Pursuant to Chapter 12.05 of the City of Happy Valley Municipal Code, every person or
company shall register prior to providing any utility services to any customer in the City, and
every December 31
st
thereafter. A person with a valid franchise agreement or license from
the City is not required to register to provide the utility services expressly permitted by
the franchise agreement or license.
Instructions: Please provide all information requested below, including applicable application fees, to the
City of Happy Valley. The application must be signed by an authorized representative of the entity
requesting a license.
Contact Information/Additional Information/Instruction Directions: Angela Tomasco, Senior Accountant,
503-783-3837or atomasco@happyvalleyor.gov
Applicant Information:
Applicant Name (Include Corporate Name registered with Oregon Secretary
of State and any DBAs and affiliates that will construct, own or control any
facilities in the ROW.)
Applicant’s Authorized Contact
Name(s) and Title(s):
Street, City, State and Zip
Phone
E-mail Address
Fax Number
Services:
Check all of the following that apply regarding the services to be provided by registrant to customers in the City
(see definitions in Chapter 12.05):
Cable Service
Communications Services
Natural Gas
Electricity
Water
Sanitary Sewer
Storm Sewer
Other: ________________________________________________________________________________________
City of Happy Valley
Right of Way Usage
Registration Application
Please provide a description of the utility services to be provided:
Please list or describe the facilities to be used to provide utility services:
Attach documentation or a statement that demonstrates that the applicant has received or is legally qualified to receive
authorizations from state and/or federal authorities necessary to conduct the activities that will require use of the ROW.
Check box if no authorizations required
SIGNATURE:
By executing this R
egistration, the undersigned affirms that he/she is an authorized representative of the
company (Registrant) with the authority to execute this Registration Application.
I hereby certify, on behalf of Registrant, that the information provided in the registration application is
true and correct as of the date hereof, and that Registrant agrees to abide by the obligations set forth
in Chapter 12.05 of the City Code of Ordinances of the City of Happy Valley.
By:
Title
Date
Mail
City of Happy V
alley
16000 SE Misty Drive, OR, 97086
Attn: Angela Tomasco, Senior Accountant
Fax
503-658-5236
Attn: Angela Tomasco,
Senior Accountant
Email
Atomasco@happyvalleyor.gov
Submit your completed application packet by choosing one of the options below:
1
2
3
or
Rev. 81519
NOTE: Registration application fee of $250.00 must be included at time of submittal
Print
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