Jay, NY · Essex County
Workers' Compensation Exemption Affidavit
This affidavit lets an owner of a one- to four-family, owner-occupied residence explain why workers’ compensation proof is not required for work covered by 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 homeowner identifies the permitted property and selects the reason they are claiming an exemption, such as doing all the work or not paying anyone to perform it. The form also describes conditions that apply when the owner hires or pays workers. Submit the notarized BP-1 with a building permit application when claiming an exemption; the form states it serves as an exemption for workers’ compensation and disability benefits insurance coverage.
Who needs it
A homeowner applying for a building permit for an owner-occupied residence of one to four families may use this form to claim an exemption from specific coverage proof.
Why it needs a notary
The homeowner signs before a County Clerk or notary public, who completes the form’s “Sworn to before me” jurat block.
How to get this notarized
- 1
Download The Affidavit
Get the BP-1 Workers' Compensation Exemption Affidavit for your building permit application.
- 2
Fill In The Form
Enter the property and homeowner details, then check the reason that applies to your situation.
- 3
Book An Online Notary
Schedule a video appointment with a commissioned online notary.
- 4
- 5
Submit To The City
Submit the notarized form with your building permit application as directed by the permit office.
Preview the form
The blank PDF straight from Jay. 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 get the workers’ compensation exemption affidavit notarized?
- Complete the form, then sign it during a video appointment with a commissioned online notary. The notary completes the “Sworn to before me” block. Check with the permit office about its submission requirements.
- Do I need to notarize this form before submitting it with my permit application?
- The form includes a “Sworn to before me” block for a County Clerk or notary public. Contact the permit office to confirm when and how to submit the notarized form.
- Can I use an online notary for this affidavit?
- New York authorizes remote online notarization by a commissioned online notary under Executive Law §135-c, in effect since 2023. If notarization occurs outside New York, Real Property Law §299 recognizes acts by an officer authorized where the act is performed. Ask the permit office about its acceptance requirements.
- What if I’m unsure whether this exemption applies to my project?
- The form lists specific reasons for claiming an exemption and conditions related to hiring or paying workers. Confirm with the city, town or village if unsure.
Workers' Compensation Exemption Affidavit in other New York cities
Each city publishes its own version of this form. Pick the city where you’re filing.