The Oregon 440 2570 form is an application used for obtaining an electrical license in the state of Oregon. This form requires applicants to provide personal information, employment history, and proof of work experience. Completing this application accurately is essential for successful processing and approval of the electrical license.
The Oregon 440 2570 form is an essential document for individuals seeking to obtain an electrical license in the state of Oregon. This form serves as the official application and encompasses several key steps that applicants must complete to ensure their submission is thorough and accurate. First, applicants are required to provide personal information, including their name, address, and social security number, which is crucial for identification and verification purposes. Following this, the form prompts applicants to list any previous electrical licenses they hold, along with the types of licenses they wish to apply for, each associated with a specific fee. Employment history plays a significant role in the application process, as candidates must detail their relevant work experience and may need to submit verification from employers to substantiate their claims. Additionally, a recent passport-style photograph is required to personalize the license once issued. The form also includes an affidavit where applicants certify the accuracy of their provided information, underscoring the importance of honesty throughout the licensing process. Finally, a checklist at the end of the form helps applicants ensure that they have completed all necessary steps before submission. By following these guidelines and submitting the Oregon 440 2570 form correctly, applicants can take a significant step toward achieving their electrical licensing goals in Oregon.
Electrical License Application
Mail application with payment to:
DCBS Fiscal Services
Department of Consumer & Business Services
P.O. Box 14610
Building Codes Division • 1535 Edgewater St. NW, Salem, Oregon
Salem, OR 97309-0445
Phone: (503) 373-1268 • Fax: (503) 378-2322
Web: bcd.oregon.gov
Important: Read the application instructions before completing this form. Please complete all steps before submitting your application and refer to the checklist at the end of this form.
STEP 1
APPLICANT INFORMATION (please print)
Last
First
Middle initial
Name:
Address (street or P.O. Box):
City:
State:
ZIP:
Phone: (
)
Fax: (
E-mail:
Social Security number (Required, ORS 25.785):
–
Your Social Security number is required for BCD licenses, certifications, and registrations according to ORS 25.785, ORS 305.385, 42 USC § 405 (c)(2)(C)(i), and 42 USC § 666(a)(13). Failure to provide this information will be basis for application refusal. Your SSN may be shared with other authorities only for tax-administration purposes and child-support enforcement (including identification).
STEP 2
PREVIOUS LICENSES
List all individual or contractor electrical licenses you hold or have held in any state. Submit a copy of all out-of-state licenses with your application.
List license(s):
STEP 3
LICENSE TYPE
Please select a license type from the list below. Fees are nonrefundable.
The application instructions list the requirements and scope of each license.
General supervising electrician (S) $100.00 General journeyman (J) $100.00
Limited supervising electrician (PS) $100.00
Limited journeyman manufacturing plant (PJ) $100.00 Limited energy technician Class A (LEA) $50.00 Limited energy technician Class B (LEB) $50.00
Limited maintenance electrician (LME) $100.00 Limited residential electrician (LR) $100.00 Limited journeyman sign electrician (SIG) $50.00 Limited journeyman stage electrician (ST) $50.00 Limited building maintenance electrician (BME) $50.00 Limited renewable energy technician (LRT) $50.00 Ltd. maintenance manufactured structures (LMM) $100.00
STEP 4
TEST LOCATION
Please refer to the enclosed list or our Web site to choose a test location.
Reciprocal applicants do not test.
Preferred testing location:
Make check or money order payable to Department of
Consumer & Business Services. If paying by credit card, applicant must sign credit card information box. DO NOT SEND CASH.
Visa
MasterCard
Discover
/
Credit card number
Expiration date
Name of cardholder as shown on credit card
$
Cardholder signature
Amount
Secure fax for
credit card payments:
(503) 947-2333
Fee varies based on license type.
DCBS Fiscal use only: 12104/0600
Page 1 440-2570 (1/08/COM)
STEP 5
EMPLOYMENT HISTORY
List your experience in order, beginning with your present or most recent position. If more space is needed, attach additional sheets.
Please print
Employer’s name:
Period of employment:
Address:
From:
To:
Hours worked per week:
Phone:
(
Position/title:
Supervisor’s name:
Describe work performed:
Applicant name:
440-2570 (1/08/COM)
Page 2
STEP 6
VERIFICATION OF WORK EXPERIENCE
To provide proof of your work experience, submit an Electrical Experience Verification form (440-2570A) from each of your employers.
