HomeMy WebLinkAboutLicense - 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 46616
Smt 1013 (a,amail.com
PHONE 574/235-9251
FAx 574/235-9171
CITY OF SOUTH BEND TAMES MUELLER, MAYOR
BOARD OF PUBLIC WORKS
April 8, 2025
RE: Approval — License Renewal of Massage Establishment
Dear Ms. Thomas:
At its April 8, 2025 meeting, the Board of Public Works approved your request for the
renewal of the Massage Establishment at 914 Lincoln Way West.
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: 03/03/2025
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: 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 (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
227 West Jefferson Blvd + Suite 14OD S -5outh Bend, Indiana 46601 •574135.5912 • F: 574.233.9021
LICENSE APPLICATION FOR - MASSAGE ESTABLIS MENr�
MUNICIPAL CODE SECTION - 4-35CC f'��
CV, y l ] $
I. APPLICATION TYPE Check One:
II. BUSINESS DATA
A. Business Name: a
New Renewal
B. Business Address: 7 f L—vvVV
City: 56 State:
C, Mailing Address (If differentfrorn above);
Zip:
City: State: Zip:
D. Business Telephone Number:
E. Business Fax Number:
F. E-Mail Address:
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 NOr
1. If yes, what was the reason:
Z. If yes, what was the business occupation following thesuspensionjrevocation:
I. Describe the nature and scope of the business: L r — `
For Office Use Only
Application Filed F E B 2 8 2025 Public Safety Approval
Application Fee Paid F" M License Fee Paid FEB2M
Sent to Dept. License Number
s
zonlrw$—
Not Approved
CITY OF SOUTH BEND, INDIANA
Reason BOARD OF PUBLIC WORKS
vl�a
Elizabeth A. Maradik, President
�� Qs�lr%tet
Gary A. Gilot, Member
� t 7rt,
Joseph R. Molnar, Vice President
Breana Micou, Member
�4
Murray L. Miller, Member
Attest: Theresa M. Heffner, Clerk
Date: April 8, 2025
For all municipal business Ike nse questions, contact: CI[y of South Bend • Department of community Imestment
227Wealeffemon BNtl • 5ulte 14005 -South Bend, Indiana 46WI • 574.235.5912 a R 5)42B5.9021
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION - 4-35
III. OWNERSHIP
A. Type of ownership (check op):
Sole Proprietorship (If sole proprietorship, proceed to 1).
Partnership (If partnership, proceed to 2).
Corporation (If corporation, proceed to 3).
1. Sole Proprietor C
Name: JAI A
Residential Address
City: State: )IS:q(oo
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, mrnad: City of South Bend • Department of Community Investment
222 Wei[lenerson Blvd • Suits 1400 s •SmAn Bend, Indiana 46601 • 574.235,5912 • F: 574.235.9021
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION -4-35
III. OWNERSHIP (Continued)
3. Corporation (Continued)
Business Address:
City: State: Zip:
Residential Address:
IV. PERSONAL DATA
A. Applicant's Legal We: 5a L LQ p
B. Residential Address: .I
City: 3ZA State: Zip:
C. Residential Telephone Number:
D. Residential Fax Number: /� CC
E. Celephone Number: 5741— 9
F. E-Mail Address: f) Q' Ol r f c-e_k`
G. Position with business:
H. Please list all criminal Convictions (if any, excluding trafFlcviolations:
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 Stale Dates
Far all municipal buslness license questions, contact: City ofsouth Bend • apartment of W mmunity Investment
227 Wert Jefferson Blvd • Suite 1400 S •South Bend, Indiana 46601 •94.2355912 • R 574.235.9011
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION -4-35
IV. PERSONAL DATA (Continued)
N. Photographs:
Atta � 'catian.
� g
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
VIL INCLUDE 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 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
lassage Establishment and/or Therapist license found in the City of South Bend Municipal
Code, Section 4-35.
;1/1
Signature �Date
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