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 PLUMBING INSPECTION REQUEST 
 
(Please Print Clearly) 
REQUESTED BY:   
 
 
DATE: 
 PHONE NO.:  
 
OWNER: 
____________________________________________ 
LOCATION OF WORK:  
 
 
BUILDING PERMIT NO.:  
 PLUMBING PERMIT NO.: ____________________ 
CONTRACTOR: 
PLUMBER: 
  
 
GENERAL DESCRIPTION: 
NO. OF W.R.  
 
NO. OF L.R.  
 
NO. OF TUB:  
 
NO. OF SHOWER:  
 
NO. OF SINKS:  
 
OTHER:  
  
 
SIZE OF DRAIN:  
 
SIZE OF DRAIN:  
 
SIZE OF DRAIN:  
 
SIZE OF DRAIN:  
 
SIZE OF DRAIN:  
 
SIZE OF DRAIN:  
 
 
VENT: 
CO. 
 
VENT: 
CO. 
 
VENT: 
CO. 
 
VENT: 
CO. 
 
VENT: 
CO. 
 
VENT: 
CO. 
 
WATER SUPPLY: 
☐ CISTERN CAP ☐ GALS. ☐ PORTABLE WATER ☐ WELL ☐ OTHER 
SEWAGE DISPOSAL: SEWER CONNECTION (SIZE) 
IN. OR SEPTIC TANK & CESSPOOL 
AND/OR DRAIN FIELD   
 
 
 
 
FINAL PLUMBING 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 Plumbing Supervisor of construction mentioned below 
SUBJECT: 
CERTIFICATION OF SUPERVISION AND TRADE WORKMANSHIP 
 
 
LEGAL DESCRIPTION 
 
NAME OF OWNER:  
 
 
LOCATION OF BUILDING:  
 
 
PLUMBING PERMIT NUMBER: 
DATE ISSUED:  
 
 
I hereby certify that the plumbing work done complies with the work proposed on the Plumbing Permit, as per the latest 
edition of the Uniform Plumbing Code and V.I. Code Title 29. 
 
 
NAME OF CERTIFYING SUPERVISOR:  
 
(Plumber, Master Plumber, Plumbing Contractor) 
 
 
Signature: 
 
Date: 
 
Certifying Supervisor 
 
 
PLEASE SIGN AND SEAL THIS CERTIFICATION FORM: 
 
Seal and Signature of USVI Licensed Plumber 
SIGN