Blank Oregon 440 2570 Form Open Editor Now

Blank Oregon 440 2570 Form

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.

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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.

Form Example

440-2570I (8/25/COM) Page 1 Electrical License Application – Information
Electrical License Application Instructions
Department of Consumer and Business Services
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
Web: oregon.gov/bcd
Mail application, required
documents, your photo,
and payment to:
DCBS Fiscal Services
P.O. Box 14610
Salem, OR 97309-0445
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.
The 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, the Building Codes Division will send a denial letter explaining your rights to a
hearing.
5.
Allow two weeks for the Building Codes Division to grade your exam. If you pass the examination, the 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
oregon.gov/bcd for 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-inch by 2-inch) with applicant’s name on the back.
7.
Payment of fee.
440-2570I (8/25/COM) Page 2 Electrical License Application – Information
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
rule reference
What this license
authorizes you to do
The requirements
for this license
General supervising
electrician
(S)
OAR 918-282-0140
Design, plan, and lay out work; sign all
permits; licensee is the only individual
authorized to direct, supervise, or control
the installation or alteration of an
electrical service.
(1) Be currently licensed as an Oregon journeyman
electrician and provide verification of an additional
8,000 hours of on-the-job journeyman experience.
OR
(2) Meet the qualifications to be licensed as an Oregon
journeyman electrician and provide verification of an
additional 8,000 hours of on-the-job journeyman
experience. (300 percent rule applies.)
Limited supervising
electrician
(PS)
OAR 918-282-0160
Design, plan, and lay out work; sign all
permits; licensee is the only individual
authorized to direct, supervise, or control
the installation, maintenance,
replacement, and repair of electrical
wiring and electrical products on or in an
existing operable plant, hospital,
commercial building, or institution.
(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
journeyman experience.
OR
(2) Meet the qualifications to be licensed as a limited
journeyman manufacturing plant electrician and provide
verification of an additional 8,000 hours of on-the-job
plant journeyman experience obtained outside of
Oregon. (300 percent rule applies.)
General journeyman
electrician
(J)
OAR 918-282-0170
Make any electrical installation under
the supervision, direction, and control of
a general supervising electrician, unless
doing work that requires the direction of
a limited supervising electrician or doing
work requiring no supervision.
(1) Completion of an approved apprenticeship in Oregon.
OR
(2) Official
transcripts verifying 576 hours of classroom
training and verification of 8,000 hours of on-the-job
experience obtained outside of Oregon. Experience must
include a breakdown of hours, showing a minimum of
1,000 hours in each category: residential, commercial,
and industrial. (300 percent rule applies.)
OR
(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,
and industrial. (300 percent rule applies.)
Reciprocal general
supervising electrician
(S)
OAR 918-030-0045
Design, plan, and lay out work; sign all
permits; licensee is the only individual
authorized to direct, supervise, or control
the installation or alteration of an
electrical service.
(1) Possess an active supervisor/master license in a state
that has a reciprocal licensing agreement with Oregon.
Please refer to our website, oregon.gov/bcd/licensing, for
reciprocal agreements and the application form, Reciprocal
Electrical and Plumbing License Application.
Reciprocal journeyman
electrician
(S)
OAR 918-030-0045
Make any electrical installation under
the supervision, direction, and control of
a general supervising electrician, unless
doing work that requires the direction of
a limited supervising electrician or doing
work requiring no supervision.
(1) Possess an active general journeyman license in a state
that has a reciprocal licensing agreement with Oregon.
Please refer to our website, oregon.gov/bcd/licensing, for
reciprocal agreements and the application form, Reciprocal
Electrical and Plumbing License Application.
440-2570I (8/25/COM) Page 3 Electrical License Application – Information
