□ Single-Family □ Multi-Family (Apartment) □
Multi-Family (Condominium)
□ Commercial (Single Business) □ Commercial (Multi-Businesses)
□ Mixed-Use □ Public Right-of-Way
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Location and Number of EVSE to be Installed:
□ Garage _____ □ Parking Level(s) _____ □ Parking
Lot _____ □ Street Curb _____
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Description of Work:
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Applicant Name:
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Applicant Phone & email:
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Contractor Name:
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License Number & Type:
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Contractor Phone & email:
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Owner Name:
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Owner Phone & email:
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EVSE Charging Level: □ Level 1 (120V) □ Level
2 (240V) □ Level 3 (480V)
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Maximum Rating (Nameplate) of EV Service Equipment = _________
kW
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Voltage EVSE = __________ V
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Manufacturer of EVSE:
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Mounting of EVSE: □ Wall Mount □ Pole Pedestal
Mount □ Other
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Specify Either Connected, Calculated or Documented Demand Load
of Existing Panel:
Connected Load of Existing Panel Supplying EVSE = ______ Amps
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Calculated Load of Existing Panel Supplying EVSE = ______ Amps
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Demand Load of Existing Panel or Service Supplying EVSE = _____
Amps
(Provide Demand Load Reading from Electric Utility)
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Total Load (Existing plus EVSE Load) = _____ Amps
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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
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EVSE Rating _______ Amps x 1.25 = _______ Amps = Minimum Ampacity
of EVSE
Conductor = # __________ AWG
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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)
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