Designer:

Bath Design Survey Form Date: Name: Residence:

Jobsite Address:

Client 1:

Client 2:

Home Phone:

Home Phone:

Work Phone:

Work Phone:

Cell Phone:

Cell Phone:

Email:

Email:

Appointment

Allied Professional

Schedule:

Name:

Call When Ready:

Firm:

Times Available:

Address:

Directions:

Office Phone: Cell Phone: Email:

Notes:

©2008 NKBA BMF9

Page 1 of 18

Copyright 2008 by National Kitchen & Bath Association. All rights reserved. No part of this document may be reproduced in any form by Photostat, microfilm, xerography, or any other means, or incorporated into any informational retrieval system, electronic or mechanical, or transmitted, in any form or by any means, without the prior consent of the copyright owner.

37945-1

General Client Information 1.

What type of project is this?

Renovation

New Construction

2.

Have you ever purchased a bathroom before?

3.

When would you like to start the project?

4.

How much time do you / will you spend at the jobsite residence?

5.

How did you learn about our firm?

6.

Has anyone else assisted you in preparing a design for the bath?

7.

Do you plan on retaining an interior designer or architect to assist in the bath planning?

Yes

No Complete the Project?

If so, Name: 8.

Phone:

Do you have a specific builder / contractor or other subcontractor / specialist with whom you would like to work? Phone:

If so, Name: 9.

What portion of the project, if any, will be your responsibility?

10. What budget range have you established for your bath project? $5,000–$10,000

$10,000–$20,000

$20,000–$30,000

11. How long do you intend to own the jobsite residence? a.

Is return on investment a primary concern?

b.

Do you plan on renting the jobsite residence?

$30,000–$50,000

$50,000–$60,000

$60,000–$75,000

$75,000+

_________________________________________________________________

_________________________________________________________________________ _______________________________________________________________________

12. What family members will share in the final decision-making process? 13. Would you like our firm to assist you in securing project financing? 14. What do you dislike most about your present bath?

____________________________________________________ Yes

No

____________________________________________________________________

_________________________________________________________________________________________________________________ 15. What do you like most about your present bath?

______________________________________________________________________

_________________________________________________________________________________________________________________ 16. Sustainable design ideas important to your family: Use of “Green” Products

General products made from recycled materials:

Cabinets

Counters

Floors

Walls

Building Materials

Wood products supplied by environmentally responsible manufacturers Water usage: Water efficient fixtures:

Sustainable design details incorporated into the plan Toilet

Bathtub

Shower

Energy efficient lighting systems:

17. If you are remodeling: Is there a room addition planned?

Yes

No How old is the present bath?

a.

When was the house built?

b.

Are you considering relocating

windows

doors

_______________________________

walls in your new plan?

18. If you are building a new home: a.

Are you able to relocate

b.

Are you able to relocate walls at this stages of construction

windows

doors

19. Is there a view from the bathroom to be considered:

walls at this stage of construction? Yes

a.

Sun exposure

b.

From where in the bathroom should the view be visible?

c.

What about privacy?

©2008 NKBA BMF9

Yes

Yes

No

No

No

________________________________________________________________________________________________ Bathtub

Vanity

Shower

Other

___________________________

___________________________________________________________________________________________

Page 2 of 18

Copyright 2008 by National Kitchen & Bath Association. All rights reserved. No part of this document may be reproduced in any form by Photostat, microfilm, xerography, or any other means, or incorporated into any informational retrieval system, electronic or mechanical, or transmitted, in any form or by any means, without the prior consent of the copyright owner.

37945-1

Specific Bath Questions 1.

Is this a

Master

Children

Other Family Member

2.

How many bathrooms are in the home?

3.

Who will use the bathroom?

4.

Characteristics of family members who use the bathroom: Are you planning on enlarging your family while living here? Yes

Special Area:

___________________________________ bathroom?

________________________________________________________________________________________

Name

5.

Guest

Age

Height

Handed

1.

R

L

2.

R

L

3.

R

L

4.

R

L

5.

R

L

No

Physical Limitations/Mobility Aids

Personal Information about the bathroom: a.

Will more than one person be using the bathroom at the same time?