License type and rule
reference
What this license
authorizes you to do
The requirements
for this license
Limited residential
electrician
(LR)
OAR 918-282-0180
Make electrical installations on one- and
two-family or multifamily dwelling
units, not exceeding three floors above
grade. (Must work under the
supervision, direction, and control of a
general supervising electrician.)
(1) Completion of an approved apprenticeship in Oregon.
OR
(2) Official transcripts verifying 288 hours of classroom
training and verification of 4,000 hours of on-the-job
residential experience obtained outside of Oregon.
(300 percent rule applies.)
OR
(3) Verification of 8,000 hours of on-the-job residential
experience obtained outside of Oregon. (300 percent
rule applies.)
Limited journeyman
manufacturing plant
electrician
(PJ)
OAR 918-282-0190
Install, maintain, replace, and repair
electrical wiring and electrical products
on or in an existing operable
manufacturing plant or industrial plant
owned or used by employer. (Must work
under the supervision, direction, and
control of a limited supervising
electrician. If there is no supervising
electrician, licensee is limited to repair
and maintenance work.)
(1) Completion of an approved apprenticeship in Oregon.
OR
(2) Official transcripts verifying 576 hours of classroom
training and verification of 8,000 hours of on-the-job
commercial and industrial experience obtained outside
of Oregon. (300 percent rule applies.)
OR
(3) Verification of 16,000 hours of on-the-job commercial
and industrial experience obtained outside of Oregon.
(300 percent rule applies.)
Limited renewable
energy technician
(LRT)
OAR 918-282-0205
Make renewable energy system
installations. (Must be employed by a
limited renewable energy contractor or
electrical contractor.)
(1) Completion of an approved apprenticeship in Oregon.
Limited journeyman sign
electrician
(SIG)
OAR 918-282-0220
Install and service electrical signs and
outline lighting. (Must be employed by a
limited sign contractor.)
(1) Completion of an approved apprenticeship in Oregon.
OR
(2) Official transcripts of required classroom training and
verification of 4,000 hours of on-the-job sign
electrical experience obtained outside of Oregon.
OR
(3) Verification of 8,000 hours of on-the-job sign
experience obtained outside of Oregon, broken down
into specific work categories.
Limited journeyman
stage electrician
(ST)
OAR 918-282-0230
Install temporary feeders, branch circuits,
and equipment used for the production of
shows, exhibits, displays, festivals,
conventions, stage, theater, film, or video
productions; perform maintenance on
temporary equipment. (Must be employed
by an electrical contractor.)
(1) Completion of an approved apprenticeship in Oregon.
OR
(2) Official tran
scripts verifying 150 hours of required
classroom training and verification of 4,000 hours of
on-the-job experience obtained outside of Oregon.
OR
(3) Verification of
8,000 hours of on-the-job stage
experience obtained outside of Oregon, broken down
into specific work categories.
Limited maintenance
electrician
(LME)
OAR 918-282-0240
Repair and maintain existing electrical
installations on or in an existing
operable plant, commercial building, or
institution. (An LME is not authorized to
make new electrical installations or to
perform work on services.)
(1) Completion of an
approved apprenticeship in Oregon.
OR
(2) Official
transcripts verifying 288 hours of required
classroom training and verification of 4,000 hours of
on-the-job training or experience obtained outside of
Oregon. (300 percent rule applies.)
OR
(3) Verification of 8,000 hours of on-the-job experience
obtained outside of Oregon, broken down into specific
work categories. (300 percent rule applies.)
440-2570I (8/25/COM) Page 4 Electrical License Application – Information
License type and rule
reference
What this license
authorizes you to do
The requirements
for this license
Limited building
maintenance electrician
(BME)
OAR 918-282-0260
Maintain, repair, and replace electrical
appliances, light switches and fixtures,
fans, receptacles, and fluorescent
ballasts on the premises of commercial
office buildings, buildings occupied by
the state or a local government entity,
and facilities designated by the Electrical
and Elevator Board in electrical systems
not exceeding 300 volts to ground.
(1) Completion of an approved one-year training program
in Oregon.
OR
(2) Verification of 2,000 hours of on-the-job training or
experience in maintenance, repair, and replacement of
