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Electrical License Application Mail application with ...

Page 1 440-2570 (1/08/COM) Electrical License Application Department of Consumer & Business Services Building Codes Division 1535 Edgewater St. NW, Salem, oregon Phone: (503) 373-1268 Fax: (503) 378-2322 Web: Mail Application with payment to: DCBS Fiscal Services Box 14610 Salem, OR 97309-0445 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 Box): City: State: ZIP: Phone: ( ) Fax: ( ) E-mail: Social Security number (Required, ORS ): Your Social Security numb

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 oregon.gov/bcd, “Statutes and Rules,” “Oregon Administrative Rules,” click on …

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