How often?

b.

What types of bathroom activities can be done in a shared bathroom space?

c.

What types of bathroom activities need to be done in private?

d.

How important is auditory privacy?

______________________________________________

__________________________________________________________ Are bathroom noises a problem?

6.

Visitability:

a.

Will this bathroom be used by visitors to the home?

b.

Will the visitors be children or adults?

c.

Do any regular or frequent visitors have any physical limitation?

7.

Do you prefer separate showering and bathing areas?

8.

Would you like to consider a tub that will accommodate more than one person?

9.

Would you like to consider a shower that will accommodate more than one person?

Yes

No

__________________

How often?

__________________

_______________________________________________

_________________________________________________________________________________ _____________________________________________________________ _________________________________________________________________ ___________________________________________ ________________________________________

10. Do you prefer the water closet and/or bidet be separate from the other fixtures, and placed in its own compartment?

____________

11. Checklist for Bathroom activities: Grooming Activities Vanity / Lavatory Body:

Teeth: Nails: Cosmetics: Face: Hair:

First Aid: Hands:

Dressing Table

Location Bathtub

Person Shower

Other Room

Person #1

Person #2

Person #3

Washing Shave - Face Shave - Body Apply Lotion Hair washing Brush Floss Finger Toe Apply Remove Skin Care Blow Dry Brush / Style Color Cut / Trim Treating cuts and burns Apply Lotion Wash

Medicines / Vitamins: ©2008 NKBA BMF9

Page 3 of 18

Copyright 2008 by National Kitchen & Bath Association. All rights reserved. No part of this document may be reproduced in any form by Photostat, microfilm, xerography, or any other means, or incorporated into any informational retrieval system, electronic or mechanical, or transmitted, in any form or by any means, without the prior consent of the copyright owner.

37945-1

Bathing / Showering Activities Bathtub Bathing:

Showering:

Sauna: Other:

Person

Location Shower

Other Room

Person #1

Person #2

Person #3

With Someone Assisting an Adult Bathing Pets Soaking / Relaxing With Someone Assisting an Adult Steam Showering Relaxing

Toileting Activities

Person Person #1

Person #2

Person #3

Assisting an Adult: Toileting: Personal Cleansing: Diaper Changing: Reading: Other Bathroom Activities

Location Vanity / Lavatory

Dressing Table

Bathtub

Person Shower

Other Room

Person #1

Person #2

Person #3

Display Collections Undressing / Hamper Dressing: Underwear / Sleep clothes Dressing: “Street” Clothes: Drink Beverages Eat Snacks Exercise w/o equipment Exercise using equipment Grow Plants Laundry: Air Dry Laundry: Hand-wash Laundry: Machine Wash Laundry: Sort / Fold Listen to Music Massage Meditation Personal Pampering Exercise Equipment Polish Shoes Read: Books / Newspapers Supervise Children Talk on Telephone Talking with People Tanning / Sunning Watch Television Other:

12. What appliances do you plan on using in the bathroom: Blowdryer Handheld Wall Mounted

Curling Iron

©2008 NKBA BMF9

Electrical Toothbrush

Radio/DVD/VCR

Valet

Electrical Razor

Television

Washer & Dryer

Fireplace Wood Burning Gas Hot Rollers

Towel Warmer Hydronic (hot water) Electric Scale

Other:

Other:

Page 4 of 18

Copyright 2008 by National Kitchen & Bath Association. All rights reserved. No part of this document may be reproduced in any form by Photostat, microfilm, xerography, or any other means, or incorporated into any informational retrieval system, electronic or mechanical, or transmitted, in any form or by any means, without the prior consent of the copyright owner.

