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 
(Please Print Clearly) 
Parcel Identification Number (PIN) ___________________________________________________ 
    Class of Work 
Owner of building: ________________________________________________________________ 
☐New ☐ Alteration
Owner mailing address: ____________________________________________________________  
☐Addition  ☐ Repair
 Zone: _____________ 
     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. 
DEPARTMENTAL USE ONLY 
☐Information requested. Remarks: _____________________________________________________________
E.C.: _____________________________
☐Permit approved ☐ Permit disapproved
 __________________________ 
Inspector 
  ________________________________
 Commissioner or Designee DPNR  
   _______________________________ 
 Permit No. 
 _______________________________ 
Seal and Signature of USVI Licensed Electrician  
 Fee 
Location of Work