GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS 
DEPARTMENT OF PLANNING AND NATURAL RESOURCES 
DIVISION OF PERMITS 
STX DISTRICT TEL: (340) 773-1082 STT/STJ DISTRICT TEL: (340) 774-3320 
 
FINAL ELECTRICAL INSPECTION REQUEST 
 
 
(Please Print Clearly) 
 
LEGAL INFORMATION 
 
DATE:  
 
NAME OF OWNER:  
  
CONTACT NUMBER: ______________________________________________________________________________ 
LOCATION OF BUILDING:  
 
USE OF BUILDING: ☐ RESIDENTIAL ☐ COMMERCIAL ☐ INDUSTRIAL ☐ OTHER 
NUMBER OF APARTMENTS:  
 
NAME OF CONTRACTOR:  
 
NAME OF ELECTRICIAN:  
 
V.I. LICENSE NO.:  
ELECTRICAL PERMIT NO.:  
 
DATE ISSUED:  
 
GENERAL DESCRIPTION 
TYPE OF FLOOR:  
WALLS:  
 
ROOF:  
 
ESTIMATED CURRENT:  
 
AMPS VOLTAGE:  
 
SERVICE ENTRANCE 
SIZE:  
TYPE:  
  ☐ SINGLE-PHASE  ☐THREE-PHASE NO. 
OF DISTRIBUTION PANELS:  
NO. OF METERS:  
 CIRCUIT DISTRIBUTION 
NO. OF 120v CIRCUITS:  
NO. OF 240v CIRCUITS:  
 
NO. OF 208v CIRCUITS:  
TOTAL NO. OF CIRCUITS:  
 
 
FINAL ELECTRICAL INSPECTION 
PAGE 2 OF 2 
 
 
CERTIFICATION OF SUPERVISION 
 
UPON APPLICATION FOR A CERTIFICATE OF USE AND/OR OCCUPANCY. 
 
TO: 
 The Commissioner of Planning & Natural Resources 
(through the Division of Permits) 
 
FROM: 
Certifying Electrical Supervisor of construction mentioned below SUBJECT: 
 
CERTIFICATION OF SUPERVISION AND TRADE WORKMANSHIP 
 
 
LEGAL DESCRIPTION 
 
NAME OF OWNER: 
 
 
LOCATION OF BUILDING: 
 
 
ELECTRICAL PERMIT NUMBER: 
 
 DATE ISSUED:  
 
 
 
I hereby certify that the above-mentioned project has been built under my supervision and that in its construction all 
the provisions of the V.I. Building Code and all other applicable laws are complied with. Also, the work done complies 
with the work proposed on the Electrical Permit as per V.I. Code, Title 29 Chapter 5, §294 © and §298 (b), the latest 
edition of the National Electrical Code, and all applicable codes. 
 
 
NAME OF CERTIFYING SUPERVISOR:  
 
(Electrician, Electrical Contractor, Master Electrician) 
(Print) 
 
SIGNATURE:  
DATE:  
 
Certifying Supervisor 
 
 
 
PLEASE SIGN AND SEAL THIS CERTIFICATION FORM: 
 
Seal and Signature of USVI Licensed Electrician 
 
 
 
 
SIGN