37945-1

Storage Checklist Item

User

Type of Equipment

Make-up Storage

(person #1)

Yes

No

(person #2)

Yes

No

Shaving Storage

(person #1)

Yes

No

(person #2)

Yes

No

Hair Grooming Equipment

(person #1)

Yes

No

(person #2)

Yes

No

Hand and Foot Grooming Equip (person #1)

Yes

No

(person #2)

Yes

No

(person #1)

Yes

No

(person #2)

Yes

No

Medicine / First Aid

Yes

No

Bathroom Paper Product Storage

Yes

No

Bath Towel Storage

Yes

No

Household Bedroom Linen

Yes

No

(person #1)

Yes

No

(person #2)

Yes

No

(person #3)

Yes

No

(person #4)

Yes

No

(person #1)

Yes

No

(person #2)

Yes

No

(person #3)

Yes

No

(person #4)

Yes

No

Pet Grooming / Bathing Area

Yes

No

Cleaning Supply Storage

Yes

No

Shoe Polishing Paraphernalia

Yes

No

Yes

No

Personal Hygiene Equipment

Personal Pampering Equip

Exercise Equipment

Other

Hanging Shoes Folded Clothing Accessories Hats

Other

Full Length Mirror Hanging Shoes Folded Clothing Accessories Hats Full Length Mirror

©2008 NKBA BMF9

Shelf / Drawer Space Required

Shelf Lengh:

# of Pairs

Boxed:

Double Pole: Yes

No

Single Pole:

Shelf Length:

# of Drawers / Pull- outs Yes Rack:

No Yes

Yes

No

Yes

No

Types: No

Boxes:

Wall Space for Racks: Yes

No

Shelf Length:

# of Pairs

Boxed:

Shelf Space:

Double Pole: Yes

No

Yes

No

Single Pole:

Shelf Length:

# of Drawers: Yes Rack: Yes

No Yes

Types: No

Boxes:

No

Page 5 of 18

Copyright 2008 by National Kitchen & Bath Association. All rights reserved. No part of this document may be reproduced in any form by Photostat, microfilm, xerography, or any other means, or incorporated into any informational retrieval system, electronic or mechanical, or transmitted, in any form or by any means, without the prior consent of the copyright owner.

37945-1

Storage Checklist (Continued) Laundry Facilities

Yes Yes

Mini Kitchen

No No

Equipment Size: What Type of Equipment? Refrigerator Other: Other:

Bar Sink

Coffeemaker

Cooktop

Microwave

Other:

Design Information 1.

What type of feeling would you like your new bathroom space to have? Have you created a scrapbook of notes, photos and ideas of bathrooms that you like? American Country

Asian / Warm Contemporary

American Formal

Craftsman / Arts and Crafts

Old World European Personal Design Statement (Eclectic)

Sleek Contemporary Traditional

_________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ 2.

What colors do you like? And dislike?

3.

__________________________________________________________________________________________

_____________________________________________________________________________________________________

What colors are you considering for you new bathroom?

_______________________________________________________________

What are the color preferences of other family members?

_______________________________________________________________

Are there specific materials, fixtures, cabinetry or other features that you have pre-selected and want included in the project?

____

_________________________________________________________________________________________________________________ 4.

Design Notes:

____________________________________________________________________________________________________

_________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________

Special Details:

©2008 NKBA BMF9

Page 6 of 18

Copyright 2008 by National Kitchen & Bath Association. All rights reserved. No part of this document may be reproduced in any form by Photostat, microfilm, xerography, or any other means, or incorporated into any informational retrieval system, electronic or mechanical, or transmitted, in any form or by any means, without the prior consent of the copyright owner.

37945-1

Cabinetry

Source

Key: BS= Bath Specialist O= Owner OA= Owners Agent Base Style

Wall

Use Existing Yes No Face Material

Tall

Furniture (Unfitted)

BS

Furnished by O/OA Base

BS

Installed by O/OA Wall Tall

Wood-Species

Built-In (Fitted)

Laminate Paint

Construction Framed

Acrylic

Frameless

Metal Other:

Door Type Full Overlay

Door Style

Partial Overlay Lip Inset

Hardware

Color and Finish

Knob Pull Finger Pull Material

Soffit / Fascia Use Existing Yes No BS Fascia / Soffit Construction Open

Extended

Flush

Furnished by O/OA Recessed

Installed by BS Fascia / Soffit Materials

Remove

Wallpaper

Other:

Cornice

Wood

Vanity

Use Existing Yes No Shower Walls

Tub Platform

Other

Concrete

Edge Treatment Thickness

Cultured Marble

Shape:

