Fiber Build Authorization

Fiber Build Authorization

In order for Holland Board of Public Works to install fiber internet at a location, this form must be signed by the landowner.
Owner Information
Owner's Name*

First NameLast Name
Owner's Email
example@example.com
Owner's Phone Number*
Please enter a valid phone number.
Is your mailing address different from the property address?*

YesNo
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Where shall the new fiber internet service be installed?
Property Address*

Street Address

Street Address Line 2

CityState

Zip Code
Is this a rental property?*
Tenant's Name

First NameLast Name
Tenant's Phone Number
Please enter a valid phone number.
Tenant's Email
example@example.com
Additional Facilities

When installing fiber optics for services, it is important to know of all buildings on the property you are interested in having service to. Garages, sheds, secondary living quarters and all other locations on the same property you would want services to should be noted below. There may be additional installation and/or service charges for buildings other than the primary location depending upon the work required and services desired.
List additional buildings located on the property where internet service is desired.
Private Utilities Disclosure

When installing fiber, HBPW follows procedures set forth by the Michigan Damage Prevention Board (MDPB) and Miss Dig to help locate existing utility lines. However, private utility lines such as sprinkler systems, buried lines to out buildings, septic systems, drain fields, etc. are not a part of the Miss Dig system. In an effort to prevent disturbing private utilities, please let us know of any private lines you are aware of. You can also upload a file to attach a drawing.
List private utility lines located on the property.
Upload a drawing or diagram of the approximate locations of private utility lines.

Cancelof
Authorization

The Undersigned hereby grants to the Holland Board of Public Works (HBPW) permission to construct, operate and maintain a communication line or system on, over, or under the above premises and in or upon all streets, roads, or highways abutting said land. The Undersigned further agrees that in the event that said undersigned does not own all private land or lands necessary to be crossed, as stated above, he or she or they shall obtain all necessary permission from the owner or owners of said land or lands, and shall submit same to HBPW prior to installation of service. The Undersigned hereby grants to HBPW access to the premises of Undersigned at all reasonable times for its purpose of installing, repairing, maintaining or removing any service to the premises. Application for services still required.
Owner's Signature*

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Holland Board of Public Works - Broadband Services
625 Hastings Ave, Holland, MI 49423
Email: fibersupport@hollandbpw.com

If you have any questions regarding the fiber build process or services available at your location, please call Customer Service at (616) 355 - 1500.
Should be Empty:

Fiber Build Authorization

Owner Information

Where shall the new fiber internet service be installed?

Additional Facilities

Private Utilities Disclosure

Authorization