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2. 

3. Community and Economic Development Department

   Building Safety Division 

   1010 Tenth Street, Suite 3100 Modesto, CA 95354

5. Submitted By:*
7. General Requirements

   1. Completed Building Permit Application
   2. Completed Electrical Load Worksheet
   3. Equipment Manufacturer's Installation Instructions
   4. Schedule an appointment for Over-The-Counter Permit service by calling 209-577-5232
9. Electronic Submittal Requirements

   1. PDF files of forms listed above
   2. PDF files of all plans
   3. Submit plans and application through permit portal: https://permits.modestogov.com
   4. PDF copy of this checklist
11. Level of EV Charging
    -- Select One --Level 1 (120V)Level 2 (240V)
12. Type of equipment being installed
    -- Select One --NEMA 14-50NEMA 5-15NEMA 5-20Other
14. What type of equipment is being installed?
15. Equipment Overcurrent Protection Rating:*
    -- Select One --15A20A30A40A50A
17. Branch Circuit Distance*
    -- Select One --100 feet or lessMore than 100 feet
18. Existing Electrical Service*
    -- Select One --100A125A150A200A

    If less than 150 amps, provide electrical load worksheet.

20. Conductor Size
    -- Select One --#14 Cu#12 Cu#10 Cu#8 Cu#6 Cu
22. Certification*

    1. I certify that I have submitted complete plans which include all of the required documents.
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