Groton, NY · Tompkins County
Workers’ Compensation Exemption Affidavit
This affidavit lets eligible owners of one- to four-family, owner-occupied residences certify an exemption from 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 affidavit is included with Groton’s building permit application materials and is for eligible homeowners of one- to four-family, owner-occupied residences. The owner checks the applicable exemption condition, signs under penalty of perjury, and has the form notarized; the form states that it serves as an exemption once notarized. Submit it with the building permit application when its conditions apply, rather than using it if the project requires proof of coverage.
Who needs it
An owner applying for a building permit for a one- to four-family, owner-occupied residence may need this affidavit if one of its listed exemption conditions applies.
Why it needs a notary
The BP-1 has a jurat: the homeowner signs the exemption certification under penalty of perjury before the notary, who notarizes the signed form.
How to get this notarized
- 1
Download The Application
Get Groton’s building permit application packet, which includes the BP-1 exemption affidavit.
- 2
Complete The BP-1
Enter the homeowner and property information, then check the exemption condition that applies.
- 3
Book An Online Notary
Arrange a remote session with a commissioned online notary before signing.
- 4
Sign On Video
Sign the BP-1 certification during the video session so the notary can complete the jurat.
- 5
Submit To The Town
Include the notarized BP-1 with your building permit application and other required documents.
Preview the form
The blank PDF straight from Groton. 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 submit the BP-1 affidavit with my Groton building permit application?
- Complete the applicable exemption section, sign before a notary, and include the notarized BP-1 with your building permit application and other required paperwork. The form lists the Town Clerk as the application and fee recipient.
- Do I need to notarize the BP-1 before filing it?
- Yes. The form states that once notarized, BP-1 serves as an exemption for workers’ compensation and disability benefits insurance coverage. The homeowner signs the certification under penalty of perjury.
- Can I use BP-1 if I hire workers for my project?
- The form lists an exemption condition for a homeowner with current homeowners insurance who pays individuals for less than 40 aggregate hours per week. It says coverage or other proof is required at 40 hours or more.
- Can I sign the BP-1 with a commissioned online notary?
- New York authorizes its own notaries to perform remote online notarizations under Executive Law §135-c, effective since 2023. Ask the Town whether it accepts the notarized form in your preferred format; confirm with the city, town or village if unsure.
Other forms in Groton
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.