Lynbrook, NY · Nassau County
Workers’ Compensation Exemption Affidavit
This BP-1 affidavit lets qualifying owners of one- to four-family, owner-occupied residences state why they are exempt from showing workers’ compensation coverage when 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 BP-1 is for an owner listed as the general contractor on a building permit for a one- to four-family, owner-occupied residence, including a condominium. The homeowner checks the applicable exemption condition, signs under penalty of perjury, and has the form notarized; the form says it then serves as an exemption for workers’ compensation and disability benefits coverage. Owners paying workers 40 or more aggregate hours per week cannot use this affidavit and must provide the coverage proof described on the form.
Who needs it
A homeowner listed as general contractor on a building permit for a qualifying owner-occupied residence may need this affidavit if one of its stated exemption conditions applies.
Why it needs a notary
The form says it must be notarized but the supplied text does not identify a jurat or acknowledgment block; the homeowner signs the affidavit before the notary.
How to get this notarized
- 1
Download The BP-1 Form
Get the Workers’ Compensation Exemption Affidavit for your building permit application.
- 2
Fill In The Affidavit
Choose the exemption condition that applies and complete the homeowner, date, and property information.
- 3
Book An Online Notary
Schedule a session with a commissioned online notary before signing.
- 4
Sign On Video
Sign the affidavit during the online notarization session and complete the notary’s instructions.
- 5
Submit To The Permit Office
Send the notarized BP-1 to the government entity issuing your building permit.
Preview the form
The blank PDF straight from Lynbrook. 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
- Who can use the BP-1 affidavit?
- The form is for an owner of a one- to four-family, owner-occupied residence, including a condominium, who is listed as general contractor on the building permit and meets a stated exemption condition.
- Do I need to notarize this form?
- Yes. The form states that once notarized, the BP-1 serves as an exemption for workers’ compensation and disability benefits insurance coverage.
- How do I complete and submit the BP-1?
- Select the exemption condition that applies, complete the homeowner and property details, sign before a commissioned online notary, then submit the notarized form to the government entity issuing your building permit.
- Can I use this affidavit if I pay workers 40 or more hours per week?
- No. The form says homeowners hiring or paying individuals for 40 or more aggregate hours per week must provide appropriate workers’ compensation coverage proof or have the general contractor provide coverage or exemption proof.
- Does New York allow online notarization?
- New York authorizes remote online notarization by a commissioned online notary under Executive Law §135-c, in effect since 2023. Confirm with the city, town or village if unsure whether it accepts this notarized form.
Other forms in Lynbrook
Workers’ Compensation Exemption Affidavit in other Nassau County cities
Each city publishes its own version of this form. Pick the city where you’re filing.