Head of the Harbor, NY · Suffolk County
Workers’ Compensation Exemption Affidavit
This BP-1 affidavit lets qualifying owners of one- to four-family, owner-occupied residences certify an exemption from workers’ compensation coverage when applying for a building permit.
At a glance
- Issued by
- City of Head of the Harbor · Head of the Harbor, Suffolk County, New York
- Notarization
- Required: sign this form in front of a notary before filing it.
- Official source
- headoftheharborny.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
- 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 who performs all the work, hires no one, or has current homeowners insurance and pays workers for fewer than 40 combined hours per week. It also describes the coverage or proof required if paid work reaches 40 or more combined hours per week. The form states that it cannot waive any party’s workers’ compensation rights or obligations.
Who needs it
An owner listed as general contractor for a qualifying owner-occupied residence may file this affidavit with a building permit application if one of the form’s exemption conditions applies.
Why it needs a notary
The form has a sworn-to-before-me jurat, and the homeowner must sign the affidavit before a notary public.
How to get this notarized
- 1
Download the BP-1 Form
Get the Workers’ Compensation Exemption Affidavit from the Head of the Harbor form source.
- 2
Complete the Affidavit
Enter the property and homeowner information, select the applicable exemption condition, and review the statements.
- 3
Book an Online Notary
Arrange a remote session with a commissioned online notary before signing.
- 4
- 5
Submit with Your Permit Application
Provide the notarized BP-1 to the government entity issuing the building permit.
Preview the form
The blank PDF straight from Head of the Harbor. 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 BP-1 affidavit online?
- Complete the affidavit, then book a session with a commissioned online notary. Sign during the video session when directed, and follow the notary’s instructions for receiving the notarized form.
- Do I need to sign the affidavit in front of a notary?
- Yes. The BP-1 includes a sworn-to-before-me jurat. The homeowner signs the affidavit before a notary public.
- Who can use this workers’ compensation exemption affidavit?
- The form is for owners of one- to four-family, owner-occupied residences listed as general contractor on the building permit, when a condition stated on the form applies.
- Is remote online notarization permitted for this form?
- New York authorizes remote online notarization by its own notaries under Executive Law §135-c, in effect since 2023. Real Property Law §299 recognizes notarial acts performed outside New York by an officer authorized where the act occurs. Confirm with the city, town or village if unsure.
Other forms in Head of the Harbor
Building Permit Application
Head of the Harbor
Application for Change of Zone
Head of the Harbor
Special Event Permit Application
Head of the Harbor
Special Permit Plan Application
Head of the Harbor
Zoning Board of Appeals Application
Head of the Harbor
Application For Site Plan Or Subdivision Review
Head of the Harbor
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.