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Forms

We have several forms related to the Fire Prevention and Building Codes department available for download.

Acceptable Forms of Insurance

The NYS Compensation Board requires any municipality issuing permits to verify the applicant has Worker's Compensation and Disability Insurance or that they are exempt.

Please choose the appropriate form listed below, and submit with your permit application.


Homeowners Doing All Work

  • BP1 (12-08) Affidavit of Exemption (owner occupied only)

Workers' Compensation Forms for Contractors

  • CE-200 (12-08) for NYS Entities and Out of State Entities with no employees (exempt)
    • This must be stamped as received by the NYS workers’ compensation board
  • C-105.2 (9-15) or U-26.3 Certificate of Workers’ Compensation Insurance
  • SI-12 or GSI-105.2 Certificate of Participation in Workers’ Compensation Self-Insurance

These forms are received from the insurance carrier
Warren County must be listed as a certificate holder


Disability Forms

  • CE-200 (12-08) (PDF) Exemption Form from above will cover this for Contractors with no employees
  • DB-120.1 (9-15) Certificate of Disability Benefits Insurance
  • DB-155 Certificate of Disability Benefits Self-Insurance

These are received upon request from the insurance carrier
Warren County must be listed as a certificate holder

We cannot accept accord forms


Building Permit Application

Before downloading a permit application, you must review the Permit Requirements!


Authorization Form (To Act as Agent For)


Unstamped Lumber form