207 Walnut Alley #4 New Cumberland17070Showroom Hours: Mon - Fri 11am - 7pm and Sat 9am - 2pm
717-975-3526 office | 717-774-1849 faxemail: [email protected]
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