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Home My WebLink AboutLicense - Massage Establishment Renewal - Council Oak Spa1316 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. Haibin Li Council Oak Spa 3302 Portage Ave., Suite A South Bend, IN 46628 Lori 94605(a,amail.com; baiyantong123(aDgmailxorn RE: Approval — License Renewal of Massage Establishment Dear Ms. Li: At its March 26, 2024 meeting, the Board of Public Works approved your request for the Massage Establishment at 3302 Portage Ave., Suite A, South Bend, IN 46628. 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 MURRAY L. MILLER BRIANA N. MIcou INTEROFFICE MEMORANDUM BOARD OF PUBLIC WORKS DATE: 02/08/2024 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: COUNCIL OAK SPA ADDRESS: 3302 PORTAGE AVE. 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 C Commercial district. For all municipal business license questions, contact: City of South Bend • Department of Community Investment 227 West Jefferson Blvd • Suite 1400 S -South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.90 1 LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT MUNICIPAL CODE SECTION - 4-35 I. APPLICATION TYPE Check One: New Renewal II. BUSINESS DATA A. Business I B. Business d City C. Mailing Address (If different from above): City: D. Business Telephone Number: E. Business Fax Number: Yt U F. E-Mail Address: "ana ra l 10D'6 Qti nit � Zip: G. Zoning of Business Location: H. Have you ever had a Massage Establishment license, or similar license, suspended or revoked by any governing municip lity within three (3) years prior to the date of this application: YES NO 1. If yes, what was the reason: 2. If yes, what was the business occupation following the suspension/revocation: I. Describe the nature and scope of the business: � �wo_ ;j r - ., - For Office Use Only Application Filed FEB ® 7 2024 Public Safety Approval Application Fee Paid FEB 0 7 2024 License Fee Paid Sent to Dept._Fio 0 7 2024 License Number I'�`� '• - . Feb. 8, 2024 sent copies of app to SBPD & SBFD Not Approved CITY OF SOUTH BEND, IND[ANA Reason BOARD OF PUBLIC WORKS tla(�k ",�Zm Elizabeth A. Maradik, President Gary A. Gilot, Member %YGwy A yn-A�-' Joseph R. Molnar, Vice President Breana N. Micou, Member Murray L. Miller, Member Attest: Laura D. Hensley, Acting Clerk Date: March 26, 2024 For all municipal business license questions, contact: City of South Bend • Department of Community Investment 227 West Jefferson Blvd • Suite 1400 S -South Bend, Indiana 46601 • 574.235.5912 • F: 574.23S.9021 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). 7ri Corporation (If corporation, proceed to 3). 1. Sole Proprietor Name: Residential Address: City: 2. Partnership (List at least two (2) partners) Name #1: Residential Address: City: Name #2: Residential Address: City: State: State: Zip: Zip: 3. Corporation Legal name of corporation: ti Date and state of incorporation: List officers and directors who own 15% or more of stock: Name #1: Title: alki Business Address: G City: State: zip: Residential Address: r r City: �. 1 . State:74V Zia: fV Name #2: Title: Business Address: City: State: Residential Address: City: _State: 2 P: p: For all municipal business license questions, contact: City of South Bend -Department of Community Investment 227 West Jefferson Blvd - Suite 1400 S -South Bend, Indiana 46601 - 574.235.5912 - F: 574.235.9021 LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT MUNICIPAL CODE SECTION - 4-35 III. OWNERSHIP (Continued) 3. Corporation (Continued) Name #3: Title: Business Address: City: Residential Address: City: IV. PERSONAL DATA A. Applicant's Legal Name: B. Residential A,d)dress: City: C. Residential Telephone Number: D. Residential Fax Number: E. Cellphone Numl F. E-Mail Address: G. Position with bL State: Zip: ate: H. Please list all criminal convictions (if any), excluding traffic violations: Nature of Conviction City State (Attach additional sheets if necessary) I. Please list all addresses for three (3) years prior to application date: Street Address City State �C7 � YDL_ (Attach additional sheets if necessary) J. Date of birth:: K. Gender: T. L. Social Security Number: M. Race: &L�U'L 3 Zip: Zip: Date Dates --2023 r 0 y For all municipal business license questions, contact: City of South Bend • Department of Community Investment 227 West Jefferson Blvd • Suite 1400 S -South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT MUNICIPAL CODE SECTION - 4-35 IV. PERSONAL DATA (Continued) N. Photographs: Attach below (3) Passport photos, INV', taken within 6 months of thr A,+- ^f this nnnlirntinn. I t k , ZIP ADates 33o_2Po,4we90 V - 4 (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 VIII. 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 certify that 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 certify that I 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. Y'La, Ra Hai _ 0t Al /2014 Signature Date 4 St. Joseph County Department of Health oProwo&v physra/ and mental health and fpn '. t,Xing the prevention of dose, injury', and ew. y� ,y for all St. Joseph County residcn& " 5T. JCSEPH COUNTY prwwrr.l�r Cr.+c►arN Permit For: Operation of a Massage Establishment Issued To: COUNCIL OAK SPA Owner.. AMOURI INCORPORATED Expires: 212SM24 SR J Permit No: 23052SB The St. Joseph County Health authorizes Massage Therapy to be performed at the facility identified above in accordance with St. Joseph County Code 113. Any person performing a massage must have a Massage Therapist Permit This permit must be posted in view of the public Diana Purushotham, M.D. St..)oseph County Health off ioer f 9:591 ail ^W), MT22308103.pdf see Indiana Professional Licensing Agency State Board of Viassage Therapy - 402 W. Washington Street, W072 Indianapolis, IN 46204 Massage Therapist U—sa Number Fxpre Dew MT22308103 05/15/2025 yingna Cai E.1c J. Holcomb Lindsay M. Hyer Governor Executive Director State of Indiana Indiana Professional Licensing Agency IndlnE PsctaayfOnat Llaansing Agency 402;V.. V.Fc htrgian 91mol, W072 [ndIsma cite, IN 4&2W Massage 7harapis4 IAi'�,2308493. c6r1F7P0a5 YOngna Call