HomeMy WebLinkAboutMassage Establishment Renewal - KT Rose Spa1316 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 13, 2025
Ms. Xiaoyan He
KT Rose Spa
244 S. Olive St.
South Bend, IN 466159
ktrosespainc(ab gmail. com
RE: Approval — License Renewal of Massage Establishment
Dear Ms. He
At its May 13, 2025 meeting, the Board of Public Works approved your request for the
renewal of the Massage Establishment at 244 S. Olive 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: 02/14/2025
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: KT ROSE SPA
ADDRESS: 244 S. OLIVE 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
I Industrial district.
For all municipal business license questions, contact; City of South Bend -Department of CCrnrnrnity Investment
227 West Jefferson Blvd • Suite 1400 S -South Bend. I ndiana 46601 • 574.235.5912 + F: 574.235.9//0''��22 {j r y� �
LICENSE APPLICATION FOR -MASSAGE ESTABLISHMENT j 01 S U0t
MUNICIPAL CODE SECTION - 4-35
I. APPLICATION TYPE Check One:
IL BUSINESS DATA
New Renewal
A. Business Name: � 1 9 2se, „I;p
B. Business Address: 14+'� 0 'Vje �
City: �1"1t.f."�i�i Rod State:_
C. Mailing Address (If different from above): &*6
Zip: b i
City: State: Zip:
D. Business Telephone Number:d�
E. Business Fax Number: 'INN
F. E-Mail Address; 4M_V_q (AG , 'gmal l' CAw-
G. Zoning of Business Location:�thI+
H. Have you ever had a Massage Establishment license, or similar license, suspended or revoked
by any governing municipalit within three (3) years prior to the date of this application:
YES NO
1. If yes, what was the reason:
Z_ If yes, what was the business occupation following the suspension/revocation.-
the naturg and scope of the business:
For Office Use Only
Application Filed Public Safety Approval J 4 J
Application Fee Paid License Fee Paid APR
Sent to Dept. 4 P R j 4'212; License Number R&C 5-02'1— Q 1-7
Not Approved
Reason
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
M,
Elizabeth A. Maradik, President
Gary A. Gilot, Member
Joseph R. Molnar, Vice President
Breana Micou, Member
Murray L. Miller, Member Attest: Theresa M. Heffner, Clerk
Date: May 13, 2025
For all munid"I business license questions, contact: City of South Bend • Departmentof Communos Investment
227 West lefhrson Blvd, Suite 1Cm 5 asouth Bend, Indiana 401 r 574.235.5912 a F: 574.235.021
LICENSE APPLICATION FOR -MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION - 4-35
Ill. OWNERSHIP
A. Type of ownership (check one):
Sole Proprietorship (If sole proprietorship, proceed to 1).
Partnership (If partnership, proceed to 2).
Corporation (If corporation, proceed to 3).
1. Sole Proprietor
Name:
Residential Address:
City: State: Zip:
2. Partnership (List at least two (2) partners)
Name#1: )(1640Ht H2
Residential Address:
LEE —
City ANSION-State Zip:
Name#2: gaNOIA Tofi
Residential Address:
City: State:=Zio:]SEES
3. Corporation
Legal name ofcorporation:
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 mundpal business license questions, wni City of South Bend • DeBanment of Community Investment
227 West Jefferson BIW • Suite terns •5ouM Bend, Indiana 46601 • 5]4.2355M • F:574.235.9021
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION -4-35
III.OWNERSHIP (Continued)
3. Corporation (Continued)
Name #3:
Title:
Business Address:
City: State:
Zip:
Residential Address:
City: State:
Zip:
IV. PERSONAL DATA
A. Applicant's Legal No OUt He
B. Residential Address:
City: State: Zip:
C. Residential Telephone Number:
D. Residential Fax Number:
E. Cellphone Number:
F. E-Mail Address: kf YDSf_ SD0._ I�rycf (, CO(A
G. Position with business:
H. Please list all criminal convictions if arty), excluding trafficviolations:
Nature of Conviction
Conviction City State
Date
IV
(Attach additional sheets if necessary)
I. Please list all addresses for three (3) years prior to application date:
Street Address City State
Dates
(Attach additional sl
J. Date of birth
K. Gender:
L. Social Security Number.
M. Race:
3
For all municipal business license que5vons, mntaM City of South Bend • Oepartmentnf Community Invertm0rt
227 West leRerson Blvd • Suite 140()S -South Bend, Ind lana 46e01 • 520.235.5912 • F: 574,235MI
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION -4-35
IV. PERSONAL DATA (Continued)
Company Address City, State,"' Dates
kT Re p SPA 2y4 S Olive St 5ou0 Ben2L 41 L wxws
— 41uys
(Attach additional sheets if necessary)
V. INCLUDE WITH APPLICATION:
Three (3) passport size photos taken within 6 months of application.
VI. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION (7theraPjSt
VIL INCLUDE A LIST OF ALL MASSAGE THERAPIST EMPLOYED BY ESTABLISHMENT rjQr yal� 10r1
Vill. INCLUDE A LIST OF SERVICES AVAILABLE AND THE COST OF SUCH SERVICES �II10 NA COYAG��.
IX. AFFIRMATION
1, 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 Establishment and/or Therapist license found in the City of South Bend Municipal
Code, Section 4-35.
yw i otiA� H J_ 7 7 n
Signature Date
n
7 DAYS A WEEK.
-4 -
* �
1/2 hour $50000
1 hour $ 70*00
1112 hour $110000
2 hour $140*00
4 HANDS $140,P
Buy 10- 1 Hour Appointments
for $600 and get
lHour Extra FREE Massage!
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