89-659 WMITE - CITV CLERK COURClI P / �
PINK - FINANCE GITY O AINT PALTL /� /'
BLUERV - MAVORTMENT File NO. u �'w
- C un 'l Resolution
.� �
Presented By �
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That application (I # 9302) for a Massage Therapist License
by Pamela A. Faric DB Sr. Rosalind's Professional Massage
Center at 734 Gran Av nue, be and the same is hereby approved.
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimond
Loa� [n Fa or
Goswitz
Rettman d B
Scheibel A ga i n t Y
Sonnen
�lson
APR 1 ,� � Form Approved by City Attorney
Adopted by Council: Date . •
Certified Pas- Council Secretary By 3 Z3 �
By ,� �
/�pprov y Mavor: Date Approved by Mayor for Submission to Council
By BY
�tl$USI�ED AP R 2 1 89
� ' ��y� G�9
. r
o1Mp�iA� ane ,eo , cu�tE corp►��O. . _
J. Carchedi
QF ����``�"' �No.fl 0 2��#�$
CONTIICr vEASON oEa�r�Er�r owECroA , r�r�q ton�erer�
Ifri s Van rn . : ' , _ — ����� 3�«� :
� 2 �ounci� ftesearch
. . �� �
F• , ,' _ ' 1. ��� ;.
i,
APp�icaticm for� a Massage Therapi t icense. 1
. . . . ' .� . . . ,
Notffication Da�te: 3-29-89 Hearing Dat` : 4-i3-89
n�oa►�:.t�varora w«�ca�► ; .
Krw+�o oo�a+ cron:se�co�a�issaN o��a+ o��a1r Mw.vsr i R+o►�No. .
norr�a� �so eps acr+oo�eawo _
� STAFF . .. . . �CFMATER�CO�diSStON AS 18 . �ADDL.MIFU.ADDEO - . .:AET'D'�t!CONTACT � � . COlIB'ffR�R .
� - � � . � . . . � � __FOR AOOL MFQ.*..� ._��(ACDEO� ..
D�TPoCT COUNCIL � �. � x T� . . � - . � � . .
. . . - . .. i . . . . .. . ;
�� &1PPf1R"fS�VYIiR:H COUNCK�:�QYdECi1VE7 . - � . . � .. •. .. . I . . - . . � .�� � . . � '
i
. . - � � . . � , . . . . �
. .. � . . .. . : � . .. , � . . . . . - � .. I . . . � . . . . . . � . .
NitA7f10 PRl�L�,NYIIE.OPPOIITIpNTY .VNwt.WherR VVIM/e.YN1Yk _ I
Pamela A. faricy DBA Sr. Rosalind s rofe.ssional IM�ssag Genter at 734 Grand .Ave. .
requests Counci,l' approval of her pp ication for a Massa e TherapisL` License.. `
. . . . . . . . . � . . . , . . .. . _
� ���, � i . . - . ..
.. �'�1R�T/t���r��r�i�1i/:.. . . . " . . '.�'.� : . -... �'.. . . .. ... ._ . . . .� . � .... . .. . ,. . .. '-..� . . . ` '��.
. . . � . I ' . � . � �
.. . . . . . � � - . . . � .
I
A11 applications and fees have be n bmitted. All requ'red depart�e�ts have �
revieKred a�ad approved this aPP�ZC ti . .
_ oaM.ou�s l�.v�n.�:.a�a ta v�o�a:,. . , _ ; .
If Caunci 1 apprbval i s not receiv , . Fari c�+ wi i 1 not be al lor�ed to _
practice massage therapy. � .�
... ,
. ., , . , ;
'�t.t�ru►n�:: '` ; ,,. . . ' � t� '
I ,
�romnr�rs:
�•
, : ` MAR 2 91989 , :
: � ._ .- ,
. _ .
_ �+�: ,
;
� _
�
. ,
,
� - ;
�. i . _. . . - a
(
. _ �RY OF. Fp�l/QRBAIiRATION/PRNiCdPAL.B: < .
�STf�cEN01.DEAS tusU rosinoN(+,-.o, �; r:wu�sri�rt.�rn� w►�u►�e Ssu�,mar�ze n��n��rn.na�
FINANCIAL IMPACT �s'r re�n csa�w»r aEOOrw venn r,o�s:
o�FU►�suoc�Er:
REYENUES QENERATED ........................................................_.....
EXPENSES:
Selaries/Frirpe Beneflts.....................................:..............:... �
EQ��M..............................................................................
- �RF��................:.................:.....:......:...........:...................:. _., -
Caitracts for Service.............................................. ....... - _
Olher
PROFR(LOSS) ............................... ............................. ...
. F!lNDINfi SOURCE FOR ANY LOSS(Neme and Mraunl)
C�AL IMPROYEIAENT BUOCiET:
DESIGNCOSTS.........:......................................................................
. AECt�iS1T10N COSTS:.............................:....:. _ : _
- C,OWSTRUCTION COSTS ................................................................
,`
E
' TOTAL..................................................................................�................
