HomeMy WebLinkAboutLicense - Massage Establishment Renewal - AB Reflexology & 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
April 8, 2025
Ms. Li Wen
AB Reflexology & Massage
2614 S. Michigan St.
South Bend, IN 46614
Liwen661 a,yahoo.com
RE: Approval — License Renewal of Massage Establishment
Dear Ms. Li Wen:
At its April 8, 2025 meeting, the Board of Public Works approved your request for the
renewal of the Massage Establishment at 2614 S. Michigan St.
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: 02/26/2025
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: AB REFLEXOLOGY & MASSAGE
ADDRESS: 2614 S. MICHIGAN ST.
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.
For all municipal business license questions, contact: City of South Bend - Department of Community Investment t-[LC I1
227 west Jefferson Blvd - Suite 1400 S -South Bend, Indiana 46601 - 574.23S.S912 - F: 574.235.9021 L-STc�77
6eC. � 0173.11
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION - 4-35
I. APPLICATION TYPE Check One:
II. BUSINESS DATA
A. Business r
B. Business I
City:
New
C. Mailing Address (If different from above):
Renewal
X
."W�Zip: "6/(Z'
City: State: Zip:
D. Business Telephone Number:
E. Business Fax Number:
F. E-MailAddress: _f 4 weh 66 l R VrA lwo ('e,,',jn
G. Zoning of Business Location:
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 ,_ XL-_
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: MaGS
v
For Office Use Only
Application Filed FEE 1 9 7025 Public Safety Approval
Application Fee Paid-, FB ]. 9 7(17Si License Fee Paid i
Sent to Dept. FF8 1 9 2025 License Number_(iiSC'A0a,I5,-0C(r
jfeal�-�50 %ab
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
Not Approved_____
Reason
Elizabeth A. Maradik, President Joseph R. Molnar, Vice President
Gary A. Gilot, Member
Breana Micou, Member
Murray L. Miller, Member
Attest: Theresa M. Heffner, Clerk
Date: April 8, 2025
For all municipal business llceme question; canted: Oty of South Bend • Department of Community Invesnnent
222 West Jefferson Blvd • 5uie 1Q05 •South Bend, Indiana E6601 •574.235.5912 • F: 574235.9021
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 to3).
1. Sole Proprietor
Name: L/ w
Residential Address:
City:2LrI1 4,rt State: 7� Zip: CL(a l
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:
Tile:
Business Address:
City:: State: zip:
Residential Address:
City: State: Zip:
2
For all municipal business license questions, Comad: CRy N South Bend • Department of Community Imrestment
227 WestleferSon Blvd• Sulte 14005 South Bend, Irarer a 466011 574.235.5912•F: 5X235.9021
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION - 4-3S
IV. PERSnmAI n4TA frnninnodt
he
O. Please list all previous employment for three
\\\(3) years prior to the date of this application:
Company Address City, State, ZIP Dates
O JZ
G,m S G/u�2W �/. rx.K n ZN 3
�had�Sllsheeessary)
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. 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 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 of the
Massage Establishment and/or Therapist license found in the City of South Bend Municipal
Code, Section 4-35.
Signature Date
4
For all municipal business limnse questions, wntaet City of South Bend • Department of Community Investment
227 West Jefferson BIW • Suite 1400 S •South Bend, Indiana 4901 • 5M235.5912 • F: 57C235.9021
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION - 4-35
III. OWNERSHIP (Continued)
3. Corporation (Continued)
Name #3:
Residential Address:
IV. PERSONAL DATA
A. Applicant's Legal Nam
B. Residential Address:
city:.,39x6, 12e,4 State: ZN Zip: 4CIj60 /
C. Residential Telephone Number:
D. Residential Fax Number:
E. Cellphone Number: ely 13
F. E-Mail Address:. IAJeek 16dl CCVV\
G. Position with business: (�,)Ae.
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
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