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1 COUNTY OF ALPINE RESIDENTIAL AND NON-RESIDENTIAL CHECKLIST FOR PERMITTING ELECTRIC VEHICLE CHARGING STATIONS (EVCS) Alpine County Communty Dev. Permit No. ☐ Single-Family ☐ Multi-Family (Apartment) ☐ Multi-Family (Condominium) ☐ Commercial (Single Business) ☐ Commercial (Multi-Businesses) ☐ Mixed-Use ☐ Public Right-of-Way Location and Number of EVCS to be Installed: Street Garage Parking Level(s) Parking Lot Street Curb (subject to jurisdictional right-of-way acceptance) Description of Work: Please complete the following information related to permitting and installation of Electric Vehicle Charging Stations (EVCS) as a supplement to the application for a building permit. This checklist contains the technical aspects of EVCS installations and is intended to help expedite permitting and use of electric vehicle charging stations. Upon this checklist being deemed complete, a permit may 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 may 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. ---PAGE BREAK--- 2 Applicant Name & Address: Applicant Phone & email: Contractor Name: License Number & Type: Contractor Phone & email: Owner Name & Address: Owner Phone & email: EVSE Charging Level: ☐ Level 1 (120V) ☐ Level 2 (240V) ☐ Level 3 (480V) Maximum Rating (Nameplate) of EV Service Equipment = kW Voltage EVSE = V Manufacturer of EVSE: Mounting of EVSE: ☐ Wall Mount ☐ Pole Pedestal Mount ☐ Other System Voltage: ☐ 120/240V, 1ϕ, 3W ☐ 120/208V, 3ϕ, 4W ☐ 120/240V, 3ϕ, 4W ☐ 277/480V, 3ϕ, 4W ☐ Other Rating of Existing Main Electrical Service Equipment = Amperes Rating of Panel Supplying EVSE (if not directly from Main Service) = Amps Rating of Circuit for EVSE: Amps / Poles AIC Rating of EVSE Circuit Breaker (if not Single Family, 400A) = A.I.C. (or verify with Inspector in field) ---PAGE BREAK--- 3 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 (Provide Demand Load Reading from Electric Utility) 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” 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) I hereby acknowledge that the information presented is a 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. Signature of Permit Applicant: Date: 10-20-2020