Decorative Laminate

Bevel

Engineered Stone (Quartz) Granite

Ogee

BS

BS

Installed by O/OA

Vanity

Shower Walls

Tub Platform

Other

Square Other: Backsplash

Grout

Height

Wood

End Splash Sides

Other Stone:

Countertop ext. over Water Closet Special Notes

©2008 NKBA BMF9

Furnished by O/OA

½ Full

Size

Special Notes

Lighted

Bull Nose Full

Marble Tile

Paint

Source

Key: BS= Bath Specialist O= Owner OA= Owners Agent

Solid Surface

Display Rail

Other:

Surfaces

Material

O/OA

Page 7 of 18

Copyright 2008 by National Kitchen & Bath Association. All rights reserved. No part of this document may be reproduced in any form by Photostat, microfilm, xerography, or any other means, or incorporated into any informational retrieval system, electronic or mechanical, or transmitted, in any form or by any means, without the prior consent of the copyright owner.

37945-1

Bath Fixtures & Fittings - Water Closet Use Existing Yes

Furnished by

No

BS

Installed by

O/OA

1 Piece Low Profile Wall Hung Round Seat Comfort Height

BS

O/OA

2 Piece Standard Height Elongated Seat Other Other

Color: Seat: Trip Lever Finish: Stop & Supply Finish:

Bath Fixtures & Fittings - Bidet / Bidet Seat Use Existing Yes

Furnished by

No

BS

Installed by

O/OA

Vertical Spray Vacuum Breaker Horizontal Spray

BS

O/OA

Color: Faucet Finish:

Other: Other:

Bath Fixtures & Fittings - Bathtub Use Existing Yes

Furnished by

No

BS

Installed by

O/OA

BS

Material

O/OA

Placement

Cast Iron

Fiberglass

Steel

Acrylic

Ceramic Tile

Cult Marble

Type: Skirted

Right Drain

Fitting #1

Configuration Platform

Left Drain

Platform w/ Steps

Free Standing

Finish:

Location:

Finish:

Location:

Fitting #2 Type:

Bath Fixtures & Fittings - Shower Use Existing Yes

No

Furnished by BS

Installed by

O/OA

Fabricated

BS

O/OA

Fittings

1 Piece

Multiple Piece

Custom Shower Wall Material: Height:

Shower Floor/ Pan Material:

Valve Type:

Head Type:

Finish:

Shower #2

Valve Type:

Head Type:

Finish:

Shower #3

Valve Type:

Head Type:

Finish:

Shower #1

Bench Seat Material:

Shower #4- Body Sprays

Finish:

Shower #5- Hand-Held

Finish:

Diverter

Finish:

Configuration Drain

Finish:

Grooming

Bench

Size:

Other

©2008 NKBA BMF9

Recess:

Size:

Page 8 of 18

Copyright 2008 by National Kitchen & Bath Association. All rights reserved. No part of this document may be reproduced in any form by Photostat, microfilm, xerography, or any other means, or incorporated into any informational retrieval system, electronic or mechanical, or transmitted, in any form or by any means, without the prior consent of the copyright owner.

37945-1

Bath Fixtures & Fittings - Lavatory Use Existing Yes

Furnished by

No

BS

Installed by

O/OA

BS

Material

O/OA Fittings

Porcelain

Glass

Cast Iron

4” Centers

Stainless Steel

Decorative Metal

Composition

Single Hole

Configuration

8” Centers Wall Mounted

Finish

Pedestal/Trap Cover Vessel

Rimmed

Self-Rimmed

Under-Counter Integral

Wall Hung

Other:

Ventilation Use Existing Yes

No

Furnished by BS

Fan

Installed by

O/OA Fan, Light (Combo)

BS

Fan, Light, Heat (Combo)

CFM Capacity:

O/OA Switch

Timer

Duct Work Space:

Heating Use Existing Yes

No

Furnished by BS

Auxiliary

Installed by

O/OA Timer

BS

O/OA

Placement:

Switch

Enclosures (Steam Door/s, Shower, Doors, Drapes, Etc.) Use Existing Yes

No

Furnished by BS

Installed by

O/OA

BS

O/OA

Tub

Finish:

Size:

Type:

Material:

