HomeMy WebLinkAboutLicense - Massage Establishment Renewal - AB Reflexology & Massage1316 COUNTY -CITY BUILDING
227 W. JEFFERSON BOULEVARD
SOUTH BEND, INDIANA 46601-1830
PHONE 574/235-9251
FAx 574/235-9171
CITY OF SOUTH BEND JAMES MUELLER, MAYOR
BOARD OF PUBLIC WORKS
February 28, 2023
Ms. Xuehong Zhang
AB Reflexology & Massage LLC
168 W. Catalpa Dr.
Mishawaka, IN 46545
V3473991040(a,gmail.com
RE: Approval — License Application for New Massage Establishment
Dear Ms. Zhang:
At its February 28, 2023meeting, the Board of Public Works approved your request for
the New Massage Establishment at 2614 S. Michigan St., South Bend, IN 46614.
If you have any further questions, please call this office at (574) 235-9251.
Sincerely,
/s/ Theresa Heffner
Theresa Heffner, Clerk
Enclosures
TH/lh
ELIZABETH A. MARADIK JOSEPH R. MOLNAR GARY A. GILOT JORDAN V. GATHERS MURRAY L. MILLER
INTEROFFICE MEMORANDUM
BOARD OF PUBLIC WORKS
DATE: 02/06/2023
TO: Brad Rohrscheib, Police Department
St. Joseph County Health Department - see attached
Gerald Ellis, Fire Department
Angela Smith, Zoning Department
FROM: Theresa Heffner, Clerk
SUBJECT: RENEWAL - MASSAGE ESTABLISHMENT LICENSE
RECOMMENDATION
BUSINESS NAME: AB REFLEXOLOGY & MASSAGE
ADDRESS: 2614 S. MICHIGAN ST.
PLEASE INSERT YOUR RECOMMENDATIONS IN THE APPROPRIATE FIELD BELOW,
BASED ON THE FOLLOWING CRITERIA FROM MUNICIPAL CODE SEC. 4-35:
1. The applicant and his/her partners have not been convicted of any crime involving unlawful
deviate conduct, deviate sexual conduct, or unlawful sexual conduct within three (3) years
prior to the date of application. (Verified by PD).
2. The applicant is a minimum of 18 years of age. (Verified by PD)
3. The applicant has passed an inspection from the St. Joseph County Health Department.
4. The massage establishment as proposed by the applicant would comply with all applicable
laws, including but not limited to the City's building, zoning, health, fire and safety
regulations. (Fire and Zoning, please verify)
5. A recognizable and legible sign shall be posted at the main entrance identifying the
establishment as a massage establishment. (PW — please verify)
POLICE: Favorable recommendation
FIRE: Favorable
COMMUNITY INVESTMENT: No issues at this time. This property is zoned NC
Neighborhood Center, which allows a massage establishment by right.
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For all municipal business license questions, contact: City of south Bend ■ epartment of Community Investment
227 West Jefferson Blvd ■ Suite 1400S •South Bend, Indiana 4MI ■ 74.235.5912 • F: 574.235.9D21
. -7 L ,
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION - 4-3S
I. APPLICATION TYPE Check One:
II. BUS INESSDATA
New Renewal X
A. Business Name: A 1' kdt eefo CO qU �2, An _5S e(,,V e
B. Business Address:
City. [-� a a- f'-�it �5tate:� Zip: _4�61?1>
C. Mailing Address (If different from above):
City: State: Zip:
D. Business Telephone Number: - 7
E. Business Fax Number:
F. E-Mail Address: �1_—l_ic 7 -3 ► 40 1,L . r_, M Cr,-i► -)
G. Zoning of Business Location: W
H. Have you ever had a Massage Establishment license, or similar license, suspended or revoked
by any governing municipality within three (3) years prior to the date of this application:
YES NO _1
1. If yes, what was the reason:
z. If yes, what was the business occupation following the suspension/revocation:
I. Describe the nature and scope of the business: _ '1GtC S C C>
J. Include a list of massape therapist employed at this location: )include a separate sheet if necessary)
`z i) .o t-tt fie c CA.fY?
