Kenmore, NY · Erie County
Homeowner's Waiver – Electric & Plumbing
This insurance waiver is for homeowners applying for plumbing or electrical permits for one- to four-family residences in Kenmore.
What this form is
Homeowners use this waiver when applying for plumbing or electrical permits for a one-, two-, three-, or four-family residence and certifying they do not need to show workers’ compensation or disability insurance coverage. It asks the homeowner to select the reason for the waiver, provide the property address and telephone number, and print and sign their name. The form also describes coverage requirements if paid work reaches 40 hours or more per week.
Who needs it
A homeowner applying for a plumbing or electrical permit for a one- to four-family residence who certifies an insurance-waiver reason needs this form.
How to submit it
Provide the waiver with the permit application to the Building Department at 2919 Delaware Avenue, Kenmore, NY 14217.
About notarization
This document is signed without a notary; it contains a penalty-of-perjury certification, and the homeowner signs it, with no notarized attachment mentioned.
How to submit this form
- 1
Download The Waiver
Download the Homeowner's Waiver – Electric & Plumbing PDF.
- 2
Complete The Waiver
Select the applicable reason, enter the residence address and telephone number, and print the homeowner's name.
- 3
Sign The Waiver
The homeowner signs the penalty-of-perjury certification.
- 4
Submit With The Permit Application
Provide the waiver with the permit application to the Building Department at 2919 Delaware Avenue, Kenmore, NY 14217.
Frequently asked questions
- What is the Homeowner's Waiver for?
- It lets a homeowner applying for an electric or plumbing permit certify why they are not required to show workers’ compensation or disability insurance coverage for the residence.
- Who can use this waiver?
- The form is for the owner of a one-, two-, three-, or four-family residence listed on the permit being applied for.
- Do I need a notary for the Homeowner's Waiver?
- No. The document has no notary block. It includes a penalty-of-perjury certification that the homeowner signs; it mentions no notarized attachment.
- How do I submit the Homeowner's Waiver?
- Provide it with the permit application to the Building Department at 2919 Delaware Avenue, Kenmore, NY 14217.
Need something notarized?
This Homeowner's Waiver – Electric & Plumbing doesn’t need a notary — but if you have another Kenmore form that does, a commissioned online notary can help.