Shower

Finish:

Size:

Type:

Material:

Steam

Finish:

Size:

Type:

Material:

Sauna

Finish:

Size:

Type:

Material:

Curtain Rod Finish:

Size:

Curtains (Color)

Size:

Light Fixtures Use Existing Yes

No

Furnished by BS

O/OA

General Incandescent

BS

O/OA

Ambient Halogen

Fluorescent

Xenon

Decorative Incandescent

Installed by

Halogen

Fluorescent

Xenon

Halogen

Fluorescent

Xenon

Cove

Recessed

Pendant

Track

Incandescent

Halogen

Surface Mounted Fluorescent

Special Details

Task Lighting Incandescent ©2008 NKBA BMF9

Page 9 of 18

Copyright 2008 by National Kitchen & Bath Association. All rights reserved. No part of this document may be reproduced in any form by Photostat, microfilm, xerography, or any other means, or incorporated into any informational retrieval system, electronic or mechanical, or transmitted, in any form or by any means, without the prior consent of the copyright owner.

37945-1

Accessories Use Existing Yes

No

Glass Shelves

Medicine Cabinet

Furnished by BS

Installed by

O/OA

BS

Qty:

Support:

Finish:

Edge Treatment:

Qty:

Surface Mount

Finish:

O/OA Size:

Recessed

Size:

Mirror Size:

Mirror

Qty:

Surface Mount

Frame

Towel Bars

Qty:

Finish:

Size:

No:

Towel Rings

Qty:

Finish:

Size:

No:

Robe Hooks

Qty:

Finish:

Size:

No:

Tub Soap Dish

Qty:

Surface Mount

Recessed

Finish:

Placement:

Shower Soap Dish

Qty:

Surface Mount

Recessed

Finish:

Placement:

Bidet Soap Dish

Qty:

Surface Mount

Recessed

Finish:

Placement:

Lavatory Soap Dish

Qty:

Surface Mount

Recessed

Finish:

Placement:

Tub Grab Bars

Qty:

Finish:

Placement:

Toilet Grab Bars

Qty:

Finish:

Placement:

Paper Holder

Qty:

Surface Mount

Recessed

Finish:

Placement:

Magazine Rack

Qty:

Surface Mount

Recessed

Finish:

Placement:

Soap/Lotion Dispenser Tumbler Holder

Qty:

Finish:

Placement:

Qty:

Finish:

Placement:

Toothbrush Holder

Qty:

Finish:

Placement:

TV

Qty:

Finish:

Placement:

Sauna Use Existing Yes

No

Furnished by BS

Installed by

O/OA

BS

O/OA

Capacity:

Interior:

Style:

Heater:

Timer Location:

Wall Material:

Floor Material:

Other:

Steam Bath Use Existing Yes Tub

No Shower

©2008 NKBA BMF9

Furnished by

Installed by

BS

O/OA

BS

O/OA

Steam Generator Location:

Timer Location:

Wall Material:

Floor Material:

Page 10 of 18

Copyright 2008 by National Kitchen & Bath Association. All rights reserved. No part of this document may be reproduced in any form by Photostat, microfilm, xerography, or any other means, or incorporated into any informational retrieval system, electronic or mechanical, or transmitted, in any form or by any means, without the prior consent of the copyright owner.

37945-1

Exercise Equipment Treadmill

Size:

Clearance Required: 30 sq. ft

Free Weights

Size:

Clearance Required: 20-30 sq. ft.

Bikes, Recumbent & Upright

Size:

Clearance Required: 10 sq. ft.

Rowing Machines

Size:

Clearance Required: 20 sq. ft.

Stair Climbers

Size:

Clearance Required: 10 to 20 sq. ft.

Ski Machines

Size:

Clearance Required: 25 sq. ft.

Single-Station Gym

Size:

Clearance Required: 35 sq. ft.

Multi-Station Gym

Size:

Clearance Required: 50 to 200 sq. ft.

