM MUST ALSO BE FILED WITH THE COMMISSION BEFORE A LICENSE
WILL BE ISSUED:
3. A COPY OF APPROVAL FROM THE INSPECTION SERVICES
DIVISION OF THE DEPARTMENT OF AGRICULTURE AND LAND
RELATIVE TO THE HANDLING OF PROPANE
PAGE 1 OF 2
National Bank Tower
501-134 Kent Street
P.O. Box 577
Charlottetown, PE
C1A 7L1
Clear Form
15
DURING WHAT HOURS DO YOU PROPOSE TO RETAIL PROPANE:
Mondays to Saturdays:
A.M.
to
P.M.
Sundays:
A.M.
to
P.M.
Holidays
A.M.
to
P.M.
16
DURING WHAT MONTHS OF THE YEAR DO YOU PROPOSE TO RETAIL PROPANE:
17
I HEREBY DECLARE THAT THE ANSWERS MADE TO THE ABOVE QUESTIONS ARE TRUE AND, IF A LICENSE IS
ISSUED, I UNDERTAKE TO CARRY OUT IN EVERY MANNER THE REQUIREMENTS OF THE PETROLEUM
PRODUCTS ACT AND REGULATIONS.
CORPORATE
SIGNATURE: NAME:
PRINT NAME: _____________________ TELEPHONE:
(Please check) Owner Lessee Agent
TITLE: DATE:
PLEASE NOTE: ALTERNATIONS ARE NOT TO BE COMMENCED UNTIL AUTHORIZATION IS RECEIVED FROM THIS COMMISSION.
A FEE AS OUTLINED IN THE CURRENT LICENSE FEE SCHEDULE FOUND ON THE COMMISSION’S PUBLIC WEBSITE WILL BE PAYABLE
TO THE ISLAND REGULATORY AND APPEALS COMMISSION WHERE A LICENSE AMENDMENT IS REQUIRED.
Information on this Form is collected pursuant to the Petroleum Products Act and will be used by the Commission in the administration of the
said Act. For additional information, contact the Commission at 902-892-3501 or by email at info@irac.pe.ca.
IRAC508(2020) PAGE 2 OF 2
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APPLICATION FOR RETAIL PETROLEUM OUTLET LICENSE O R (Prince Edward Island Regulatory & Appeals Commission)

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Completed 24 July 2021

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