Affidavit of Exemption – Knox County, TN

The Affidavit of Exemption is a Knox County, Tennessee form on which a permit applicant swears and affirms that they are exempt from the proof of workers' compensation insurance requirements of T.C.A. §50-6-902 when applying to the Knox County Department of Codes Administration.

The form is used with one of two kinds of application, and you check the one that applies:

• a Building Permit;
• a Use and Occupancy Permit.

You then check one of four reasons for the exemption:

• A. You are not required to obtain coverage under the Tennessee Workers' Compensation Law, T.C.A. §50-6-903. A copy of your Workers' Compensation Exemption Registration, issued in accordance with T.C.A. §50-6-904, must be provided.
• B. You are performing work on your own property in your own county of residence.
• C. You are directly supervising work on your own property in your own county of residence.
• D. You are applying for occupancy only, with no work to be done.

The form carries the Knox County Engineering & Public Works heading and is signed and dated by the permit applicant. It does not itself grant a permit: it is the sworn exemption statement that accompanies the permit application. Knox County Code Administration describes its mission as protecting the safety, health, welfare and property of county residents through building regulatory codes.

The main group is a permit applicant who is applying to the Knox County Department of Codes Administration for a building permit or a use and occupancy permit and who is exempt from the proof of workers' compensation insurance requirements of T.C.A. §50-6-902. The form lists four situations, and you check only one:

• You are not required to obtain coverage under the Tennessee Workers' Compensation Law (T.C.A. §50-6-903). You must provide a copy of your Workers' Compensation Exemption Registration.
• You are performing work on your own property in your own county of residence.
• You are directly supervising work on your own property in your own county of residence.
• You are applying for occupancy only, with no work to be done.

If none of these statements is true for you, the form does not apply to you, because it is a sworn statement that one of them is. The form names only the permit applicant as signer and gives no rule for anyone signing on the applicant's behalf.

Complete the Affidavit of Exemption when you apply to the Knox County Department of Codes Administration for a building permit or a use and occupancy permit and you claim an exemption from proof of workers' compensation insurance. It has no due date of its own: it goes in with that permit application. The form is dated by the person signing, with a printed line reading "Signed this day of 20", so sign it when you complete the application. The form sets no validity period or renewal. Check the permit application itself and Knox County Code Administration at https://www.knoxcounty.org/codes/ for any timing that applies to the permit.

The Affidavit of Exemption is submitted to the Knox County Department of Codes Administration together with the building permit or use and occupancy permit application it supports. The form prints no mailing address, portal or appointment rule of its own, and it names no separate channel.

• With your permit application: include the signed affidavit in the package you give the Department of Codes Administration. Knox County Code Administration publishes its information at https://www.knoxcounty.org/codes/.
• If you check reason A: attach a copy of your Workers' Compensation Exemption Registration.

Ask Knox County Code Administration how it accepts permit applications and any fees that apply to the permit. FillingPDF lets you fill out and download the PDF; submission follows the county's channels above.