Kenmore, NY · Erie County
Homeowner’s Waiver – Building
This waiver lets a homeowner of a one- to four-family residence certify why workers’ compensation or disability insurance proof is not required for a building permit.
What this form is
Homeowners applying for a building permit for a one-, two-, three-, or four-family residence can use this waiver to certify why they are not required to provide proof of workers’ compensation or disability insurance coverage. It asks the owner to select the applicable work or insurance circumstances and provide the property address, telephone number, printed name, and signature. The certification is made under penalty of perjury.
Who needs it
A homeowner applying for a building permit for a one- to four-family residence who meets one of the waiver’s stated conditions may submit this form.
How to submit it
Submit the waiver with the building permit application to the Building Department at 2919 Delaware Avenue, Kenmore, NY 14217.
About notarization
This waiver is signed without a notary; it includes a certification under penalty of perjury, but no notarized attachment or related step is stated.
How to submit this form
- 1
Download The Waiver
Download the Homeowner’s Waiver – Building PDF.
- 2
Complete The Form
Select the applicable condition, enter the address and telephone number, print the homeowner’s name, and sign.
- 3
Attach It To The Permit Application
The waiver refers to the building permit application and, for one condition, a homeowners insurance policy covering the property.
- 4
Submit To The Building Department
Submit the waiver with the building permit application to 2919 Delaware Avenue, Kenmore, NY 14217.
Frequently asked questions
- Do I need a notary for the Homeowner’s Waiver?
- No. The waiver has a homeowner signature field and a certification under penalty of perjury, but it does not require notarization or identify a notarized attachment.
- Who can use this building waiver?
- The form is for the owner of a one-, two-, three-, or four-family residence listed on the building permit they are applying for, if one of the stated conditions applies.
- What information does the waiver request?
- It asks the homeowner to select the applicable work or insurance condition and provide the property address, telephone number, printed name, and signature.
- How do I submit the waiver?
- Submit it with the building permit application to the Building Department at 2919 Delaware Avenue, Kenmore, NY 14217.
Need something notarized?
This Homeowner’s Waiver – Building doesn’t need a notary — but if you have another Kenmore form that does, a commissioned online notary can help.