What is the Workers’ Compensation Insurance Exemption Form?

It is a BP-1 affidavit for an eligible homeowner to state why specific proof of workers’ compensation coverage is not required for a building permit.

Who can use this exemption form?

The form is for an owner of a one-, two-, three-, or four-family owner-occupied residence who is listed as general contractor and meets a stated exemption condition.

Do I need a notary for the Workers’ Compensation Insurance Exemption Form?

No. This document is signed and dated without a notary; the homeowner completes the signature and date fields.

How do I submit the exemption form?

Provide it to the government entity issuing the building permit. The document does not give a specific department, address, email, or online submission method.

Nunda, NY · Livingston County

No notary required

Workers’ Compensation Insurance Exemption Form

Homeowners of qualifying owner-occupied residences use this BP-1 affidavit when applying for a building permit and claiming an exemption from workers’ compensation coverage.

What this form is

This BP-1 affidavit lets the owner of a one-, two-, three-, or four-family owner-occupied residence explain why specific proof of workers’ compensation coverage is not required for a building permit. The homeowner checks the applicable exemption reason and provides a signature, date, property address, and printed name. The document describes conditions involving who performs the work, whether workers are paid, and weekly work hours.

Who needs it

A homeowner listed as general contractor on a building permit may use this affidavit if the owner-occupied residence and work situation meet the stated exemption conditions.

How to submit it

Provide the form to the government entity issuing the building permit, as directed in the document. It does not list a specific department, address, email, portal, or fee.

About notarization

This document is signed and dated without a notary; the signer completes the homeowner signature and date fields on the affidavit.

How to submit this form

1
Download The Form
Download the BP-1 affidavit PDF.
2
Complete The Affidavit
Check the applicable exemption reason and fill in the requested homeowner and property information.
3
Gather Permit Information
Have the building permit information available; the document refers to the attached building permit.
4
Submit To The Issuing Entity
Provide the completed form to the government entity issuing the building permit.

Frequently asked questions

What is the Workers’ Compensation Insurance Exemption Form?: It is a BP-1 affidavit for an eligible homeowner to state why specific proof of workers’ compensation coverage is not required for a building permit.
Who can use this exemption form?: The form is for an owner of a one-, two-, three-, or four-family owner-occupied residence who is listed as general contractor and meets a stated exemption condition.
Do I need a notary for the Workers’ Compensation Insurance Exemption Form?: No. This document is signed and dated without a notary; the homeowner completes the signature and date fields.
How do I submit the exemption form?: Provide it to the government entity issuing the building permit. The document does not give a specific department, address, email, or online submission method.

Need something notarized?

This Workers’ Compensation Insurance Exemption Form doesn’t need a notary — but if you have another Nunda form that does, a commissioned online notary can help.