Yoga Matte

Size:

Clearance Required:

Flooring Use Existing Yes

No

Furnished by BS

Installed by

O/OA

Floor Preparation Removal:

BS

O/OA

Floor Covering Material

Leveling:

Bamboo

Carpet

Ceramic Tile

Cork

Shim:

Laminate

Linoleum

Vinyl-Sheet

Vinyl-Tile

Subfloor Material:

Wood

Wood-Engineered

Stone

Other

Underlayment:

Color or Pattern:

Baseboard:

Describe:

Transition Treatment

Check all that apply. Slider = S Casement = C Double-Hung = DH Skylight = SL Bow = BO Bay = BA Vinyl = V Aluminum = A Aluminum Clad = AC Wood = W Glass Block = GB

Windows Use Existing Yes

Furnished by

No

BS

Interior Wall Patch: Window #

Configuration

©2008 NKBA BMF9

O/OA Exterior Wall Patch:

Installed by BS

O/OA Sink Vent Relocation:

New Windows Sizes Screen:

Yes

No

Screen:

Yes

No

Screen:

Yes

No

Screen:

Yes

No

Screen:

Yes

No

Screen:

Yes

No

Page 11 of 18

Copyright 2008 by National Kitchen & Bath Association. All rights reserved. No part of this document may be reproduced in any form by Photostat, microfilm, xerography, or any other means, or incorporated into any informational retrieval system, electronic or mechanical, or transmitted, in any form or by any means, without the prior consent of the copyright owner.

37945-1

Check all that apply. Bi-Fold = BF Slider = S Pocket = P French = F Swing = SW Solid Core = SC Steel = ST Hollow Core = HC Furnished by Installed by

Doors Yes

No BS

Door #

O/OA

Configuration

BS

O/OA

Hinge

Size

Screen

Yes

No

Screen:

Yes

No

Yes

No

Screen:

Yes

No

Yes

No

Screen:

Yes

No

Yes

No

Screen:

Yes

No

Yes

No

Screen:

Yes

No

Yes

No

Screen:

Yes

No

Yes

No

Screen:

Yes

No

Yes

No

Screen:

Yes

No

Hardware Finish:

Passage

Privacy

Knob

Lever

Decorative Surfaces Use Existing Yes

No

Furnished by BS

Installed by

O/OA

BS

O/OA

Wall Preparation

New Plaster/Drywall

Clean

Patch Exist

Remove Exist. Covering:

Wall Finish

Paint

Wallpaper

Tile

Other

Ceiling Finish

Paint

Wallpaper

Ceiling Preparation

New Plaster / Drywall

Clean

Other: Window Treatment

Fabric

Shutters

Suspended Patch Exist Repairs:

Vaulted

Other:

Remove Existing Covering

Other:

Blinds

©2008 NKBA BMF9

Page 12 of 18

Copyright 2008 by National Kitchen & Bath Association. All rights reserved. No part of this document may be reproduced in any form by Photostat, microfilm, xerography, or any other means, or incorporated into any informational retrieval system, electronic or mechanical, or transmitted, in any form or by any means, without the prior consent of the copyright owner.

37945-1

Construction

Source Use Existing

HVAC Details:

Category

Responsibility

BS

O / OA Air Conditioning System Age: Planned Improvements: Heating System Age: Planned Improvements: Bathroom Exhaust Fan Age: Planned Improvements:

Electrical Work:

New Service Panel: Code Updates: Modifications to Exist. Service: Heated Floor:

Yes

Heated Towel Bar: Plumbing:

No Yes

No

New Rough-In Requirements: New Drainage Requirements: New Vent Stack Requirements: Modifications to Exist. Lines:

General Carpentry:

Demolition Work Exist. Fixture and Equip. Removal: Trash Removal: Reconstruction Work (Except as previously noted.) Widows: Doors: Interior Walls: Exterior Walls: Insulated: Cabinet Install. / Trim-Out:

Miscellaneous Work:

Jobsite / Room Clean-up: Building Permits: Structural Engineering / Architectural Fees: Inspection Fees: Jobsite Delivery: Other:

©2008 NKBA BMF9

Page 13 of 18

Copyright 2008 by National Kitchen & Bath Association. All rights reserved. No part of this document may be reproduced in any form by Photostat, microfilm, xerography, or any other means, or incorporated into any informational retrieval system, electronic or mechanical, or transmitted, in any form or by any means, without the prior consent of the copyright owner.