OR
Applicants relying on military experience must submit the following:
• Official documentation from supervising official showing the type and approximate hours of work experience
• Other reliable documentation verifying training and experience if supervisor not located
STEP 7
PHOTOGRAPH OF APPLICANT
Applicants must submit a 2” x 2” passport-style photo. Write your name on the back of your photo and submit it with your application. This photo will be printed on your license when it is issued. Please do not staple the photo.
STEP 8
APPLICANT AFFIDAVIT
1.I hereby certify that, to the best of my knowledge, the information on this application is complete and correct.
2.I understand that my license may be suspended, conditioned, or revoked if I have deliberately falsified my application. ORS 455.125
3.I understand that, if I provide false information on this application or cheat on a licensing examination, my application will be denied and I may not apply for any license or be allowed to take any division-related examination for one year from the date of denial. OAR 918-001-0040
4.I certify that I have read these statements and understand the terms of my license.
Name (print):
Applicant signature:
Date:
STEP 9
CHECKLIST FOR APPLICANTS
1.
2.
3.
4.
5.
6.
7.
Application form completed (Form 440-2570) Affidavit signed and dated (Step 8 on application)
Verification of work experience (Form 440-2570A) from each employer. Additional documentation:
Proof of completion of an Oregon-approved apprenticeship or training program
Proof of completion of an out-of-state apprenticeship program recognized by the state of Oregon Official transcripts of classroom training
Proof of a high school diploma, GED, or equivalent. A college degree will substitute. Passport-style photo (2” x 2”) with applicant’s name on the back
Payment of fee
DEPARTMENT USE ONLY
Approved
Signature:
Denied
Comments:
Apprentice applicants must provide proof of completion of a recognized apprenticeship program.
Page 3
Electrical Experience Verification
Mail verification to:
Building Codes Division
P.O. Box 14470
Salem, OR 97309-0404
Phone: (503) 373-1268 • Fax: (503) 378-2322 • TTY: (503) 373-1358
Instructions: You must submit a separate experience verification form for each place of employment. If you are submitting more than one form, do not overlap dates of employment.
Name (applicant):
PERIOD OF EMPLOYMENT
Applicant’s position/title:
VERIFIER INFORMATION
Applicants submitting verification of equivalent training and experience under OAR 918-030-0030(1)(c) must provide verification from the following persons:
• A current or previous employer actively involved with the applicant’s work;
• The individual who supervised the work if the current or previous employer is no longer in business, is deceased, or otherwise cannot be located; or
• A co-worker who was directly involved in the work performed, only if both the employer and the supervisor cannot be located. Co-worker verification must be accompanied by supporting documentation, such as employment records, showing that the verifier worked with the applicant and has knowledge of the work performed.
Name of verifier:
License number(s):
Verifier’s employment relationship to applicant:
440-2570A (7/06/COM/WEB)
Page 1
Applicant (print name):
VERIFIED EXPERIENCE
1.Enter the type of license you are applying for:
2.From license types on Page 3, choose the categories in which you have work experience and enter them under “Category.” (See example, below.)
3.Under “Total hours,” enter the hours of work experience in each category. The division will consider no more than 2,000 hours of experience per year. OAR 918-282-0030(4).
4.Enter your specific work duty experience under “Description of duties.” If you need more information, see bcd.oregon.gov, “Statutes and Rules,” “Oregon Administrative Rules,” click on 918-282, then scroll down to the desired license type.
5.Make copies of this page, if needed.
Category
Total hours
Description of duties
(example) Residential wiring
2000
Installations, wire pulling, service and panel, conduit, flex, metal
romex boxes, electrical heating systems
VERIFIER CONFIRMATION
As the verifier of the preceding information, I confirm that it is true and correct to the best of my knowledge.