electrical appliances, light switches, light fixtures,
fans, receptacles, and fluorescent ballasts. (300
percent rule applies.)
Limited energy
technician,
Class A
(LEA)
OAR 918-282-0345
OAR 918-282-0355
Install, alter, and repair all limited
energy systems. (An LEA must be
licensed as an electrical contractor or
must work for an electrical contractor,
limited energy contractor, or for one
employer in an industrial plant.)
(1) Completion of an approved apprenticeship in Oregon.
OR
(2) Official transcripts verifying 432 hours of required
classroom training, and verification of 6,000 hours of
on-the-job training broken down into specific work
categories. (300 percent rule applies.)
OR
(3) Verification of 12,000 hours of work experience
obtained outside of Oregon, broken down into specific
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
percent rule applies.)
Limited energy
technician,
Class B
(LEB)
OAR 918-282-0360
OAR 918-282-0365
Perform limited energy electrical
activity that does not include protective
signaling. (An LEB must be licensed as
an electrical contractor, or must work for
an electrical contractor, limited energy
contractor, or for one employer in an
industrial plant.)
(1) Completion of an approved apprenticeship in Oregon.
OR
(2) Provide verification of 4,000 hours of work
experience equivalent to a board-approved
apprenticeship program broken down into specific
work categories. (300 percent rule applies.) Refer to
OAR 918.282.0365 for a detailed list of minimum
hour requirements.
AND
Completion of a board approved 32-hour training
program (may be taken after application is approved).
OR
(3) Verification of 8,000 hours of lawfully obtained work
experience broken down into specific categories. (300
percent rule applies.) Refer to OAR 918-282-0365 for
a detailed list of minimum hour requirements.
440-2570 (8/25/COM) Page 5 Electrical License Application
Electrical License Application
Department of Consumer and Business Services
Building Codes Division
1535 Edgewater St. NW, Salem, Oregon
Mailing address: P.O. Box 14470, Salem, OR 97309-0404
503-373-1268 • TTY: 503-373-1358 • www.oregon.gov/bcd
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)
Name:
(Last, First, Middle Initial)
Address (street or P.O. Box):
City:
State:
ZIP:
Phone:
Fax:
Email:
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 licenses:
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
Limited maintenance electrician (LME) $100.00
General journeyman (J) $100.00
Limited residential electrician (LR) $100.00
Limited supervising electrician (PS) $100.00
Limited journeyman sign electrician (SIG) $50.00
Limited journeyman manufacturing plant (PJ) $100.00
Limited journeyman stage electrician (ST) $50.00
Limited energy technician Class A (LEA) $50.00
Limited building maintenance electrician (BME) $50.00
Limited energy technician Class B (LEB) $50.00
Limited renewable energy technician (LRT) $50.00
STEP 4 TEST LOCATION
Select a test location from the list below. All applicants must test. More details can be found at
www.oregon.gov/bcd/licensing/Pages/exam.aspx.
Bend
Eugene
Hermiston
Klamath Falls
Ontario
Pendleton
Portland
Roseburg
Salem
White City
Make check or money order payable to the
Department of Consumer and Business Services. If
paying by credit card, the applicant must sign the credit
card information box. Do not send cash.
Secure fax for
credit card payments:
503-947-2333
Fee varies based on license type.
Visa MasterCard Discover
Phone:
DCBS Fiscal use only: 12104/0600
$
Cardholder signature
Amount
Name of cardholder as shown on credit card
/
Credit card number
Expiration date
440-2570 (8/25/COM) Page 6 Electrical License Application
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:
Employer’s name: Period of employment:
Address: From: To:
Hours worked per week:
Phone: Position/title:
Supervisor’s name:
Describe work performed:
Employer’s name: Period of employment:
Address: From: To:
Hours worked per week:
Phone: Position/title:
Supervisor’s name:
Describe work performed:
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 (09/24/COM) Page 7 Electrical License Application
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. Self-verification of hours is not an acceptable means of verification.
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-inch by 2-inch 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.
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.
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
5.
