Torrington, CT · Litchfield County
Proof of Workers’ Compensation Coverage
This three-part form documents workers’ compensation coverage or an applicable exemption for property owners, sole proprietors, general contractors, and principal employers applying for a building permit.
- licensed online notary
- ~15 min average
- Notarized PDF emailed
What you’ll need
- Government-issued photo ID
- Webcam-enabled device (laptop or phone)
- This form, ready to upload as a PDF
What this form is
The form offers three options based on the applicant’s role and workers’ compensation status: an owner or sole proprietor who will not act as general contractor, one who will act in that role, or a general contractor or principal employer excluded from coverage. Applicants use the applicable section when applying for a building permit and provide the requested information. Sections 7B and 7C include an affidavit for certain applicants to swear to before a notary public or Commissioner of the Superior Court.
Who needs it
Property owners, sole proprietors, general contractors, or principal employers applying for a building permit should complete the section matching their role and coverage status.
Why it needs a notary
Sections 7B and 7C carry a subscribed-and-sworn affidavit block; the applicable owner, sole proprietor, general contractor, or principal employer signs before the notary.
How to get this notarized
- 1
Download the Form
Get the workers’ compensation proof form used with a building permit application.
- 2
Choose and Complete a Section
Select the section matching your role and coverage status, then fill in the applicable information.
- 3
Book an Online Notary
If your section includes an affidavit, arrange a session with a commissioned online notary.
- 4
Sign on Video
Sign the applicable affidavit during the online notary session.
- 5
Submit to the City
Include the completed form with your building permit application as directed by Torrington.
Preview the form
The blank PDF straight from Torrington. Look it over, then upload your filled copy to start the notary session.
You’ll need ID and a webcam.
A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.
Frequently asked questions
- How do I complete the workers’ compensation proof form?
- Choose the section matching your role and coverage status, fill in the requested details, and complete the affidavit if it applies. Sign that affidavit before a notary or Commissioner of the Superior Court.
- Do I need to notarize this form?
- Not every section requires an affidavit. Sections 7B and 7C say to sign the applicable affidavit before a notary public or Commissioner of the Superior Court.
- Can I sign the affidavit with an online notary?
- Connecticut authorizes remote online notarization by its own notaries under Public Act 23-28, codified at Conn. Gen. Stat. §3-95b, effective October 1, 2023. A commissioned online notary can notarize eligible documents; confirm with the town clerk if unsure.
- Where do I submit the completed form?
- The form is for a building permit application and identifies the property location and permit applicant. Submit it with your application as directed by Torrington; confirm any filing instructions with the town clerk if needed.