Verifier name (please print):
Verifier signature:
ELECTRICAL WORK EXPERIENCE CATEGORIES
General journeyman (J)
General supervisor (S)
Limited residential (LR)
•Stockroom, materials handling
•Residential wiring
•Commercial installations
•Industrial installations
•Troubleshooting and maintenance
•Finishing and fixture hanging
•Signal and control systems
•Remodeling
•Underground construction
Limited supervisor (PS)
Limited plant journeyman (PJ)
Limited maintenance electrician (LME)
•Electrical circuits
•Motors and generators
•Controls, manual and automatic
•Troubleshooting
•In-place motor cleaning
•Lighting
•Electrical drawings
Limited journeyman sign (SIG)
•Pattern and blueprints
•Layout design
•Assembly of display
•Display painting and component parts
•Display installation, service, and maintenance
•Transportation and hoisting equipment maintenance and repair
Limited journeyman stage (ST)
•Stage/film and video/event lighting
•Stage/film and video dimmer distribution
•Three-phase temporary power distribution
•Stage/film and video lamp operator
•Stage/film and video/event property
Limited energy, Class A (LEA)
Limited energy, Class B (LEB)
•Protective signaling (fire alarm, nurse call, burglar alarm, security and voice evacuation systems that are part of a fire or life safety system) (LEA only)
•HVAC
•Medical
•Boiler controls
•Intercom, paging, sound, CCTV
•Clock systems
•Data telecommunications
•Instrumentation
•Security
•Stockroom, materials handling, shop and service
•Limited energy wiring: installations, wire pulling, splices, conduit, flex, tray and duct, control panels and controls, wiring devices, removal and finish work
•Outdoor installations, overhead and underground
•Occupation or trade-specific training related to license
Limited building maintenance (BME)
•Electrical appliances
•Light switches
•Light fixtures
•Fans
•Receptacles
•Fluorescent ballasts
Limited renewable energy technician (LRT)
Available only by completing an Oregon apprenticeship
Limited maintenance manufactured structures (LMM)
Two years of experience as a trainee in the repair and maintenance of electrical problems found in manufactured structures, while employed by a manufactured structures manufacturer
To see a detailed list of minimum hourly requirements for each category, go to our Web site, bcd.oregon.gov, “Statutes and Rules,” “Oregon Administrative Rules,” click on 918-282, then scroll down to the desired license type.
Electrical License Application Instructions
Building Codes Division • 1535 Edgewater St. NW, Salem, Oregon P.O. Box 14470, Salem, OR 97309-0404
Phone: 503-373-1268 • Fax: 503-378-2322
Mail application, required documents, your photo, and payment to:
LICENSING PROCESS
1.Review the licensing information on Pages 2-4 to determine the scope of work allowed under each license and whether you meet the qualifications for the license.
2.Complete the electrical license application (Form 440-2570) and send all required documentation, your photograph, and fees to the Department of Consumer and Business Services (DCBS). Use the checklist below to ensure your application is complete. Incomplete applications may delay evaluation of your applications.
3.Building Codes Division sends approved applicants a letter of authorization to take an examination. The letter explains the examination procedures and provides the address and telephone number of the test site. The applicant is responsible for scheduling the examination with the test site office.
4.If your application is denied, Building Codes Division will send a denial letter explaining your rights to a hearing.
5.Allow two weeks for Building Codes Division to grade your exam. If you pass the examination, Building Codes Division will issue your license and mail a photo identification card to you.
6.During each three-year license period, all licensees are required to complete continuing education. Go to bcd.oregon.gov to see the continuing education requirements for each license type.
ELECTRICAL LICENSE EXPERIENCE VERIFICATION INSTRUCTIONS
Most applicants are required to submit verification of electrical experience (Form 440-2570A), signed by a verifier, for each place of employment.
1.The person verifying the applicant’s work must be a current or previous employer. If an employer is not available, the person who supervised the work may verify experience. If neither an employer nor supervisor is available, a co-worker who was directly involved may verify experience.
2.The verifier must identify specific categories (e.g., “finishing and fixture hanging,” “commercial installations,” “troubleshooting and maintenance”) from Page 3 of the verification form and list the number of hours worked in each category on the form. A description of duties for each category must be included.
3.The verifier must sign and date the form.
CHECKLIST FOR ELECTRICAL LICENSE APPLICATION
1. Application form completed (Form 440-2570).
2. Affidavit signed and dated (Step 8 on application).
3. Verification of work experience (Form 440-2570A) from each employer.
4. Any additional required documents:
Proof of completion of an Oregon-approved apprenticeship or training program.
Proof of completion of an out-of-state apprenticeship program recognized by the state of Oregon.
Official transcripts of classroom training.