Proof of a high school diploma, GED, or equivalent. A college degree will substitute.
6.
Passport-style photo (2-inch by 2-inch) with applicant’s name on the back.
7.
Payment of fee.
DEPARTMENT USE ONLY
Approved
Signature:
Date:
Denied
Signature:
Date:
Comments:
Apprentice applicants must provide proof of completion of a recognized apprenticeship program.
Applicant name:
440-2570A (8/25/COM) Page 8 Electrical License Application - Verification
Electrical Experience Verification
Department of Consumer and Business Services
Building Codes Division
• 1535 Edgewater St. NW, Salem, Oregon
Phone: 503-373-1268 • Fax: 503-378-2322 • TTY: 503-373-1358
Web: oregon.gov/bcd
Inst
ructions: 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.
STEP 1 APPLICANT INFORMATION (please print)
Name
(applicant)
:
Address:
City:
State: ZIP:
Phone:
Fax: Email:
STEP 2 PERIOD OF EMPLOYMENT
Employer’s name: Period of employment:
Address:
From:
To:
Hours worked per week:
Phone:
Applicant’s position/title:
STEP 3 VERIFIER INFORMATION
Applicants submitting verification of equivalent training and experience under OAR 918-030-0030(1)(c) must provide
verification from the following people:
• A current or previous employer actively involved with the applicant’s work;
• The person 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.
SELF-VERIFICATION OF HOURS WILL NOT BE ACCEPTED
Name of verifier:
Address: Phone:
City:
State: ZIP:
License numbers:
Verifier’s employment relationship to applicant:
440-2570A (8/25/COM) Page 9 Electrical License Application - Verification
Applicant (print name):
STEP 4 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.” (Refer to 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 918-030-0030(4).
4. Enter your specific work duty experience under “Description of duties.” If you need more information, refer to
oregon.gov/bcd, “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
STEP 5 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:
Date:
SELF-VERIFICATION OF HOURS WILL NOT BE ACCEPTED
440-2570A (8/25/COM) Page 10 Electrical License Application - Verification
ELECTRICAL WORK EXPERIENCE CATEGORIES
General journeyman (J)
Limited energy, Class A (LEA)
General supervisor (S)
Limited energy, Class B (LEB)
Limited residential (LR)
•
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)
•
Stockroom, materials handling
•
Residential wiring
•
Commercial installations
•
HVAC
•
Industrial installations
•
Medical
•
Troubleshooting and maintenance
•
Boiler controls
•
Finishing and fixture hanging
•
Intercom, paging, sound, CCTV
•
Signal and control systems
•
Clock systems
•
Remodeling
•
Data telecommunications
•
Underground construction
•
Instrumentation
•
Security
Limited supervisor (PS)
•
Stockroom, materials handling, shop and service
Limited plant journeyman (PJ)
•
Limited energy wiring: installations, wire pulling,
splices, conduit, flex, tray and duct, control panels
and controls, wiring devices, removal and finish work
Limited maintenance electrician (LME)
•
Electrical circuits
•
Motors and generators
•
Troubleshooting and maintenance
•
Controls, manual and automatic
•
Outdoor installations, overhead and underground
•
Troubleshooting
•
Occupation or trade-specific training related to license
•
In-place motor cleaning
•
Lighting
Limited building maintenance (BME)
•
Electrical drawings
•
Electrical appliances
•
Light switches
Limited journeyman sign (SIG)
•
Light fixtures
•
Stockroom, materials handling
•
Fans
•
Pattern and blueprints
•
Receptacles
•
Layout design
•
Fluorescent ballasts
•
Assembly of display
•
Display painting and component parts
Limited renewable energy technician (LRT)
•
Display installation, service, and maintenance
Ava
ilable only by completing an Oregon
apprenticeship
•
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
To see a detailed list of minimum hourly requirements for each category, go to our website, oregon.gov/bcd, “Statutes
and Rules,” “Oregon Administrative Rules,” click on 918-282, then scroll down to the desired license type.

Document Characteristics

Fact Name Details
Purpose The Oregon 440-2570 form is used for applying for an electrical license in Oregon.
Governing Laws This form is governed by Oregon Revised Statutes (ORS) 25.785, ORS 305.385, and ORS 455.125.
Application Process Applicants must complete all steps, including submitting a photograph and verification of work experience.
Fees Fees vary by license type, with amounts ranging from $50 to $100, and are nonrefundable.
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