State of Connecticut Workers' Compensation Commission, John A. Mastropietro, Chairman
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WCC New Building Permit Forms Memorandum - October 22, 2004


MEMORANDUM NO. 2004-07

TO: City & Town Building Inspectors/Officials, City & Town Planning & Zoning Boards/Commissions, State Treasurer Investigations Unit, Workers' Compensation Advisory Board, Legal Advisory Panel, Commissioners and District Administrators
FROM: John A. Mastropietro, Chairman
DATE: October 22, 2004
RE: New Building Permit Forms Available

I am pleased to announce the availability of three new forms, 7A, 7B, and 7C, which must be completed by a person applying for a building permit and submitted to the local building official from whom that person is requesting the permit. The filing of a form 7A, 7B, or 7C provides proof of workers' compensation insurance coverage pursuant to Section 31-286b of the Workers' Compensation Act. In addition, a separate 7A-7B-7C Directions document is also available and provides detailed instructions as to who must submit which form in order to satisfy the requirements of Section 31-286b.

For your convenience, we have enclosed one complete set of the Directions and the Forms 7A, 7B, and 7C. You may use these as originals from which to make photocopies for applicants, or you may refer applicants to download the forms from our website at the following URL:

http://wcc.state.ct.us/download/forms.htm

It is hoped that those of you receiving this memorandum will use the newly-revised forms beginning November 1, 2004 to assist the Commission in providing its services as efficiently and effectively as possible. Thank you for your anticipated cooperation.


State of Connecticut Workers' Compensation Commission, John A. Mastropietro, Chairman
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State of Connecticut
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Page last revised: October 22, 2004
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