HomeMy WebLinkAboutMassage 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
March 25, 2025
Ms. Rachael Thompson
Rachael T Massage & Essential Oils
616 E. Colfax Ave.
South Bend, IN 46617
Rachaeltmassage. eoils4,gmail. c om
RE: Approval — License Renewal of Massage Establishment
Dear Ms. Thompson
At its March 25, 2025 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/hh
ELIZABETH A. MARADIK JOSEPH R. MOLNAR GARY A. GILOT MURRAY L. MILLER BREANA N. MIcou
INTEROFFICE MEMORANDUM
BOARD OF PUBLIC WORKS
DATE: 03/04/2025
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. COLFAXE 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 (passed fire inspection)
COMMUNITY INVESTMENT: A massage establishment is a permitted primary use in the
NC Neighborhood Center district.
Far all municipal business license questions, contact: City of South Bend • De--artmen:of Community Investr:ient
227 West Jefferson Blvd • 5ulte 1400 5 -SDuth Bend, Indiana 4E601 • 574.235.5912 • F: 57,4.235.9021 j
W- &9
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT'
MUNICIPAL CODE SECTION - 4-35
I. APPLICATION TYPE Check One
11. BUSINESS DATA I
A. Business Name: QCIM1 T
B. Business Address:
New -Rtenewal
fllkf
State: aj 7ip: ql � 17
C. Mailing Address (If differentfrom above):
City:
D. Business Telephone Number: J li-0`t`1-JV/V
E. Business Fax Number:
F. E-M a I Address: 1 a014 -4 VY)wsanj , PDI k A� fl VW1111 - t b ryY
Zip:
j{ L � .
G. Zoning of Business Location: V
H. Nave you ever had a Massage Establishment license, cr simiIa r license, suspended or revoked
by any governing municipality within three (3) years prior to the date of th is a p plicatio n:
YES NO�
1. If yes, what was the reason:
2. If yes, what was the business occupation following thesuspens ion/revocation:
L Describe the nature and scope of the business:
0
For Office Use Only
Application Filed MAR 0 3 2025 Public Safety Approval
Application Fee Paid l 1Hlt 0 3 2 OF License Fee Paid rv)!', { 0 3 WS
Sent to Dept. 1 rvlh;� t -q ?D17 License Nurnber ry SC AVn
�5010 ` J& CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
Not Approved
Reason
taa4
Elizabeth A. Maradik, President
Gary A. Gilot, Member
pt",,r 7rrti0�
Joseph R. Molnar, Vice President
Breana Micou, Member
Murray L. Miller, Member Attest: Theresa M. Heffner, Clerk
Date: March 25, 2025
For all municipal business license que ibons, contact: City of South Bend • 0epar[mentof Community Investment
227 Wea eRerson Blvd • Suite 1E00 5 •SouN Bend, IMalaria 46601 a 574.235.5912 a F: 574.235.9021
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION -4-35
III. OWNERSHIP
A. Type of ownership, check one):
N Sole Proprietorship (If sole proprietorship, proceed to I) -
Partnership (# partnership, proceed to 2).
Corporation (If corporation, proceed to3).
1. Sole Proprietor
Name: PcIJVJ IDMP500
Residential Address:
City:.PA La State: T9 Zip:
2. Partnership (List at least two (2) partners)
Name #1:
Residential Address:
City: State: Zip:
Name#2:
Residential Address:
City: State'. ]i p:
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 thinness Ilcense questions, contact: City of South Bend • Departmentof Community Investment
227 West Jefferson Blvd • Suite 14M S -South Bend, Indiana 46601 •574.235.5912 • F: 570.235.9021
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION -4-35
IV. PER
♦r
it
0. Please list all previous employment for three (3) years prior to the date of this application:
Company Address(14 L toQ1 City, State, ZIP Dates
I— )U C)AIIId n C401 SQ LLIW4
(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
VI I. INCLUDE A LIST OF ALL MASSAGE THERAPIST EMPLOYED BY ESTABLISHMENT
Vill. INCLUDE A LIST OF SERVICES AVAILABLE AND THE COST OF SUCH SERVICES
IX. 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 noway attempted to
mislead the City in this application by omitting facts known tome. 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 Est lishmentand/or Therapist license found in the City of South Bend Municipal
QOde, Sect n -35.
ulfV Y J�0 ��
�Ig Fdture Date
4
For all munIdpal buslness Hoarse questions, mmacn City of South Bend • Deyartment of Community Investment
227 West Jefferson BIM • Surte 1400 S -South Bend, Indiana M601. 5]1235.5912. F: 524.235.9021
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION - 4-35
III. OWNERSHIP (Continued)
3. Corporation (Continued)
Name p3:
Title:
Business Address:
City: .State: Zip:
Residential Address:
City: State: Zip:
IV. PERSONAL DATA n�
A. Applicant's Legal Name: Ra—
rril IRDfYlDm
S. Residential Address:
r
City: ` hk W state.?♦) Zip: ULIt15
C. Residential Telephone Number: IN -50-.3&q
D. Residential Fax Number:
E. Cellphone Number: mq - 3qqq
F. E-Mail Address:
G. Position with business: OWD1Y D tta
H. Please list all criminal convictions (if any), excluding trafficviola ions:
Nature of Conviction City State Date
Y1DV1l
(Attach additional sheets IF necessary)
I. Please list all addresses for three (3) years priorto application date:
Dates
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Specialized Headache Relief Massage
30 minute session/ $50 1 hour session/$95
Sinus Relief Massage Session
20 minute $30
45 minute session/ $70
Rachael's Signature Express Neck Relief
15 minute session/ $30
Relaxation Massage Sessions
30 minute session/$45 45minute session/$59 1 Hour session/$78 90 minute
session/$130 2Hours session/ $155
For more services:
https://square.site/appointments/bookl9T2CAYZ62NNNHIrachael-t-massage-essential-oils-south-
bend-in
Monday 9:30 am- 4:00 pm
Tuesday 9:30 am- 8:00 pm
Wednesday 9:30 am- 8:00 pm
Thursday 9:30-2:30 pm & 5:00-8:00 pm
Friday 9:30 am- 2:30 pm
Saturday 9:00 am- 8:00 pm