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Home My WebLink AboutLicense - 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 TAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS March 26, 2024 Ms. Xuehong Zhang AB Reflexology & Massage LLC 168 W. Catalpa Dr. Mishawaka, IN 46545 V3473991040ggmail.com RE: Approval — License Renewal of Massage Establishment Dear Ms. Zhang: At its March 26, 2024 meeting, the Board of Public Works approved your request for the 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, Is/ Theresa Heffner Theresa Heffner, Clerk Enclosures TH/lh ELIZABETH A. MARADIK JOSEPH R. MOLNAR GARY A. GILOT MURRAY L. MILLER BRIANA N. MIcou INTEROFFICE MEMORANDUM BOARD OF PUBLIC WORKS DATE: 01 /26/2024 TO: Brad Rohrscheib, Police Department St. Joseph County Health Department - see attached Gerard Ellis, Fire Department Kari Myers, Zoning Department FROM: Theresa Heffner, Clerk SUBJECT: RENEWAL - MASSAGE ESTABLISHMENT LICENSE RECOMMENDATION BUSINESS NAME: AB REFLEXOLOGY & MASSAGE, LLC. 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: The use is a permitted primary use in the NC Neighborhood Center district. For all municipal 4u5lFiess license questions, contact: City of South Bend • Department of Community Investment 227 West Jefferson Blvd • Suite 1400 S *South Bend. lndiana 46601 + 574.235.5912 • F: 574-7155..9�1 1,j-f7q 1-5'V.Asf� LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT MUNICIPAL CODE SECTION - 4-35 I. APPLICATION TYPE Check One 11. BUSINESS DATA A. Business Name: New Renewal C B. Business Address: City: Se"N7-1-i '6;5 l.D State: r A/ Zip: ; C. Mailing Address (If difFerentfrom above): /6,5 141 Z22rIZ422 i2212'. City: M/ �1l,�f r State. /A� Zip: l D. Business Telephone dumber: 5 :Zy''OZZ — Zz9a E. Business Fax Number: E-Mail Address: V' 0--'2Z�r Giry'Z G. Zoning of Business Location: 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 thisapplication: YES NO 1. If yes, what was the reason. 2. If yes, what was the business occupation following thesuspension/revocation: I. Describe the nature and scope of the business: � 5si%t.,r Laf,e For Office Use Only Application Filed JAN 2 5 2024 Public Safety Apprevai Application Fee PaidJAN t 5 M4 License Fee Paid Sent to Dept_ License Number CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS Not Approved _ loozP1 Reason Elizabeth A. Maradik, President Joseph R. Molnar, Vice President Gary A. Gilot, Member Breana N. Micou, Member — Murray L. Miller, Member Attest: Laura D. Hensley, Acting Clerk Date: March 26, 2024 For all municipal business license questions, corl Cry of South Bend • Department of Community Investment 227Wertlefferson Blvd • Suite SCmS •So dh Bend, Indiana 46601 • 574.2355912 • F 574.235.9021 LICENSE APPLICATION FOR — MASSAGE ESTABLISHMENT MUNICIPAL CODE SECTION — 4-35 III. OWNERSHIP A. Type of ownership (check ne): Sole Proprietorship (If sole proprietorship, proceed to 1). Partnership (If partnership, proceed to 2). Corporation (If corporation, proceed to 3). 1. Sole Proprietor Name: X, I F1 seslteel // Residential Address: %�ii ��SALPtY city: _A1 1Sf1Ruk&4�t State: At% Zip: ii�6-`/,5' 2. Partnership (List at least two (2) partners) Name #1: Residential Address: City: State: Zip: Name rig: 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 questions, ctn na: City of South Be • Department of Community Investment 227West Jefferson Blvd • Suite lEW 5 •South Bend, IMlana E6601 1576235.5912 • F:59E33SM21 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 A. Applicant's Legal Name: Zzeeo�b-49 z4er vir3 B. Residential Address: zll "g` !Y CZ4"11=4 -AP/9 City: i✓/Gyittee,;A Ff} State: /A/ ip: /�65905 C. Residential Telephone Number:_y�-399 D. Residential Fax Number: � E. Celephone Number: F.E-Mail Address: G. Position with business: 4Jiiidf� H. Please list all criminal convictions If any), excluding trafficviolations: Nature of Conviction City State Date (Attach additional sheets if necessary) I. Please list all addresses for three (3) years prior to application date: Stree[Adlress City State9 Dates For all nr WI business license quest am, content: cry of South Bend• Department ofrummunity IIII ant 222 West Jefferson Blad • Sulte 14005 •South Bend, Indiana 46601 • 374.235.5912 • F: 5)Q235.9021 LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT MUNICIPAL CODE SECTION -4-35 IV. PERSONAL DATA (Continued) N. Photographs: as 6 ition. u. rleaae ,uL <II, prev,ouIn.........—__ L-, ,_airs pooroo u,c va,=.., .l.... mr..__tion: Company Address City, State, ZIP Dates 146 /4/1gS'Vcr 26/2i y `r1e 16 O �� O s P�22 -7aZy ✓L4�E �PSA�sI-- .(iv h% �'IYsO.v .4e; 'm<t�+��iuic4!000V (Attach additional sheets if necessary) V. INCLUDE WITH APPLICATION Three (3) passport photos taken within 6 months of application. VI. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION VII. INCLUDE A LIST OF ALL MASSAGE THERAPIST EMPLOYED BY ESTABLISHMENT Vill. AFFIRMATION I, hereby, certify and affirm that all ofthe information I have given in this application is true and accurate to the best of my knowledge. I further certify that I have in no way attempted to mislead the City in this application by omittingfacts 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 certify that 1 will not allow massage therapy to be performed at this establishment by any person who does not possess a current massage therapist license. 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. i J Z LP-�tiC� l/ 22 z o2 �S Bra tore Date 4 :"0 perw n wantiTiaci aL C'- IF Ammo "4 t� perfwm Mane M' ftwrapy in arXordiwx s wiU, 5t 3wrVt+ CaunYy Cade 113. JA2&%apc Therapy may anW be pertarmnd at a laciiity rvlth a Mautiwa ttablishma*�?emit Robot EiAim M•0• St ]osoph County Health O"Icer