All measurements are in inches.
Distance A
Distance B
Distance C
Distance D
Distance E
Distance F
Distance G
Distance H
Distance I

Is there a GAS LINE in the firebox?
Yes
Capped Off
No
Comment

Fireplace Facing:
Rough Stone
Brick
Wood
Other
Comment

Mantle:
Wood Mantle
Non-Wood Mantle
No mantle
Comment

Any Other Comments

Customer Name
Address
City
State
Zip Code
Day Phone
Evening Phone
Email Address

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Please do the following before installation:

• Clean fireplace of any debris.
• Remove all breakable items from area.
• Check and clean chimney.

Thank You!