207 Walnut Alley #4 New Cumberland17070Showroom Hours: Mon - Fri 11am - 7pm and Sat 9am - 2pm

717-975-3526 office | 717-774-1849 faxemail: info@andersonchimney.com

www.CoalEnergyPlus.com | www.AndersonChimney.com

Date: Customers Phone:

Customers Name:

Address:

Email: Sales Person / Technician:

A- Width Front of firebox:

B- Width Rear of firebox:

C- Height - Center:

D- Height- Side:

E- Firebox Depth:

F- Hearth Measurement:

G- Distance to side mantle left G- Distance to side mantle left (or combustible surface):

H- Height to mantle (or combustible surface):

J- Distance to side mantle right (or combustible surface):

K- Width of lintel:

Is this an arched fireplace : [ ] Yes [ ] No

Is this a prefabricated or all metal fireplace: [ ] Yes [ ] No

Is this an all masonry fireplace: [ ] Yes [ ] No

Is there a drop between the hearth and the firebox:[ ] Yes [ ] No If yes, how many inches:

Please note any protruding brick:

Is theIs there anything unusual about the fireplace: [ ] Yes [ ] No

Fireplace facing material:[ ] Brick [ ] Stone [ ] Tile [ ] Other

Is a flue liner in the chimney: [ ] Yes [ ] No [ ] Unknown

Fireplace / Insert Measurement Worksheet

When filling out this form, if you have any questions please give us a call at 717-975-3526