55728.00001\45189155.2
1 RESIDENTIAL AND NON-RESIDENTIAL
CHECKLIST FOR PERMITTING ELECTRIC
VEHICLE CHARGING STATIONS
The purpose of Chapter 15.14 of the Municipal Code is to promote and encourage the use of electric vehicles by creating an expedited, streamlined permitting process for electric vehicle charging stations while promoting public health and safety and preventing specific adverse impacts in the installation and use of such charging stations.
Please complete the following information related to permitting and installation of Electric Vehicle Service Equipment (EVSE) and submit with a building permit application.
This checklist contains the technical aspects of EVSE installations and is intended to help expedite permitting and use for electric vehicle charging.
Upon this checklist being deemed complete, a permit shall be issued to the applicant. However, if it is determined that the installation might have a specific adverse impact on public health or safety, additional verification will be required before a permit can be issued.
This checklist substantially follows the “Plug-In Electric Vehicle Infrastructure Permitting Checklist” contained in the Governor’s Office of Planning and Research “Zero Emission Vehicles in California: Community Readiness Guidebook” and is purposed to augment the guidebook’s checklist.
Project Information:
Address: __________________________________________________________________________________________ APN: ______________________ Tract: ___________________ Lot: __________________ Block: __________________ ☐ Single-Family ☐ Multi-Family (Apartment) ☐ Multi-Family (Condominium) ☐ Commercial (Single Business) ☐ Public Right-of-Way ☐ Commercial (Multi-Businesses) Location and Number of EVSE to be Installed:
Garage:Parking Level(s): ________________ Parking Lot: ____________________Street Curb: ____________________ Valuation: _________________________________________________________________________________________ Scope of Work: _____________________________________________________________________________________ __________________________________________________________________________________________________ Property Owner Information:
Name: ____________________________________________________________________________________________ Address: __________________________________________________________________________________________ Phone: _______________________________________________ Email: _______________________________________ Contractor Information:
Company Name: ____________________________________________________________________________________ Representative Name: ________________________________________________________________________________ Contractor’s License Number: _____________________ Exp. Date: _____________________ Class: ________________ Address: __________________________________________________________________________________________ Phone No.: ________________________________________________________________________________________ Workman’s Comp. No.: ____________________________ Exp. Date: _____________ Company: ___________________ City Business License No.: _____________________________________ Exp. Date: ______________________________ 55728.00001\45189155.2
2 EVSE Information:
EVSE Charging Level: ☐ Level 1 (120V) ☐ Level 2 (240V) ☐ Level 3 (480V) Maximum Rating (Nameplate) of EV Service Equipment: ____________________________________________________ Voltage EVSE: ______________________V Manufacturer / Model # of EVSE: _______________________________ Mounting of EVSE: ☐ Wall Mount ☐ Pole Pedestal Mount ☐ Other System Voltage Information:
☐ 120/240V, 1ɸ, 3W ☐120/208V, 3ɸ, 4W ☐120/240V, 3ɸ, 4W
Rating of Existing Main Electrical Service Equipment: ____________________Amperes Rating of Panel Supplying EVSE (if not directly from Main Service): ____________________Amperes Rating for Circuit for EVSE: _____________ Amps / _______________ Poles A/C Rating of EVSE Circuit Breaker (if not Single Family, 400A): __________ A.I.C. (or verify with Inspector in the field) Specify Either Connected, Calculated, or Documented Demand Load of Existing Panel:
Connected Load of Existing Panel Supplying EVSE: ___________Amps Calculated Load of Existing Panel Supplying EVSE: __________Amps Demand Load of Existing Panel or Service Supplying EVSE: __________Amps Total Load (Existing Plus EVSE Load): __________ Amps
For Single Family Dwellings, if Existing Load is not known by any of the above methods, then the Calculated Load may be estimated using the "Single-Family Residential Permitting Application Example" in the Governor's Office of Planning and Research "Zero Emission Vehicles in California: Community Readiness Guidebook." (https://www.opr.ca.gov) EVSE Rating ____________ Amps X 1.25 ____________ Amps = Minimum Ampacity of EVSE Conductor = # _________ AWG
For Single-Family: Size of Existing Service Conductors = # _________________AWG or kcmil OR Size of Existing Feeder Conductor Supplying EVSE Panel = # ___________AWG or kcmil (or verify with Inspector in field) Please provide a link to the manufacturer's installation instructions to be coordinated with the EVSE Manufacturer / Model number as specified in the EVSE Information above: ________________________________________________________ I hereby acknowledge that the information presented is true and correct representation of existing conditions at the job site and that any causes for concern as to life-safety verifications may require further substantiation of information.
Applicant's Signature: ________________________________________ Date: _________________________________ 55728.00001\45189155.2
3 Regulations:
[FINAL LANGUAGE OF APPROVED ORDINANCE TO BE INSERTED]