5. Proof of high school diploma, GED, or equivalent. A college degree will substitute.
6. Passport-style photo (2" x 2") with applicant’s name on the back.
7. Payment of fee.
Page 1 440-2570-I (3/08/COM)
ELECTRICAL LICENSE REQUIREMENTS AND SCOPE OF WORK
Applicants are required to provide proof of training and work experience equivalent to an Oregon apprenticeship program. If applicants do not have related training classes, they may alternatively submit verification of twice the amount of required work experience. OAR 918-030-0030(2)
“300 percent rule”: For some licenses, no more than three times the number of minimum hours (300 percent) will be allowed for a single category of work experience. Categories of work experience (residential, commercial, industrial, etc.) required for each license type are listed on the Electrical Experience Verification (Form 440-2570A). Example of
“300 percent rule”: If the minimum requirement is 1,000 hours of residential work, the maximum credit allowed in the residential category is 3,000 hours — three times 1,000.
Below is a brief summary of the work a license holder is allowed to perform and the requirements for each license.
License type and
What this license
The requirements
rule reference
authorizes you to do
for this license
(1) Be currently licensed as an Oregon journeyman
Design, plan, and lay out work; sign all
electrician AND provide verification of an additional
General supervising
8,000 hours of on-the-job journeyman experience.
permits; licensee is the only individual
electrician
authorized to direct, supervise, or control
(S)
(2) Meet the qualifications to be licensed as an Oregon
the installation or alteration of an
journeyman electrician and provide verification of an
OAR 918-282-0140
electrical service.
additional 8,000 hours of on-the-job journeyman
experience. (300 percent rule applies.)
(1) Be currently licensed as an Oregon limited journeyman
manufacturing plant electrician AND provide verification
of an additional 8,000 hours of on-the-job plant
Limited supervising
journeyman experience.
the installation, maintenance,
(PS)
replacement, and repair of electrical
(2) Meet the qualifications to be licensed as a limited
OAR 918-282-0160
wiring and electrical products on or in an
journeyman manufacturing plant electrician AND provide
existing operable plant, hospital,
verification of an additional 8,000 hours of on-the-job
commercial building, or institution.
plant journeyman experience obtained outside of
Oregon. (300 percent rule applies.)
(1) Completion of an approved apprenticeship program
in Oregon.
(2) Official transcripts verifying 576 hours of classroom
Make any electrical installation under
training AND verification of 8,000 hours of on-the-job
General journeyman
the supervision, direction, and control of
experience obtained outside of Oregon. Experience MUST
a general supervising electrician, unless
include a breakdown of hours, showing a minimum of
(J)
doing work that requires the direction of
1,000 hours in EACH category: residential, commercial,
OAR 918-282-0170
a limited supervising electrician or doing
and industrial. (300 percent rule applies.)
work requiring no supervision.
(3) Verification of 16,000 hours of on-the-job experience
obtained outside of Oregon showing a minimum of
2,000 hours in EACH category: residential, commercial,
Reciprocal general
(1) Possess an active supervisor/master license in a state
that has a reciprocal licensing agreement with Oregon.
supervising electrician
Please refer to our Web site: bcd.oregon.gov/licensing for
reciprocal agreements and the application form, Reciprocal
OAR 918-030-0045
Electrical and Plumbing License Application.
(1) Possess an active general journeyman license in a state
Reciprocal journeyman
440-2570-I (3/08/COM)
License type and rule
reference
Make electrical installations on one- and
Limited residential
(2)
Official transcripts verifying 288 hours of classroom
two-family or multifamily dwelling
training AND verification of 4,000 hours of on-the-job
units, not exceeding three floors above
residential experience obtained outside of Oregon.
(LR)
grade. (Must work under the
(300 percent rule applies.)
supervision, direction, and control of a
OAR 918-282-0180
general supervising electrician.)
(3)
Verification of 8,000 hours of on-the-job residential
experience obtained outside of Oregon. (300 percent
rule applies.)
Install, maintain, replace, and repair
electrical wiring and electrical products
on or in an existing operable
Limited journeyman
Official transcripts verifying 576 hours of classroom
manufacturing plant or industrial plant
manufacturing plant
owned or used by employer. (Must work
commercial and industrial experience obtained outside
under the supervision, direction, and
(PJ)
of Oregon. (300 percent rule applies.)
control of a limited supervising
OAR 918-282-0190
electrician. If there is no supervising
Verification of 16,000 hours of on-the-job commercial
electrician, licensee is limited to repair
and industrial experience obtained outside of Oregon.
and maintenance work.)
