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Home My WebLink AboutLicense - Massage Establishment Renewal - Massage by Suzanne1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND, INDIANA 46601-1830 Ms. Suzanne Thomas Massage by Suzanne 914 Lincoln Way West South Bend, IN 46615 smt1013kgmail.com PHONE 574/235-9251 FAx 574/235-9171 CITY OF SOUTH BEND TAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS April 23, 2024 RE: Approval — License Renewal for Massage Establishment Dear Ms. Thomas: At its April 23, 2024 meeting, the Board of Public Works approved your request for the Massage Establishment at 914 Lincoln Way West. 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 Derek Erquhart, Fire Department Kari Myers, Zoning Department FROM: Theresa Heffner, Clerk SUBJECT: RENEWAL - MASSAGE ESTABLISHMENT LICENSE RECOMMENDATION BUSINESS NAME: MASSAGE BY SUZANNE ADDRESS: 914 LINCOLN WAY WEST 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 Recommendation COMMUNITY INVESTMENT: The use is a permitted primary use in the NC Neighborhood Center district. For all municipal business license questions, contact: City of South Bend -Department of Community Investment 227 West Jefferson Blvd - Suite 1400 5 -South Send, Indiana 46601 •574,235.5912 - F: 574.23SM21 y rec- �-, ?_UN Ii? ? LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT OV431�5�'fi MUNICIPAL CODE SECTION - 4-35 I. APPLICATION TYPE Check One II. BUSINESS DATA A. Business Name: B. Business Addres. New Renewal City:- - —State; lip _Zip: C. Mailing Address (If differentfromabove): City- State: �7 Zip: D. Business Telephone Number: 5� 93 — 6 37 E. Business Fax Number: t F. E-Mail Address: G. Zoning of Business location: L-1 H. Have you ever had a Massage Establishment license, or similar license, suspended or revoked by any governing municipality with' 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: For Office Use Only Application Filed Public Safety Approval Application Fee Paid License Fee Paid Sent to Dept._ License Number —% -leal44_N-"5* Q1q CITY OF SOUTH BEND INDIANA Not Approved Reason BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President C - Gfsl�ile-� Gary A. Gilot, Member Murray L. Miller, Member Joseph R- Molnar, Vice President Briana Micou, Member KI«/ Attest: Theresa M. Heffner, Clerk Date: April 23, 2024 ro.ai inononai business license Question, mmxa: City dsouth cend • cewrtmemdwmmunnr swestmesrc 22711thestJ n non aiw • wne woos -South send, Imona ascot-sta.2as.ssu • F: 57a235.91021 LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT MUNICIPAL CODE SECTION - 4-35 Ill. OWNERSHIP A. Type of ownership (check : Sole Proprietorship (If sole proprietorship, proceed to 1). Partnership (If partnership, proceed to 2). Corporation (If corporation, proceed t03). 1. Sole Proprietor Name: Residential Address: City: State: Zinr_64�P(n/�5 2. Partnership (List at least two (2) partners) Name #1: Residential Address: Name#2: Residential Address: 3. Corporation Legal name of corporation: Date and state of incorporation: List officers and directors who own 15%or more of stock: Name #1: Business Address: Residential Address: Name For all municipal business license questions, coma¢ city ofsouth Bend • Department of Community Inwstment 227 West JeRerson BIW • Suite 1400 S -South Bend, Indiana 45601 • 570.235.5912 • F: 574.23SB021 LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT MUNICIPAL CODE SECTION -4-35 III. OWNERSHIP (Continued) 3. Corporation (Continued) Name#3: Residential Address: City: State: Zip: IV. PERSONAL DATA A. Applicant's Legal Name: B. Residential Address: City. s --Q • State: fA/ Zip: L� C. Residential Telephone Number: D. Residential Fax Number: E. Cellphone Number: F. E-Mail Address: 2 G. Position with business: 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 Q�S f For all munldpal business license questions, contact: City W south Bend • nepadmertaf o mmunM1y Imrertment 227 West Jefferson Blvd • Suite 14005 -South Bend, Indiana U601 •574.235.5912 • F: 574.235.9021 LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT MUNICIPAL CODE SECTION - 4-35 IV. PERSONAL DATA (Continued) ph E application. O. Please list all previous employment for three (3) years prior to the date of this application: Company Address City, State, ZIP Dates (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 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 e, Section 4-35. Signature Date 4 St. Joseph County Department of Health "To prornote health and wellness v vlth corrrpasslbn and integrity through partrerships, education, prvte&ian, and advocacy for all who reside rn and visit Si Joseph County: " ST-aOSEPH COVNT'Y DEvp RTMEIJT OF f1EA LTH Permit For: Operacion of a Massage Establishment Issued To: MASSAGE 6y 4LJLANNE Owner: SUZANNE T• 0MAS Expires: 2)2-f;/ 25 SR/ Permit No: 24111199 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 Purushotharn, M.D. St. Joseph County Health Officer