SOtlRCE OF FUNDMG(Narrre and Amount) '
IIMAC7 ON BUDOET:
ANOUNT CURRlN[I'I.Y BUD(�TED................:....:..:.:....... ........ _ _ _ _ � . . , .
- : . . _ .
A#AOUNT IN EXCESS OF CtJKREM 8llDOET.........................._ ` _ _
SOURCE OF ARAOUNT OV�t BUQOET........................................ ,
PROP6RTY TAXES GENERA'1'ED flOST1 .:.....:.
�At10N FIfSPO�.(T1f:
DEPT/OFFICE DIVISION FUN[)TITLE
_ .
8UD(�ET ACTNITY NUMBER&'TITLE ACI7VITY MI1NA(iER -
FIOW PERFORMAtICE WIL.L 9�MEASIIRED?:
ppQORAM OBJEC7IVES: PROGWAILMiWCATORS 1ST YR. 2ND YR.
E1/ALUA710N REB�lTY:
�r� oEwr. Prwne rw. REPORT TQ COINVCN.OF onTE .
FlRST QUARTERLY
: . _ - _ _ _ BY
. �'9 ��'
DiVISION OF LICENSE AND P�RMIT ADMIN ST TION DATE ✓ �I 0 � / � � (�[
INTERDF.PARTI�fENTAL REVIEW CHECKLIST Appn ro essed/Recei ed by
�
Lic Enf Aud
Applicant ���Q,�(,(,, �. �(,�y��� Home Address 1� 3(� �dm,, n �
�
Rusiness Name Sr �OY�rn�S 1� lo b.� Home Phone �p �i� Q �Q �
/��lQ SSce C. ('�n•�.�'�'
Business Address �� Type of License(s) /�QS�(�jQJ
Business Phone �,Q►/f���s�
Public Hearing Date �� gq License I.D. 46 � 9 3 Q Z
at 9:00 a.m, in the Counci Chauibers �1
3rd floor City Hall and Courthouse State Tax I.D. �i v� � � `J � aU
llate A'otice Sent; �I2� �G ��l o Dealer �� � �/-�''
to Applicant - 1
rederal I'i.rearms �� � ��
Public Nearing
DATE T.NS EC IUN
REVIEW VERFIED ( 0 UTER) CUMMENTS
A roved ot A roved
�
Bldg I & D +
��120 ��
Health Divn. �
�
�� ��1 � o�
Fire Dept. � �
� 31wI �
! s�n� 3( �
Police Dept. I
i
License Divn. '
3� 2� , ��
City Attorney �
3/�3 ! o k
Date Received:
Site Plan IU �
To Council Research ��o'L.� ��y
Lease ar Letter Date
f rom Landlord '�J
CURRENT INFORMATION NEW INFOFtMATION
Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
Current Officers: Insurance:
Bond:
Workers Compensation:
New Officers:
Stockholders:
CI�7 OF ST. PAUL
DEPAR17�1R OF F CE MA1�AG�IT SBttVICES
LICEl�SB DIV�SIOA
These ststement toTma are iasued in i t�. Pleaae ans++�r all questions 11i1]y aad
em�pletely. This spplication ia thos� cmecked. At�y laltilication +rill be csvse
for denial.
� � 19 �7
1. Application for �ti � : � - � �� : ��:^_?c< . � (I.icense) (Perait)
�i °
2. Aame o! applicsat �a rv�l � �,.� l L.�.
�
3. If applicant is/has been a married e e, list maidea name
b. Dste of birth 7 � 1 `�- Age� place ot birth �_�,�y, �c'� .
-
5. Are you a citizen of the IInited Sta es � Aati�e l�_Faturalized _
6• Are you a registered voter , Where
?. Aose a+ddress �� ' EG� YYZU r �, S-� . P f"�'�r1- � �� �4=2.C; j
� Prc��cc , ��-,��c�t
- . Present business address ���- __uainess tel�ptiant �� ���
9. u,civa� �+ �' r 5'�ro� '-"' .
n6 Y�' Pretent bnsiness/emp , v�at bnsiness�i�ployseat ha�e y6��
Pollo�+ed for the past liv�e years,
Busirreas/F�eploymerrt Address
��.� ����i�, rv�s��� (�.,, - �3 �a,�.d �- : I`��Q i^�U� .
c�mu2.E �u i1n ct.1� ��Ji c�.-i G2°_� .L(n,�• ,_ ,,�. ��S �C.t-�L�D �Q s51. ��U q. ST�-vL �r
L2Q��@.o. ,
C6t,���S_e,F. -
'� � � � �� • C . �.r �c�,, r„`-�
_ , f , �
10. Married _ If ans`rer is yes", li � a�dr�:s rrt �s�
I1. ?iave yvu ever been arrested for an fe e tbat has resulted in a coQVictionT
If answer ia "yes", list dates of a s, rrhere, charget, cmrvictions and
aentenees.
