HomeMy WebLinkAboutLicense - Massage Establishment Renewal - Southside Massage Retreat1316 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
May 14, 2024
Ms. Sara Cozort
Southside Massage Retreat
401 E. Colfax Ave., Suite 180
South Bend, IN 46601
smretreat(iDhotmail. corn
RE: Approval — License Renewal of Massage Establishment
Dear Ms. Cozort:
At its May 14, 2024 meeting, the Board of Public Works approved your request for the
renewal of your Massage Establishment at 401 E. Colfax Ave., Suite 180.
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: 03/08/2024
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: SOUTHSIDE MASSAGE RETREAT
ADDRESS: 401 E. COLFAX 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 Recommendation
COMMUNITY INVESTMENT: The use is a permitted primary use in the DT Downtown
district.
For all municipal business Ycense questions, contact- City of Soutr Bend • Devartment of Community Investment
227 West Jefferson Blvd - Suite 14CO 5 •5outh Bend, Indiana 46641 • 74.Z35.5912 - F: 574.235.9021
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LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT CY—L'045
MUNICIPAL CODE SECTION - 4-35
I. APPLICATION TYPE Check One: New Renewall
Ii. BUSINESS DATA
A. Business Name:
B. Business Address:
City
C. Mailing Add
City:
Wft
D. Business Telephone Number:
E. Business Fax Number:
F. E-MaiIAddress:
G. Zoning of Busirn
H. Have you ever had a Massage Establishment license, or similar license, suspended or revoked
by any governing municipality Rhin three (3) years prior to the date of this a pplication:
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_ S Yl Public Safety Approval
Application Fee Paid License Fee Paid
Sent to Dept. MA R 90,7a License Number M Se-f1D -01
CITY OF SOUTH BEND, INDIANA
Not Approved BOARD OF PUBLIC WORKS
Reason 1*1�(4
Elizabeth A. Maradik, President
Gary A. Gilot, Member
pZ—, A
Murray L. Miller, Member
�7�t
Joseph R. Molnar, Vice President
Briana Micou, Member
Attest: Theresa M. Heffner, Clerk
Date: May 14, 2024
0
For all municipal business license quesbors, mntam City of5outh Bend• cepartmem of community lmmtment
227 Wertleaerson BlW - SOW 1400 S -South Bend, Indiana 46601 •574.235.5912 • F: 94]35.9021
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION - 4-35
III. OWNERSHI/Checkone):
A. Type of ownershi
Sole Proprietorship (If sole proprietorship, proceed to 1).
Partnership (If partnership, proceed to 2).
Corporation (If corporation, proceed to 3).
1. Sale Proprietor
Name: tl
Resi
City:
2. Partnership (List at least two (2) partners)
Name 41:
Residential Address:
City: State. Zip:
Name H2:
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 Hl:
Title:
Business Address:
City: State: Zip:
Residential Address:
City: State: Zip:
Nameh2:
Title:
Business Address:
Chy' State: Zip:
Residential Address:
City: State: Zip:
2
For all municipal business Ilcanse Questions, contact City of South Send • Department of CommunYry Imprtment
222 West Jefferson BNtl • Suite 14005 -South Bend, Indiana 4E101 • 574.235.5912 • F. 510.235.9021
LICENSE APPLICATION FOR -MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION - 4-35
Ill. OWNERSHIP (Continued)
3. Corporation (Continued)
Business
Residential Address:
IV. PERSONAL DATA
A
A. Applicant's Legal Na
B. Resident. ' AAA.,,
Cit, likii
C. Residential Telephone Number:
D. Residential Fax Number:
E. Cellphone Number:
F. E-Mail Address: 4 C1:C7'A'1
G. Position with business: Q� 5�
H. Please list all criminal convictions (if any), ex,
x u ing 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:
For all municipal business license quesdom, coma¢: City of South Bend • 0epartmemof communlN Investment
227 Wertlefferson Bivd • Suite 34m S -South Bend, Income 45501 • 574.235.5912 • F. 574.235.9021
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION -435
IV. PERSONAL DATA (Continued)
O. Please list all previous employment for three (3) years prior to the date of this application:
Company Address
Dates
N
(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 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 certifythat 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 ofthe
Massage Establishment and/or Therapist license found in the City of South Bend Municipal
Code, Section 435.
Doc
Sign Lure Date
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