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So, I went out and bought the game today, decided on retail since I have a surf limitation on my current internet connection. Turned out to be a waste since only 5GB of the actual game is on the disc and you need a 20GB download during install, with my 4G speed, this took me roughly 3 hours.
That's not what I wanted to write about though, so here are my first, short impressions after roughly 4 hours of playing.

Controls and combat feel
The controls are tight and responsive, aiming outside of VATS is quite easy and even weapons without proper sights are fairly simple to handle at medium distance. The combat is somewhat too easy though, especially when fighting humans, the enemies which should exhibit the highest intelligence are the most stupid of them all and they are hopeless at taking cover and have terrible aim.
The critical system is good, just like in New Vegas, but some monsters you face early on have a shocking amount of HP, I ran into a monster that took about 9 full clips from my .38 rifle (that's over 100 shots), most went to the head.
Melee is kind of overpowered in the beginning but VATS has changed in a significant way; enemies are no longer stationary when you select which spots to aim for.
This is both good and bad; good because it makes it a bit harder but bad because it causes the percentages to vary greatly (and make it difficult to select the right part as well, especially on smaller and flying enemies) and the enemy can sometimes "hide" the juicy bits behind wings, arms, legs or other parts.

Visuals and sound
I find the visuals to be great, personally, I'm running it at 1440p with everything set to the absolute max, including all draw distance and godrays. The style is more pleasant than in previous games, this is at the expense of the more dreary feel though and I sometimes miss the lonely and oppressing atmosphere of the other titles, it simply becomes a bit too cheery at times, especially outside.
Overall though, bar a few poor animations and weird ass faces, the visuals are good.

The sound and music are fantastic, especially the music, I turned it off in F3 and NV since it annoyed me but I feel the need to listen to it in F4. Gunshots, and especially laser weapons, are improved, especially how they sound at a distance and the voice-acting is good, but not great.
Monsters sound as scary as they should but your dog companion becomes annoying right away and his constant yapping will drive you insane unless your name is Conegamer and your love for dogs trumph the annoying barking...

Customization and variation
There are a lot more weapons in F4, and the first ones you'll find are quite rudimentary, as they should be. The building interface is beyond terrible and clearly designed with controllers in mind, but I can't imagine using it with those either (tried it briefly with my 360 controller, didn't really help). The new armor system is great, you can wear a bodysuit and then individual plating on top of that, one on each limb, a helmet and even chest plates, this allows for more and varied bonuses and some fairly unique looks to your character. It's actually one of the biggest and best improvements in the game, in my opinion, and lends depth on all fronts.
Power armor is completely revamped and is more like a vehicle now, you enter it and can then leave it, just like a vehicle, this is also good since it's severely overpowered (lending a fair set of stats and qualities that match the name).
I still haven't modded my gear any so I can't say much about it but I can imagine it being sort of a chore to gather raw materials for mods since your inventory capacity is rather limited and you need to pick up everything you can that can be sold for some caps, money is rather hard to come by compared to the previous games and ammo is very expensive compared to NV and F3.

AI
The AI in Fallout 4 is terrible, no way around it. Humans enemies are the worst; they get stuck on walls, take cover behind low tables that leaves half the torso and all of the legs visible and exposed, forget you shot them in the stomach after 30 seconds or roaming around looking for you when you sneak and generally behave like morons. As has become commonplace in Bethesda titles, the sneaking mechanic is grossly overpowered and even early weapons can one-shot most human enemies in the beginning.
The monsters are sometimes more challenging since they can have enormous amounts of HP and appear out of nowhere, rad scorpions can burrow now and they have insane hit points. However high their HP is though, they remain quite easy to beat due to their AI, I avoided a rad scorpion's attacks simply by stepping onto a low rock, areas where he could not burrow seemed to be places where he wasn't interested in moving or attacking.
Another monster with insane hit points appeared in a house near the beginning, I shot him in the head and expected him to bound out the door and towards me where I was squatting in the low grass in broad daylight, but he never saw me and I kept firing, I shot over 100 bullets into its head without it caring or even moving outside to find me.
AI is the least impressive part of the entire game for me, this is an area in gaming in general that needs serious upgrades and a huge, open world populated solely by blind, blithering idiots takes some of the magic away for me.

Performance
Perhaps the most talked about part of Fallout 4 is the performance and there are reports popping up everywhere of poor frame rates and other issues. I'm happy to report that my experience thus far has been good in that regard, except for a few clipping issues and some draw distance shenanigans. My frame rates are more or less constantly 60 (appears to be locked and won't go higher), I've had my fps drop into the low 40's at worst.
Loading times are atrocious in this game, even with a SSD game disc, going from outside to inside and vice versa can take up to 20-25 seconds. Loading savegames is lightning fast though; loading quicksave takes me only 2-3 seconds at most, even less when inside a building/location.
Cutscenes have a tendency to tear a little but in-game is no problem.

 

Overall, my impressions are good, the dialogue system is so-so and the AI is a drag, but it's a solid title with some amazing qualities. I expected bigger issues, especially on the performance side, but I'm glad not to find them.
Yes; it's more of the same from Bethesda, but that's not always a bad thing when the same holds a standard and entertainment value like this.