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Official Connecticut 7B Template in PDF

The Connecticut 7B form serves as a proof of workers' compensation coverage required when applying for a building permit. This form is essential for property owners or sole proprietors who will act as general contractors or principal employers on construction projects. By completing this form, applicants confirm their compliance with state regulations regarding workers' compensation insurance for all employees involved in the project.

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When embarking on a construction project in Connecticut, understanding the Connecticut 7B form is crucial for both property owners and sole proprietors. This form serves as a vital document to demonstrate compliance with workers' compensation insurance requirements when applying for a building permit. If you plan to act as the general contractor or principal employer for your project, you must provide proof of workers' compensation coverage for all employees involved. The form requires you to indicate your role—whether you are the owner of the property or a sole proprietor—and to submit the necessary documentation accordingly. Additionally, if you choose not to submit proof yourself, you can still affirm your commitment to ensuring that all contractors and workers on-site have the required insurance coverage. Completing this form accurately not only helps protect your interests but also ensures the safety and legal compliance of your construction endeavors. Understanding the ins and outs of this form can save you time and hassle as you navigate the permitting process.

Connecticut 7B Example

State of Connecticut Workers’ Compensation Commission

Please TYPE or PRINT IN INK

Rev. 3-17-2006

Proof of Workers’ Compensation Coverage when Applying

for a Building Permit for the Sole Proprietor or Property Owner who WILL act as General Contractor or Principal Employer

APPLICANT FOR BUILDING PERMIT

Name of Applicant for Building Permit

Property located at

in the City / Town of

ATTEST

If you are the owner of the above-named property or the sole proprietor of a business doing work on the site of the construction project at the above-named property and you WILL act as the general contractor or principal employer, you must provide proof of workers’ compensation insurance coverage for all employees.

Complete this form and, if applicable, sign the Affidavit below in the presence of a Notary Public or a Commissioner of the Superior Court.

CHECK ONE (1) BOX ONLY, provide the appropriate information, and sign:

I am the OWNER of the above-named property. I WILL act as the general contractor or principal employer and, as such, will submit proof of workers’ compensation insurance coverage for all employees who are doing work on the site of the construction project at the above-named property.

Signature of OWNER Applicant

I am the SOLE PROPRIETOR of a business doing work at the above-named property. I WILL act as the general contractor or principal employer and, as such, will submit proof of workers’ compensation insurance coverage for all employees who are doing work on the site of the construction project at the above- named property.

Signature of SOLE PROPRIETOR Applicant

I am the OWNER of the above-named property or the SOLE PROPRIETOR of a business doing work at the above-named property. I will not personally submit proof of workers’ compensation insurance coverage, but I will attest to the following:

AFFIDAVIT

I hereby swear and attest that I will require proof of workers’ compensation insurance for every contractor, subcontractor, or other worker before he or she does work on the site of the construction project at the above-named property in accordance with Section 31-286b of the Workers’ Compensation Act.

Signature of OWNER or SOLE PROPRIETOR Applicant

Name of Business—if applicable

Federal Employer ID# (FEIN)—if applicable

Subscribed and sworn to before me this

day of

, 200

Signature of Notary Public / Commissioner of the Superior Court

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Document Specifications

Fact Name	Description
Purpose	The 7B form is used to provide proof of workers’ compensation coverage when applying for a building permit in Connecticut.
Applicable Law	This form is governed by Section 31-286b of the Connecticut Workers’ Compensation Act.
Who Must Use It	Property owners or sole proprietors acting as general contractors or principal employers must complete this form.
Proof of Coverage	Applicants must submit proof of workers’ compensation insurance for all employees working on the construction site.
Affidavit Requirement	If not submitting proof personally, the applicant must sign an affidavit confirming they will require proof from all contractors and subcontractors.
Signature Requirement	The form must be signed by the owner or sole proprietor, and notarized or signed by a Commissioner of the Superior Court.
Form Revision Date	The current version of the form was revised on March 17, 2006.
Location Information	Applicants must provide the address of the property where the construction project will take place.

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