Dste of arraat 19 �
_..._
CHAFCE
CONVICTION g�
Dnte �2' arrest I9 er
CHARGr
CONVIGTSOtI S��
12. List the names and addresses (i ed, name ot spouse also) o! all persooa,
corporations, partnerships, ass i ions or organizations wtrich in a�r �r hava:
a. A mortgage interest in the sed premise,
b. A security interest in the ed presises, license, or fnrniahings o! the
licensed presis�,
c. A prcmissory note !or funds d tor the aperatio� of the liceneed p�emise
or the pnrchase ot'the lice e,
d. Finar�cially contributed to t e ch8ae oP the premise or the license it-
self
e. ArLy other interest either di ec or indirect, either Pinancial or other+rise
�
in the licensed premise or t e icenae itself,
Attach a copy hereto of any and all d nts referred to in thia attidsvit.
1?. Give names and addresses oP t�o r ons, resideats of St. Paul, Mirmesota, rbo
cat� giv�e iuformatioti concerning ou
AA1� AD�S
�.r-,d� �ac -a � ��- a���c� Sk . {��{,�.� �����-
�ct �' �a.r t c 1�� m.�s,,���► `� �; +�e.t� .�� v���q
, J:�I��v
14. Addreas of premisea for �+hich Li en e or Permit is ms+de
Address Zone classificatian
1�. �etWeen rrhat cross streets Which aide of street
16. Naae under rhich thia bnsiness. 11 be corWucted 1'i'�D`1'CS�G6Y�C� �.Q-�� U
17. Business telephoae number c� �` ���
1°. Attach to thia applicstion, a de si ed deacription of the design, locstioa, and
aquare footage of the premises t b licensed
�9. are oremises nrn+ �ccupied t business '���,��cSt�v��-� H� loog=c�?S .
� II�Ct..d-OCZC�' �,4.v\�
20. Liat license w!zich you currently ho d, or formerly held, or m�y have an intere
in
' . �,. • � � C CUI.Q-Wt..l L(�Q � G1��1
' . /l.Gi C,t��
� . � . � b �.
21. Hav any of the licenses listed y ou in Ro. 20 ever been sevoked. Yes
No . If anaver is "yes", is dates and reaaona:
22. Do you have an interest of at�y t e in aqy ot.ber business or business premises. ��
I° anBwer is "yes", list busines , iness address aad tele�hone numb�r.
23. If business is incorporated, giv d of incorporation 19
and attach copy oP Articles of I co oration and ffinutes of first meeting.
24. List all officers of the corpora io giving their names, office held� hame
address, and home and buainesa t le one nt�bers:
25. If business is partnership, list (s) address and telephooe nt�bers:
Name dreas Te1.No.
-
.__
26. Is there a�►one else rho will ha interest ia thia buai�as or premisea4
If answcr ia "yes", give name, h dreaa, telrphane nt�bers aad in w�st
manner is tt�eir interest:
27. Are yo�u goin�t to operate this bus ne a peraonally _ i! aot, xho xill operate
it:
A� Hosoe address �e1.Ao.
,, _ . •
Are you going to have a Mana�er o a aieteat in this business? If ansNer is
��yes", give name and ho:ae address an home telephone number:
Natne sddress Z�e1.No.
29. Has arLyone ya: have named in ques io s 22 through 26 ever been arrested? IP
answer is "yes", list name of per on, dates of arrest, where, cherges, comric-
tions and sentence
. 30. Z understand this premise may be in-
spected by the police, Pire, heal h d other city ofticials at a�r and aU.
��mes wher the busin�ss is in o�e at on.
State of ylinnesota)
)5S
County of Ramsey )
��''��a' �' �� be g irst du�y sNOrn, deposes and says upo�n
oath that he has read the oregoing st te nt bearing his si�ature and lmovs the
contents thereof, aad that the same is t of s own lu�arledge excrpt a� to those
matters therein stated upon informatio a liet snd as to thoae �atters he be-
lirves them to be true. %
Subscribed and sirorn to bePor.e me ����'� �l ' t
Signature of ,Applica.nt.
this �� day oP 1?�
Natary Public, l�amsey Coua Minne,sot
�r co�issioa eacpires �5�l y
__ ,�,w�n,,,w„� ■
- i"� CHRISTlNE A R�ZEH �
� ' �NdTARVPG3LIC—Mi?JN=SUTA
� �'�. RAM�EY �:�tiNTv
� My Commissan txpues Aug. 15, i994
� ■
,��••e, CITY OF SAINT PAUL
'� �' DEPARTMENT Of COMMUNITY SERVICES
. .
. :
•� �� DIVISION OF PUBLIC HEALTH
•••• SSS Cedu Saeat.S�int Pwl.Minnewts SS101
Geo►ge latime► (6121 292-7741
Maycr
November 14, 1988
Pamela Faricy
163� Edmund Avenue
St . Paul , Mn. 55104
Dear Ms . Faricy :
I am happy to inform you that yo h ve passed the massage therapist
written and practical examinatio s• You may now make application for
a license at the License Inspect r' Office, Room 203 City Hall,
15 W• Kellogg Blvd. , St• Paul , M . 5102.
Bring this letter with you when ak' ng application.
Sincerely,
CC!��'�Q�
Gary J . Pechmann
Environmental Health Program Man ge
6JP/msg
`,
<