For Office Use Only
Application Filed FEB 0 3 2023 Public Safety Approval
Application Fee Paid FR 0 3 7023 License Fee PaidFEB
Sent to Dept. FEY 4 3 2073 License Number MIr-A 5_00'
CITY OF SOUTH BEND, INDIANA
Not Approved BOARD OF PUBLIC WORKS
Reason 1*64
Elizabeth A. Maradik, President Joseph R. Molnar, Vice President
Q�rit t
Gary A. Gilot, Member
Jordan V. Gathers, Member
�4
Murray L. Miller, Member
Attest: Theresa M. Heffner, Clerk
Date: February 28, 2023
For all municipal budrem license questions, contact City of south send • Department of Community Iroertment
222 West Jefferson Blyd • suite 140e S -South Bend, Indiana 46601 •574.235.5912 • F: 570.235.9@3
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION - 4-35
III.OWNERSHIP
A. Type of ownership (check one):
/ Sole Proprietorship (if sole proprietorship, proceed to 1).
Partnership (If partnership, proceed to 2).
Corporation (it corporation, proceed to 3).
1. Sole Proprietor� ,�.. �//�� � '
Name: s04—e A�9('l.lYi! !IY—
Residential Address: '`� lb�,Q Ls) C DA C-
City A42 c 4.2 OOA, State: ;A! Zip:
2. Partnership (List at leasttm (2) partners)
Name #1:
Residential Address:
City: State: Zip:
Name #2:
Residential Address:
City: State: Zip:
3. Corporation
Legal name of corporation:
Date and state of incorporation:
List officers and directors who own 15%or more of stock:
Name #1:
Title:
Business Address:
City: State: Zip:
Residential Address:
City: State:. Zip:
Name #2:
Title:
Business Address:
City: State: Zip:
Residential Address:
City: State: Zip:
2
For all municipal business license question; correct: City or south Bend • Department a Community Investment
222 WaUeRereon Blvd' Suite 1400S 'South Bend, IMlana 46601 • 594.M.5912 • F: 57C235.9021
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION - 4-35
Ill. OWNERSHIP (Continued)
3. Corporation (Continued)
Name #3:
Title:
Business Address:
City: State: Zip:
Residential Address:
City: State: Zip:
IV. PERSONAL DATA � � /
n,. A. Applicant's Legylgame: dIL��Ef Lfl
B. Residential Address: 16 g tk-� catewtith ciL . _
City: lctk.C,�W�te: 4V Zip:
C. Residential Telephone Number:
D. Residential Fax Number:
E. Celephone Number: IQ -32Ci/y, Lo
F. E-Mail Address: J3&c a4a/'o d fill- cl+m-Kl.ri . el m
G. Position with business:
H. Please list all criminal convictions (if any), excluding trafhcviolations:
Nature of Conviction City State Date
(Attach additional sheets if necessary)
I. Please list all addresses for three (3) years prior to application date
StreetQ`ddres5 City State Dates
/4, d'/, l 74f i4 sae. A)?CWdWXA 201B AtV
(Attach additio
J. Date of b'
K. Gender:
L. Social
M. Race:
3
For all munid pal business Ilcense 9uertlons, contact: City of South Bend • oepartment of Community Investment
227 West.aelferson BIW • Suite 1400 $ •South Bend, Indiana 464301 •94.Zi5.5912 • F'. 57&235.9021
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION -4-35
IV. PERSONAL DATA (Continued)
N. Photographs:
`-'---"1 Pass - "" "" "" north of the date of this application.
A
Company Address - C
1A e �osw I o�T
(Attach additional sheets ifnecessary)
V. INCLUDE WITH APPLICATION:
Three (3) passport photos taken within 6 months of application.
VI. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION
VII. AFFIRMATION
I, hereby, certify and affirm that all of the information I have given in this application is true and
accurate to the best of my knowledge. I further certifythat I have in no way attempted to
mislead the City in this application by omitting facts known to me. I agree to cooperate with any
review conducted pursuant to the licensing procedures, including permission to enter and
inspect the place of business and facilities in conjunction with such review. I have read and
understand the regulations of the Massage Establishment and/or Therapist license found in the
City of South Bend Municipal Code, Section 4-35.
due �r zlC. /i0�>_3
Soo ure Date
4