Stony Point, NY · Rockland County
Workers’ Compensation Insurance Exemption Affidavit
This affidavit lets qualifying owners of one- to four-family owner-occupied residences claim an exemption from workers’ compensation and disability benefits 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
Stony Point uses Form BP-1 when a qualifying homeowner is listed as the general contractor on a building permit and meets one of the form’s conditions, such as doing all the work or paying workers for fewer than 40 total hours per week. The affidavit explains when the homeowner may claim an exemption and when coverage or other proof is required instead. Once notarized, the form serves as an exemption for workers’ compensation and disability benefits coverage.
Who needs it
A homeowner applying for a building permit for an owner-occupied one- to four-family residence may need this form if listed as the general contractor and eligible for the stated exemption.
Why it needs a notary
The form contains an affidavit declaration under penalty of perjury; the homeowner signs it before a commissioned online notary for notarization.
How to get this notarized
- 1
Download The Affidavit
Get Form BP-1 from the Stony Point building department.
- 2
Complete The Form
Review the exemption conditions and fill in the homeowner, property, and building permit information.
- 3
Book An Online Notary
Schedule a remote session with a commissioned online notary.
- 4
Sign On Video
Show identification and sign the affidavit during your online notary appointment.
- 5
Submit To The City
Submit the notarized Form BP-1 with your building permit application.
Preview the form
The blank PDF straight from Stony Point. 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 notarize the workers’ compensation exemption affidavit online?
- Complete the form, then book a session with a commissioned online notary. Sign during the video appointment and submit the notarized affidavit with your building permit application.
- Do I need to notarize Form BP-1?
- Yes. The form states that once notarized, it serves as an exemption for workers’ compensation and disability benefits insurance coverage.
- Who can use this exemption affidavit?
- The form is for owners of one- to four-family owner-occupied residences who are listed as the general contractor on the building permit and meet one of the conditions stated in the affidavit.
- Can I use Form BP-1 if I pay workers 40 or more hours per week?
- The form says homeowners hiring or paying individuals for 40 or more aggregate hours per week may not file BP-1 and must provide appropriate coverage proof or have the general contractor provide it. Confirm with the city, town or village if unsure.
- Can I complete the notarization remotely?
- New York authorizes remote online notarization by its notaries under Executive Law §135-c, in effect since 2023. A commissioned online notary can notarize your affidavit during a video appointment.
Workers’ Compensation Insurance Exemption Affidavit in other New York cities
Each city publishes its own version of this form. Pick the city where you’re filing.