37945-1

Existing Construction Details 1. Age of Home:

Access Roads to Home: Elevator Size Limitations:

Delivery Truck Clearances: Through House

Access to Bath:

Exterior Access

2. Type of Neighborhood: Rural

Suburban

Urban

Historic

Mixed Use

Multi-Family

Gated Community

Planned Development

3. Type of Home: Single Family

Duplex

Townhouse

Condominium

Two-Story

Three-Story

Ranch

Apartment / Flat

Other:

4. Structure of Home: One Story

Split-Level

Split-Foyer/Raised Ranch

Other:

5. Approximate Size of Home: 6. Style of Home (Exterior): 7. Is the home historic?

Yes

No

What time period?

Are there historic covenants or restrictions affecting the home?

8. Is the home part of a Homeowner’s Association?

Yes

No

Are there Homeowner’s Association covenants or restrictions affecting the home?

9.

Yes

No

Style of Home (Interior) Colors: Materials: Furniture: Accessories: Other:

10. Room Below Bathroom

©2008 NKBA BMF9

Room Above Bathroom

Page 14 of 18

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37945-1

Existing Construction Details- continued 11. Condition of – Surface Walls Floors: Ceilings: Soffit/Fascia: Squareness of Corners:

Parallel Wall to Within ¾)

Is there any hazardous material to be removed? 12. Construction of Floor:

Slab

13. Direction of Floor Joists: 14. Exterior:

Brick

15. Interior:

Drywall

Parallel to Longest Bathroom Wall

Aluminum

Sliders

18. Sewage System:

Stucco

Lath & Plaster

16. Windows Can Be Changed: 17. Windows:

Frame

Yes

Wood No

Double-Hung

City Service

Wood

Perpendicular to Bathroom Longest Wall Joist Height: Other:

Other:

Doors Can Be Relocated: Skylights

Septic System

Casement

Yes

No

Greenhouse

Walls Can Be Relocated: Bow/Bay

Yes

No

Other:

Other:

19. Type of Roof Material:

Age of Roof

Access: Can Equipment Fit Into The Room? Basement:

Attic:

Material Storage:

Crawl Space: Trash Collection Area:

HVAC: Describe Existing System: Heating:

Ventilation:

Air Conditioning:

Plumbing: Location of Existing Vent Stack:

Type of Trap:

Add Additional Line:

Electrical GFCI Existing:

Yes

New Wiring Access:

No Hard

Average

Existing Electrical Service Capacity: ©2008 NKBA BMF9

Easy

Number of Open Circuits for Expansion: Number of 120V Circuits:

Number of 240V Circuits: Page 15 of 18

Copyright 2008 by National Kitchen & Bath Association. All rights reserved. No part of this document may be reproduced in any form by Photostat, microfilm, xerography, or any other means, or incorporated into any informational retrieval system, electronic or mechanical, or transmitted, in any form or by any means, without the prior consent of the copyright owner.

37945-1

Existing Plumbing Center Lines

©2008 NKBA BMF9

Page 16 of 18

Copyright 2008 by National Kitchen & Bath Association. All rights reserved. No part of this document may be reproduced in any form by Photostat, microfilm, xerography, or any other means, or incorporated into any informational retrieval system, electronic or mechanical, or transmitted, in any form or by any means, without the prior consent of the copyright owner.

37945-1

Existing Construction Details

©2008 NKBA BMF9

Page 17 of 18

Copyright 2008 by National Kitchen & Bath Association. All rights reserved. No part of this document may be reproduced in any form by Photostat, microfilm, xerography, or any other means, or incorporated into any informational retrieval system, electronic or mechanical, or transmitted, in any form or by any means, without the prior consent of the copyright owner.

37945-1

Existing Mechanical Details

©2008 NKBA BMF9

Page 18 of 18

Copyright 2008 by National Kitchen & Bath Association. All rights reserved. No part of this document may be reproduced in any form by Photostat, microfilm, xerography, or any other means, or incorporated into any informational retrieval system, electronic or mechanical, or transmitted, in any form or by any means, without the prior consent of the copyright owner.

37945-1