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Home My WebLink AboutLicense - Massage Establishment Renewal - Soul Fire Yoga LLC1316 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. Alyssa Rios Soul Fire Yoga 2314 E. Mishawaka Ave. South Bend, IN 46615 soulfireyogasbggmail. com RE: Approval — License Renewal of Massage Establishment Dear Ms. Rios: At its March 26, 2024 meeting, the Board of Public Works approved your request for the Massage Establishment at 2314 E. Mishawaka Ave., South Bend, IN 46615. 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: 02/29/2024 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: SOUL FIRE YOGA ADDRESS: 2314 E. MISHAWAKA 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 NC Neighborhood Center district. For all m.inici pal butlness license questions, rortart: City of South Bend ■ Department of Community Investment 221 West JeffefSV'1 Blvd • Suite 14005 -South Send, Indiana 46WI • 574.235.5912 • F: 574.235.902 15 LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT CK 114A 7 z MUNICIPAL CODE SECTION - 4-35 I. APPLICATION TYPE Check One; New II. BUSINESS DATA A. Business Name: B. Business Address: %(A PI t newal LK to,003II3 $14i ZV City: S ign mind State: IN Zip: Lkokl5 C. Mailing Address (If differentfrorn above): City: State: ii'' rr Tip: D. Business Telephone Number: 14 --� 3—,A "t`"i' E. Business Fax Number: F. E-Mail Address:V.1,ar� _caw-% G. Zoning of Business Location: 1m1'DV)Maa umu 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. 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: lOwA ShdlO,,�� For Office Use Only Application Filed FEB 2 9 2024 Public Safety Approve! Application Fee Paid FEV, I Tmi License Fee Paid FEB 2024 Sent to Dept. FEB Z t 2024 License Number MSFA0 0,L4 - C11 Q Health 2401256 SBPD CITY OF SOUTH BEND, INDIANA Not Approved SBFD BOARD OF PUBLIC WORKS � �a �� 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 Ilcome quetlons, mirtam 00 of south Send • Departmemof CommuNry Investment 222 Wertleffl Bled • Suite IWO S ISouM Bend, Indiana 46WI 574.235.5912 • F: 524235.9n21 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 to2). Corporation (If corporation, proceed to 3). 1. Sole Proprietor Name: MxlssG Vb S Residential Address: City: tate: 1W Zip: qL*G( 2. Partnership (List at least two (2) partners) Name ttl: 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 N1: Title: Business Address: City: State: Zp: Residential Address: City: State: Zip: Name k2: Title: Business Address: City: State: Zip: Residential Address: City State: Zip: 2 For all municipal business license questions wreact: City of South Bend • Department of Community Invesbnem 227Wertleffemon Blvd -Suite 14WS South Bend, Indiana 06601 v 570335.S912• F 574235.9D21 LICENSE APPLICATION FOR -MASSAGE ESTABLISHMENT MUNICIPAL CODE SECTION - 4-35 III. 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 Na—_. A4\.If t• Qir:C B. Residential Address: City: C&� State: Zip: ylaLly C. Residential Telephone Number: D. Residential Fax Number: E. Cellphone Number: F. E-Mail Address: G. Position with business: x90 b,;o.4 f 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: Street Address City State Dates raB N %Ll V b�%DE)atkn l 3 For all muodpal business license questions, contact: City of South Bend • Departmental Cammunity Invertment 227 WeStJenerson Blvd • Suite 1400 S -South Bend, Indiana 46601 • 574.23i5912 • F: 514235.9021 LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT MLINI CI PAL CODE SECTION - 4-35 IV. PERSONAL DATA (Continued) N. P Atta 1", :ofth -. tF I ! O. Please list all previous employment for three (3) years prior to the date of this application: Company Address City, State, ZIP Dates %W lPttt ot0 a?%q E.'l�tt6�wV6Y.t �t r%pIA1 t��14 _D42DUllli mtr Ltnkr SB 9(D6u.W4siun he Ill Walebi 61 1CM111 -vall 1tthyd ?mV (knhalf� 1a6, E.Ir l.hd s6 wy�p�l ) ab SU3F (Attach additional sheets if necessary) 12G V. INCLUDE WITH APPLICATION: Three (3) passport photos taken within 6 months of application. VI. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION VIL INCLUDE A LIST OF ALL MASSAGE THERAPIST EMPLOYED BY ESTABLISHMENT 90" WWdS Vill. 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. azolil '% 42) ca Ja.3/ay 17 Signature Date 4 Q St. Joseph County Department of Health To promote health and wellness with compassion and integrity through partnerships, education, protection, and advocacy for all who reside in and visit St. Joseph County. " ST. JOSEPH COUNTY DEPARTMENT OF HEALT4 Permit For: Operation of a Massage Establishment Issued To: SOUL FIRE YOGA Owner: ALYSSA RIOS Expires: 21281202E SR/Permit No: 2401256 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. Joseph County Health Officer