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2. This is an application for a Hazardous Materials Operational Permit. This is not the permit. A permit is not valid until signed and received from Ashland Fire and Rescue. Applications for Hazardous Materials Operational Permits must be received 30 days before the issuance date. Hazardous Materials Operations are required be in compliance with the Oregon Fire Code, Ashland Municipal Code and any other applicable codes.

   At the end of this permit, you will be asked to upload a Hazardous Material Management Plan and a Hazardous Material Inventory Statement. Please prepare these in advance so they can be included with your application.

4. Applicant First Name:*
5. Applicant Last Name:*
7. Business Name:*
9. Mailing Address*

   Including City, Sate, and Zip Code.

11. Business Phone:

    No punctuation, Ex:541555.

12. Cell Phone:*

    No punctuation.

14. Site Address:*
16. Business Owner Name:*
18. Email:*
19. Website:
21. Building Owner Name:*
25. Describe Operation:*
27. HMIS Upload:

    Upload the Hazardous Materials Inventory Statement here. The HMIS form can be found at the AF&R website.

28. HMMP Upload:

    Upload the Hazardous Materials Management Plan here. Plan format can be found at the AF&R website.

30. Inspection Request:

    Include a range of dates and best times of the day at least 30 days from now.

31. Start Date of Operation:*
    Start Date of Operation:
33. Hazard Classifications:

    1. Aerosols
    2. Combustible Dust
    3. Combustible Fibers
    4. Combustible Liquids
    5. Corrosives
    6. Cryogenic Flammable
    7. Cryogenic Oxidizing
    8. Explosives
    9. Flammable Gas
    10. Flammable Liquids
    11. Flammable Solids
    12. Organic Peroxides
    13. Oxidizer
    14. Oxidizing Gas
    15. Pyrophoric
    16. Toxics
    17. Unstable (reactive)
    18. Water Reactive
    19. Other

    Select all of the classifications that best represent the hazardous materials at this site.

37. Statement of Application:

    By signing, you agree that all information on this application is true and correct, and to comply with all applicable city ordinances, state, and federal rules. This application does not imply compliance with or approval of a permit. A permit will be issued separately from this application. A permit has not been issued until both the applicant and the Fire Code Official have signed a permit.

39. Full Name:*

    After selecting submit, you will receive an email confirming that your application has been received. Please note that until a permit is signed by you and an Ashland Fire and Rescue Fire Code Official, the permit has not been issued.

Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field