Other Room Design Questionnaire Form

3620 Winnetka Ave N, Crystal, MN. 55427, 763-544-5950,

Other Room Design Questionnaire Form

What rooms are included: ☐Lower Level ☐Laundry ☐Wine/Wet Bar ☐Library

☐Entertainment Center ☐Sewing/Hobby Room ☐Home Office ☐Outdoor Kitchen

See separate sections below.

General Information

Date______

Name______

Address______

City/ State/Zip______

HomePhone______

Work Phone______

Cell Phone______

E-Mail______

Industry Partners (Contractor/ Architect/ Designer)______

Which of our services are you interested in CKC providing: ☐carpentry ☐sheetrock

☐electrical ☐plumbing ☐HVAC ☐ cabinetry ☐counter tops ☐appliances

☐lighting ☐flooring ☐other

How did you hear of Crystal Kitchen Center? ______

Start or Completion date? ______

Age of home? ______

Style of home? ______

How long do you plan on living in this home? ______

What is your budget? ______

Family and Lifestyle

How many are in your household? ______Ages? ______

How many will be using this space? ______

“Dislikes” of current space? ______

“Likes” of current space? ______

Type of entertaining? ______Size of gatherings? ______

Any Physical Limitations you would like to plan for? ☐yes ☐no

If so What?

Design and Style

Style of room: ☐Contemporary ☐Traditional ☐Transitional ☐Rustic

☐Other

Color Preference______

Have you collected photos or notes of ideas? ☐yes ☐no If so, please share with us

List of priorities

1. ______

2. ______

3. ______

If the design could be improved, would you be willing to make structural changes:

☐yes ☐no

Cabinet Preference______

Counter Top Preference______

Backsplash Preference______

Appliance Preference______

Flooring Preference______

Lighting Preference______

Decorative Surfaces (walls, ceiling) Preference______

Circle 3 words to describe your new space:

Some of our descriptive words…

Airy / Bold / Bright / Calming / Cheery / Classic / Clean / Comfortable
Colorful / Cool / Country / Cozy / Casual / Cluttered / Crisp / Contemporary
Dynamic / Dark / Different / Dramatic / Ethnic / Exotic / Energetic / Distinguished
Eclectic / Easy / Elegant / Exciting / Feminine / Formal / Fresh / Friendly
Grand / Fun / Gracious / Happy / Informal / Inviting / Light / Humorous
Lived-in / Open / Masculine / Modern / Natural / Personal / Pretty / Mysterious
Powerful / Quiet / Refreshing / Relaxing / Romantic / Rustic / Rich / Pampering
Sensual / Soft / Serene / Simple / Sparse / Stable / Stylish / Sophisticated
Striking / Warm / Tailored / Timeless / Tropical / Tranquil / Unique / Traditional
Vibrant / Wow / Whimsical / Youthful / Zen

Lower Levels

What rooms are included: ☐Family room ☐Game room ☐Home office

☐Bathroom ☐Storage ☐Laundry ☐Sewing/Hobby ☐Exercise room

☐Work Shop ☐Bar ☐Full kitchen ☐Mechanical Room

(see individual groups below)

Furniture requirements:

Sofa, Theater chairs______

Game tables (Pool, Ping-pong, Foosball, Air hockey, etc…)______

☐Fireplace: ☐gas ☐ wood burning

Laundry Room

Storage needs:

☐Washer/Dryer: size, type______

☐Front load ☐stacking ☐pedestal ☐ under counter

☐Laundry sink/faucet______

☐Hamper(s)

☐Ironing board/steamer/iron

☐Hanging Rod

☐Drying racks

☐Waste basket

☐Drying valet

Wine/Wet Bar

How many bottles of wine? ______Display of bottles? ______

☐Wine cooler (size) ______

☐Sink/faucet______

Appliances: ☐microwave ☐refrigerator ☐dishwasher ☐icemaker ☐beer taper

☐oven ☐cooktop ☐warming drawer

Cabinet Preference?

☐Open shelves

☐Glass doors

☐Liquor storage

☐Locks

☐Wine Glass storage

☐Roll out shelves

☐Drawers

☐Trash/recycling

Seating for how many? ______

Snack Bar: ☐30”high ☐36”high ☐42” high ☐other______

Entertainment Center

Equipment: ☐ hidden ☐ open

Size

TV
Stereo Receiver
Cable box
DVD/CD/Blue Ray
Speakers
Game Systems
Other

Storage quantity

Tapes
CD’s
DVD’s
Records
Video games, equipment

Cabinet Preferences: ☐Roll out shelves ☐Drawer dividers ☐Open shelves

☐Glass doors

Sewing/Hobby Room

What type of sewing do you do? ______

Equipment (with size)

☐Sewing machine (s) ______

☐Surge______

☐Ironing board ☐steamer ☐iron

☐Wastebasket

☐Rollouts

☐Drawers

☐Cutting table

Storage: ☐Notions ☐Patterns ☐Material ☐Hobby supplies

Hobby:______

Library

How many books? ______☐open ☐ closed storage

☐Reading area

☐Desk/Computer equipment

☐Storage of supplies? What______

☐TV

Home Office

Computer equipment (size)

Monitor
PC
Printer
Fax
Scanner
Other
Shredder

☐File drawers (quantity) ______☐letter ☐legal

☐Number of users______

☐Open shelves

☐Glass doors

☐Rollouts

☐Drawers

☐Wastebasket

Outdoor Kitchen

Equipment

☐Grill ☐gas natural ☐ propane ☐size______

☐Charcoal ☐side burners ☐ infrared grill ☐ smoker oven ☐ wok burner

☐Refrigerator

☐Ice Maker

☐Beverage Center

☐Warming Drawer

☐Beer Taper

☐Teppanyaki grill

☐Pizza Grill

☐Sink

☐Media needs: ☐TV ☐ CD player ☐ Speakers

☐Heat Lamps

☐Fireplaces ☐Fire Pits

☐Fans

☐Access to: ☐Water ☐Electric ☐Gas

Storage cabinets: ☐shelves ☐ year around material

☐Dishes, glasses and serving pieces ☐inside ☐outside

☐Drawers

☐Waste basket

☐Recycling center

Seating for how many? ______Table (size) ______

☐Chairs ☐Ottomans ☐Lounges ☐Chaise

Snack Bar: ☐30” high ☐36” high ☐ 42” high

Weather conditions

☐Winds natural traffic patterns______

☐Sun: ☐does it need to be shaded ☐ solid roof ☐awnings ☐motorize

☐Winterizing system