Structure
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.
7B
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
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
Signature of OWNER Applicant
I am the SOLE PROPRIETOR of a business doing work at the
Signature of SOLE PROPRIETOR Applicant
I am the OWNER of the
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
Signature of OWNER or SOLE PROPRIETOR Applicant
Name of
Federal Employer ID#
Subscribed and sworn to before me this |
|
day of |
|
, 200 |
|
. |
Signature of Notary Public / Commissioner of the Superior Court
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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