On his return from Europe, Peretyatkovich designed his first major project - Solodovnikov's Cheap Apartment Building in Moscow (it was executed by Traugott Bardt), a typical Northern Moderne, Saint Petersburg version of Art Nouveau.

In Saint Petersburg, Peretyatkovich designed various office and residential buildings; the best known, Wawelberg Trade Bank (1911-1912), combines neoclassical composition with Renaissance exterior (in the same period, Ivan Zholtovsky built a similar but far smaller Tarasov House in Moscow).

His other major project was the Roman Catholic church of Notre-Dame de Lourdes (1908–09), inspired by Romanesque architecture of Northern Europe and designed in collaboration with Leon Benois.

Peretyatkovich, as the youngest member of Neoclassical Revival movement after 1915, had a solid influence on Saint Petersburg architects of his period, securing the leading role of this style together with Vladimir Shchuko and Ivan Fomin.

His early reputation as a talented graphic artist in college and a very short architectural career that left a lasting influence are reminiscent of another architect, Konstantin Melnikov.