Limited renewable
Make renewable energy system
energy technician
installations. (Must be employed by a
(1)
Completion of an approved apprenticeship program
(LRT)
limited renewable energy contractor or
OAR 918-282-0205
electrical contractor.)
Limited journeyman sign
Install and service electrical signs and
Official transcripts of required classroom training AND
verification of 4,000 hours of on-the-job sign
outline lighting. (Must be employed by a
(SIG)
electrical experience obtained outside of Oregon.
limited sign contractor.)
OAR 918-282-0220
(3) Verification of 8,000 hours of on-the-job sign
experience obtained outside of Oregon, broken down
into specific work categories.
Install temporary feeders, branch circuits,
Official transcripts verifying 150 hours of required
and equipment used for the production of
classroom training AND verification of 4,000 hours of
shows, exhibits, displays, festivals,
on-the-job experience obtained outside of Oregon.
stage electrician
conventions, stage, theater, film, or video
(ST)
productions; perform maintenance on
Verification of 8,000 hours of on-the-job stage
OAR 918-282-0230
temporary equipment. (Must be employed
by an electrical contractor.)
(1) Completion of an approved apprenticeship in Oregon.
Repair and maintain existing electrical
Official transcripts verifying 288 hours of required
Limited maintenance
installations on or in an existing
operable plant, commercial building, or
on-the-job training or experience obtained outside of
(LME)
institution. (An LME is not authorized to
OAR 918-282-0240
make new electrical installations or to
perform work on services.)
Verification of 8,000 hours of on-the-job experience
obtained outside of Oregon, broken down into specific
work categories. (300 percent rule applies.)
Maintain, repair, and replace electrical
Completion of an approved one-year training program
appliances, light switches and fixtures,
fans, receptacles, and fluorescent
Limited building
ballasts on the premises of commercial
maintenance electrician
Verification of 2,000 hours of on-the-job training or
office buildings, buildings occupied by
(BME)
experience in maintenance, repair, and replacement of
the state or a local government entity,
OAR 918-282-0260
electrical appliances, light switches, light fixtures,
and facilities designated by the Electrical
fans, receptacles, and fluorescent ballasts. (300
and Elevator Board in electrical systems
percent rule applies.)
not exceeding 300 volts to ground.
(2) Official transcripts verifying 432 hours of required
classroom training, AND verification of 6,000 hours of
Limited energy
Install, alter, and repair all limited
on-the-job training broken down into specific work
technician,
energy systems. (An LEA must be
categories. (300 percent rule applies.)
Class A
licensed as an electrical contractor or
(LEA)
must work for an electrical contractor,
Verification of 12,000 hours of work experience
limited energy contractor, or for one
OAR 918-282-0345
OAR 918-282-0355
employer in an industrial plant.)
work categories. Requires trade-specific installation
experience in protective signaling that includes fire
alarm, nurse call, burglar alarm, and other systems
that are part of a fire or life safety system. (300
(2) Official transcripts verifying 288 hours of required
classroom training AND
Perform limited energy electrical
(a) Verification of 4,000 hours of work experience
broken down into specific work categories (300
activity that does not include protective
percent rule applies) AND
signaling. (An LEB must be licensed as
Class B
(b) Completion of a board-approved 32-hour training
an electrical contractor, or must work for
(LEB)
program (may be taken after application is
an electrical contractor, limited energy
approved).
OAR 918-282-0360
contractor, or for one employer in an
OAR 918-282-0365
industrial plant.)
Verification of 8,000 hours of work experience
work categories (300 percent rule applies), AND
completion of a board-approved 32-hour training
program (may be taken after application is approved).
(1) Two years of experience, consisting of at least 4,000
hours, in repair and maintenance of electrical
problems in manufactured structures while employed
by a manufactured structures manufacturer.
manufactured structures
Repair or maintain electrical wiring and
Two years of employment as a limited-maintenance
(LMM)
equipment in manufactured structures.
manufactured-structures trainee working with a
OAR 918-282-0250
licensee or for an employer of a licensee.
(3) A combination of (1) and (2) above equaling two
years of experience.
Page 4
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