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Home My WebLink AboutLicense - Massage Establishment Renewal - Rachael T 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 August 13, 2024 Ms. Rachael Thompson Rachael T Massage & Essential Oils 616 E. Colfax Ave. South Bend, IN 46601 Rachaeltmassage. eoils(ab gmail. com RE: Approval — License Renewal for New Massage Establishment Dear Ms. Thompson: At its August 13, 2024 meeting, the Board of Public Works approved your request for the Renewal of the Massage Establishment at 616 E. Colfax Ave. 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: 03/22/2024 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: RACHAEL T. MASSAGE & ESSENTIAL OILS ADDRESS: 616 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 FIRE: Favorable 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 Invest merit CV 227 West lefferson Blvd ■ Suite 1400 5 -South Bend, Indiana 46601 ■ 574.235,5912 • F: 574.235.9021 �+ ^4tC LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT C4-577 MUNICIPAL CODE SECTION - 4-35 I. APPLICATION TYPE Check One 11. BUSINESS DATA t] A. Business Name: 4�QC B. Business Address: 6itP City: Slw�sv New Renewal V/ 1rswwI &A bikj C. Mailing Address (If different from above): City: State:JJ - zip: gtvtb 17 — -- State: D. Business Telephone Number:(ggj E. Business Fax Number: ---- F. E-MailAdd ress: I"QdA( «I)YlAAe -eoo4 (a 41)1QIt, CofyI G. Zoning of Business Location: Zip: 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: Z. If yes, what was the business occupation following the suspension/revocation: I. Describe the nature and scope of the business: Pay iL dT 46-alz At wii1AA -'1LI• For Office Use Only Application Filed MAR 2 1 2024 Public Safety Approval Application Fee Paid MAR 1 2024 License Fee Paid u I?. Sent to Dept. MAP 2, 2024 License Number Hea1A—i9go1-16L- S P:>Fa Nt Ad �LPb CITY OF SOUTH BEND, INDIANA opprove Reason BOARD OF PUBLIC WORKS IwLa 7Tt Elizabeth A. Maradik, President Gary A. Gilot, Member P 2—" /. 7—"*- Murray L. Miller, Member Joseph R. Molnar, Vice President Briana Micou, Member 6 ;</X,/, �'. Attest: Theresa M. Heffner, Clerk Date: August 13, 2024 For all mumdpal business Ilcen6e questions, contact: city of Soup Bend • Department of Community bNeannem 227 WesUef erson BIW • Sulte 3440 5 •Sou h Bend, Were 46601 • 574.2355912 • F: 524.235.5@I LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT MUNICIPAL CODE SECTION - 4-35 III. OWNERSHIP A. Type of owners p(checkone): Sole Proprietorship (If sole proprietorship, proceed to 1). Partnership (if partnership, proceed to 2). Corporation (If corporation, proceed to 3). 1. Sole Proprieto�II^I� -} Name: In4lIAL IfL"YYIYfi�1t� Resider,el=I enn. City: 2. Partnership (List at least two (2) partners) Name#1: 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 #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, contact: City of South Bend • Cepa"me ntuf Community In"Amerd 222 West Jefferson BIM • suiR 340n S •South Bend, Indiana 46601 • 524.235 5912 • F:524.235.9021 LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT MUNICIPAL CODE SECTION - 4-35 III. OWNERSHIP (Continued) 3. Corporation (Continued) Name N3: Business Address: Residential Address: IV. PERSONAL DATA A. Applicant's Legal B. Residential Add C. Residential Telephone Numbek ORU 64LI-6w D. Residential Fax E. Cellphone Numb F. E-Mail Address: G. Position with business: AVWX i H. Please list all criminal convictions Ill 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 For all municipal business license questions, mMatt: City of South Bend • Department of Cemmunity Investment 227 West Jefferson Blvd • Suite 1400 S -South Bend, Indiana 46601. 574235.5912 • F. 51A235.9023 LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT MUNICIPAL CODE SECTION -4-35 O. Please list all previous employment forth ree (3) years prior to the date ofthis application: Company Address VaLhIld (DIUC (401 Rvr es3f�+� of I (Attach additional sheets if necessary) V. INCLUDE WITH APPLICATION City, State, ZIP Dates 5,1rh�nd� y�vn �nfs-citrvcn-+ 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 ofthe Massage Establishment and/or Therapist license found in the City of South Bend Municipal Code, Section 4-35. 1pat PU �63lavlau� u Sig ure Date }§ 0- J ■ \ }!« I - ®/ ` \ \ \ ) ! ) . . \\} DR ƒ \ J