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 
APPLICATION for ELECTRICAL PERMIT 
Parcel Identification Number (PIN)_________________________________________________________ 
Owner of the building: ___________________________________________________________________   
Owner’s phone number: ________________________ Owner’s email: _____________________________ 
Owner’s mailing address: _________________________________________________________________ 
       Class of Work: New ☐ Alteration ☐ Addition ☐ Repair ☐ Zone: _________________ 
Location of Work 
Use of Building 
Plot No. 
Estate 
Quarter 
☐ Private or Rental Dwelling ☐ Store/Warehouse
House No. 
Street 
☐Restaurant ☐ Bar ☐ Office ☐Other
   (If Applicable) 
       General statement of the proposed work: __________________________________________________________________ 
_________________________________________________________________________________________________________ 
_____________________________________________________________________________________________________________________ 
Service Entrance:   ☐  Existing     ☐   Proposed
Estimated Current 
Voltage ☐ 110 ☐ 220 ☐ 440 
Type of Structure 
Conductor Size 
☐Underground ☐ Overhead
☐Concrete Block
☐Single Phase ☐ Three Phase
Number of Meters 
☐Mass Masonry
Height of Weatherhead 
Number of Dwellings 
☐Frame
No. of Distribution Panels 
Size of Ground 
List below circuits to be installed: 
Circuit No. 
Voltage 
Wire Type and Size 
No. of Outlets 
Other Loads 
(Please attach additional sheet(s) if extra space is needed). 
Total estimated cost of proposed work $ 
Has work started? 
The electrician who will do this work:  
License No.: 
Signature of Electrician:  
Date Signed: 
Mailing address of Electrician:  
 Phone No.:  
Note: Permit will be issued in the licensed electrician’s name, who is authorized to do the work on behalf of the owner. 
      Seal and Signature of USVI Licensed Electrician